By John Henwood
Deputy Ian Gorst lost points on my scorecard when, soon after the last election, he said he would seek the reinstatement of the role of Senator. His stock fell to a new low last month when, now Treasury Minister, he refused to accept the will of the Assembly when it rejected his proposal.
A week is said to be a long time in politics, but how quickly events can change one’s perspective. Such is the snakes and ladders of local politics that in less than a month Deputy Gorst had reclimbed the ladder of my estimation. Initially I reacted positively to his appointment as Treasury Minister, describing him as a safe pair of hands and believing he was more likely than most to be careful with our money. Whatever one thought of the detailed provisions of his mini-budget, it was impossible to criticise the celerity with which he acted.
What really saw his stock rise, though, was his determination to rein in that inefficient and apparently bottomless money pit that is the Health and Community Services Department.
Last year, Deputy Gorst was persuaded to release an additional £13 million to Health which, the department claimed, was needed to deal with ‘unavoidable pressures’. They were weasel words designed to cover the department’s inability to budget, leading to an overspend of many millions.
Some of the cash to paper over Health’s failures was to be drawn from the Health Insurance Fund, but in a moment of common sense and insight (some might say a too infrequent occurrence) the States Assembly refused the proposal. The Chief Minister apparently saw this as a major reversal and, in what was easily perceived as an impetuous reaction, she described the Assembly’s decision as a ‘massive nosebleed’ for the government. I’m pretty sure I’m not the only observer who applauded the States’ judgment.
Now the Treasury Minister has added points to his scorecard by making it very clear to Health that the budget is the budget and they had better not come along again doing an Oliver Twist. Let us not forget that the Health Insurance Fund has already been plundered to the extent of over £40 million to aid the setting up of the Jersey Care Model, the future of which is now being seriously questioned. The HIF was established over 50 years ago with the express purpose of subsidising the cost of doctor visits and prescription costs. In a short-sighted decision prescriptions were later made free to all, whether or not they could afford to pay a nominal sum, but the subsidy for doctor visits has not been increased in over a decade. With current rampant inflation the omission is shocking.
Robbing the HIF to pay for a half-baked Care Model administered by a department that can’t operate adequately within a £250 million budget is nothing short of shameful.
Now is the time for an enterprising backbencher to bring a proposition demanding that the government raises the subsidy on doctor visits to a level which allows people to seek medical help without financial worry. Having flexed its muscles over the HIF, the Assembly would be likely to support it.
In making it clear that Health could not raid the piggy bank in 2023, Deputy Gorst reminded us of negative comments on the Health and Community Services Department. He said it was clear those reports, the latest from the Comptroller and Auditor General, not only highlighted shortcomings in financial control (a very long-running issue) but also underlined the equally persistent problems of bad internal communications and cultural concerns running through the department. In something of an understatement, he reflected that the public was unable to feel assured that they were getting value for their tax pounds.
There isn’t space here to rehearse all the issues and complaints, but perhaps the most consistent one concerns poor treatment of clinical staff and a breakdown of relationships between those staff and Health Department management. This is the sort of problem we hear of so frequently in NHS Trusts and we should not be surprised that we have imported it because practically all the senior management at Health have been recruited from the failing NHS bringing their own apparent failings with them.
Those senior managers should understand that staff at the sharp end, the patient-facing doctors, nurses, therapists and support staff, know much more about day-to-day problems than they do and the only way to find out is for the chiefs to talk directly to the braves rather than allowing layers of middle managers, anxious to justify their positions, to get in the way.
When I read last month that Health Minister Deputy Karen Wilson had approved a team of external fixers to sort out Health’s communications problems, I could hardly believe it. It is the height of failure of a senior management team to admit they don’t know how to talk to their own people. The minister and her director general should be ashamed of such an admission.
So, who is really calling the shots at Health – the minister or her director general? The latter was appointed in 2018 after 28 years in the NHS. Her previous three appointments were with UK health trusts, none of which has a spotless record, according to the Quality Care Commission. If she is not capable of communicating directly and effectively with departmental staff then she is probably not able to provide the kind of leadership the wider Health Service and the people of Jersey are entitled to expect. The minister has been in the job less than a year, but answers to us and it’s time she also demonstrated she is up to the job.
