Narrow survival would leave board permanently damaged

HEALTH and Social Services members face a bitter battle for their future tomorrow.

But whichever way the vote of no confidence pans out, the department and the States have already been badly damaged by the whole overspend saga.

Minister Hunter Adam has failed to rally the Policy Council around him both in private and, perhaps more importantly, in public too.

Since making a statement on actions to try to put the brakes on a £2.5m. overspend, the silence from his senior colleagues has been deafening.

There have been plenty of opportunities for ministers to show some solidarity – they so far have failed to do so.

Then we have the tattered relationship between the biggest-spending department in HSSD and the keepers of the public purse, Treasury and Resources.

Two members of T&R have signed the motion of no confidence in the department, deputies Garry Collins and Mark Dorey.

All members have also signed off on a damning letter of comment to the emergency report released by HSSD.

In it they say the States is being asked to sign off a fait accompli request to increase the HSSD budget by up to £2.5m. – something which may require money out of the contingency reserve. In effect, this would deepen the island's financial black hole.

'For the avoidance of doubt, individual departments are responsible for the detailed monitoring of their budgets, analysing variances and forecasting out-turns,' the letter said.

'Therefore, the TRD is not in a position to give the States an assurance that the underlying reasons for expenditure being in excess of the budget allocation are as described by the HSSD.'

It warns, too, that this is not the end for the overspends, suggesting there is a strong possibility the department will bust its budget again in 2013.

So concerned are those at the top about spending in Health that States chief executive Mike Brown has triggered a review of financial management in the department.

There are five members of staff in HSSD's financial team, only two accountants, and one of those is chief officer Mark Cooke.

Treasury wants that review to go even further and leaves an open door for the Public Accounts Committee to step in.

'The TRD welcomes this review and strongly recommends that the terms of reference should include an assessment of the expected level of resource requirements for the level of service delivered in 2012 – i.e. is the HSSD demonstrating value for money and delivering the appropriate level of services in the most effective, efficient and economic manner,' its letter said.

One member of PAC, Deputy Sandra James, has also signed the no-confidence motion.

Few, it seems, trust what Health is saying at this stage. Tomorrow members will be weighing up whether it is the system that is to blame, which is essentially HSSD's argument, or whether the way members handled the situation should lead to them losing their seats.

The department in recent times has used the explanation – or excuse, depending on your stance – that its budget is 'demand-led'.

It outlines escalating costs throughout the year, some of which it managed to bring under control earlier with little outcry, but the last few months tipped it into action, closing wards and postponing operations to save what it now estimates to be £500,000 this year, having been unable to come up with a figure when it announced the action.

It still does not quantify what it means for next year when it will have to pick up the bill again, beyond the minister under questioning at various points suggesting that fewer agency staff would be used, making it cheaper.

Examining the details provided in its emergency report, it is noticeable how much of their problems come down to staffing.

Each area of overspend is explained and they can make grim reading for HR professionals:

'A high rate of sickness', 'staff vacancies which are extremely difficult to recruit to', 'a high level of long-term sickness', 'team vacancies', 'difficulty in recruiting qualified and skilled neonatal nurses', 'a locum social worker to cover long-term sickness' and 'increased use of bank staff to cover long-term sickness'.

HSSD has long faced recruitment problems, but it has also faced the accusation that it simply has not always asked for long-term licences to make its placements more attractive and halt the turnover.

It will be tough for HSSD tomorrow simply because it faces discontent that is not consistent.

Some deputies have been disappointed with the performance of the minister, not just during this episode but also in handling the tobacco licensing issue.

Some argue it should have simply overspent its budget and not taken the last-minute drastic action it did. Others will say that it has been reckless in letting spending get so far out of control in the first place and that restraint is a key promise made to the electorate.

In its report, HSSD says it is 'satisfied that the forecast overspend is not associated with poor performance or any lack of effort to meet savings targets'.

It has already been given a savings holiday over the Financial Transformation Programme next year, where it will deliver less than originally asked for.

Next year it will bring a report that will demonstrate the 'huge amount of work that the board has been doing on correcting the problems with the current health and social care system'.

They say, essentially, trust us and you will see all our good work.

It also wants another review of how money is allocated to the department.

'At the present time there is no particular rationale or methodology by which States resources are distributed, other than on historical expenditure or specific one-off developments.'

That, at least, there is some agreement on – it is just a shame this has all come so late in the day.

When they make their decisions on the no-confidence motion, some might just be weighing up the amount of time two of the board members have had on the department.

What the States needs now is clear, decisive decision-making.

If tomorrow's vote leads to a murky split and narrow survival, the board will be left permanently damaged.

But that is precisely where the States is headed unless some spectacular speeches can turn the tide firmly one way or another.