Bowel Cancer Screening

The New Year kicked off with a Motion of No Confidence being put forward by Deputy Mike Hadley against the health and Social Services Department. I spoke on behalf of the Public Accounts Committee.  The purpose was not to comment for or against the motion, but to inform Members of the facts from a financial scrutiny point of view.

Sir, I will be speaking on behalf of the Public Accounts Committee.

However, let me make it very clear from the start that, whilst individual members of the Committee may have their own views on the motion of no confidence the Public Accounts Committee has no opinion on the matter.

The Committee considered it necessary, given the context in which the motion of no confidence was proposed, that we comment in relation to the figures provided in relation to bowel cancer screening and the findings from our recent report into HSSD’s financial management in so far as it relates to the Motion.

I will firstly focus on the financial information recently provided by HSSD in relation to bowel cancer screening.  The Committee welcomes the publication of the internal report on this topic and notes the Department’s acknowledgement that there was an underspend on this budget of £87k in 2012 and £156k in 2013.

Whilst we have had limited time to analyse the information, it is evident to the Committee, that there are questions surrounding both the level of the original budget and actual expenditure.

In October 2011 the States approved, as part of the SSP, a budget of £294k for the first year and then £328k on an on-going basis.  This was based on the business case produced by HSSD. It would be logical to assume that a budget request would be based on the additional costs that would be required to undertake that service.

However, it is clear that not all these costs have been incurred as some elements of the work have been absorbed by existing staff. Whilst it would appear that this has not prevented the service from running, we note the comment that it may have had an effect on workload elsewhere.

However, we do question whether the original budget needed to include the level of pathology costs indicated given that this is a tiny fraction of the annual workload undertaken by the laboratory.

Therefore, we agree with the statement made in the internal evaluation report undertaken by HSSD that the budget allocation included a higher allocation than was actually required, although we don’t necessarily agree that this is because of the reduced cohort. The underspend therefore should be seen in this context.

The Committee noted that the initial business case allocated £45k for an IT system from capital expenditure, but that at present it appears that a system to support this screening requirement has not been implemented and this is causing major difficulties for the staff. There appears to be no reason given in the report why this system has yet to be implemented when it would clearly allow staff to make more effective use of their time. It may also reduce the need for additional staff time should numbers screened increase.

In the initial proposal document it states that there would be a tendering process for the full programme to obtain best value for money and that costs obtained from local tenders would be benchmarked against those available from UK providers to ensure value for money is achieved prior to any contract award. It would appear that such a process was not undertaken. It cannot therefore be assumed that we are getting value for money until that review is undertaken.

The Bowel Cancer Screening service is minor in cost terms when compared to the overall HSSD budget, around 0.3% in fact. But, the issues identified merely serve to confirm the Committee’s findings in its recent report that financial management in the period reviewed had been weak.

However, the Committee found that financial management was improving.  Indeed, one of our recommendations is that T&R should provide an oversight role with a clear focus on enhanced communication. It is therefore encouraging to see that T&R have assisted HSSD in terms of verifying figures, albeit that it has come with certain caveats.

The PAC report into financial management within HSSD made it clear that matters have not been helped by frequent Board changes and, as such we have recommended that during the transition of Board membership, there is a need to focus on knowledge transfer, specifically with regard to financial matters. The Committee is also of the view that more generally there should be financial expertise on all Boards and such a requirement is imperative for a Department responsible for over £100m of annual expenditure.

This particular issue just emphasises the fact that the States of Guernsey needs to determine and prioritise the services it wishes to provide and decide how these will be delivered in the most sustainable manner for the future. Until we do that we cannot be assured that we are getting value for money from our expenditure on health and social services provision.

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