Health requires ‘urgent action’

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GOVERNANCE structures within health and social care are ‘inadequate’ and ‘urgent action’ must be taken to ensure it is fit for purpose, the Comptroller and Auditor General has said.

Karen McConnell. Comptroller and Auditor General to the States of Jersey. Picture: JON GUEGAN. (22523631)

A report carried out by C&AG Karen McConnell has uncovered a string of failings in the way the services are managed and has found the overall system was overly complex.

Ms McConnell said the structure, whereby responsibility for health and social care is split between three departments – Health and Social Services, Social Security and Community and Constitutional Affairs – is ‘not fit for purpose’.

Among her concerns were that:

Proposals for structural change were developed without a clear, documented evaluation of current arrangements.

There has been insufficient focus on the effective use of complaints and whistleblowing as tools of governance.

On occasions reporting of performance has been inaccurate.

There has been ‘insufficient impetus’ to implement independent regulation and inspection of all health and social care provision.

She also criticised spending within the department, stating that of the £6.2 million targeted in efficiency savings this year, ‘virtually none’ had been found.


‘Strong and effective governance is of major importance in the delivery of health and social care,’ the C&AG said. ‘I am concerned that urgent action needs to be taken in Jersey to ensure that health and social care governance is fit for purpose.

‘I have reported before on the impact of silo working. In this case structures seemed to be based around historic issues including funding flows rather than the needs of patients and service users.

‘Responsibility was split between three departments with different ministerial accountabilities without strong system wide oversight to identify future needs, provide assurance on current delivery, maintain effective relationships with the voluntary and private sectors and drive change.’

She added that the management team needed to ‘embrace learning’ to promote change and ensure that staff had the confidence to speak out.


Anthony McKeever, interim director general for Health and Community Services, said that the department ‘fully accepts’ the findings of the report and is already working to address the concerns raised.

He said: ‘We accept that governance has not always been as clear or rigorous as it should have been, and we are committed to doing all we can, following the report’s findings, to improve and strengthen governance in the department and implement the report’s recommendations.

‘My team and I – supported by our ministers – are fully committed to ensuring that good governance becomes part of the everyday lifeblood of the organisation. Through the changes and improvements we are making, we will be clear about what good governance means for staff as they go about their day-to-day work with patients, clients, and each other. Changes will take time, but I and my senior team are committed to making them happen.’

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