Health and Care Jersey Advisory Board and Partnership Board (P.52/2025) – comments
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STATES OF JERSEY
HEALTH AND CARE JERSEY ADVISORY BOARD AND PARTNERSHIP BOARD (P.52/2025) – COMMENTS
Presented to the States on 26th September 2025 by the Health and Social Security Scrutiny Panel
STATES GREFFE
2025 P.52 Com.
COMMENTS
Executive Summary
The Health and Social Security Scrutiny Panel has reviewed proposals for the establishment of a Health and Care Jersey Partnership Board.
The Panel recognises the importance of strong governance in health and care services and supports initiatives that provide clarity of purpose, strengthen accountability, and foster collaboration. However, the current proposals for the Partnership Board are not well developed and leave many areas of uncertainty.
Key concerns identified by the Panel include:
• Evidence base – The rationale for creating a new Partnership Board is not underpinned by a rigorous or systematic analysis. It remains unclear whether the risks of introducing an additional bureaucratic layer have been fully evaluated, or whether the decision has been primarily political in nature.
• Remit and mandate – The proposed scope of the Board, the legitimacy of its membership, and the mechanisms for managing disagreement lack clarity. The relationship to the existing Advisory Board is also unclear.
• Resources and capacity – It is uncertain whether the Board will have the resources and authority necessary to deliver its ambitious objectives.
• Consultation – Stakeholder engagement has been limited in duration, breadth and strategic focus to provide a robust foundation for implementation.
• Governance alternatives – The potential to build on the existing Health and Care Advisory Board, including the establishment of a Partnership Committee within it, was not sufficiently explored during consultation.
The establishment of a Partnership Board is a significant step. Whilst there are potential gains, there are also considerable risks and there is a danger that the desire to make rapid progress has trumped critical examination of the proposals. Instead, the Panel considers that:
• The Minister should clarify the areas of concern identified in this report.
• A temporary Partnership Board model should be trialled over an initial 18- month period, with regular review of its performance, activities, and membership.
• Following this pilot, the Minister working with the Assembly, should determine whether the Board should continue, be amended, or be disbanded.
This phased and evidence-led approach would allow for careful testing and evaluation, ensuring that any permanent governance structure is fit for purpose, properly resourced, and capable of delivering genuine benefits for Health and Care Jersey.
Background
On 24th June 2025 P.52/2025 Health and Care Jersey Advisory Board and Partnership Board was lodged au Greffe by the Minister for Health and Social Services (the MHSS'). The proposition is in two parts, to agree:
- that the non-statutory Health and Community Services Advisory Board, established further to the Act of the States dated 14th June 2023, should continue to operate and provide improved governance and oversight for the services delivered by Health and Care Jersey.
- that the Minister for Health and Social Services should establish a new non statutory Health and Care Jersey Partnership Board which will operate in accordance with the terms of reference set out in Part 2 of the report accompanying the proposition.
Part 1: Continuation of existing non-statutory Health and Community Services Advisory Board
The Health and Community Services Advisory Board (now the Health and Care Jersey Advisory Board) was established by the MHSS following a States Assembly's decision on 14th June 2023 (P.19/2023) for an 18-month trial, ending in June 2025, the first meeting of the Board was on the 5th October 2023. The Board's mandate is to assure the Minister regarding the quality, safety, performance, and development of services provided by the Government of Jersey's Health and Care (HCJ) Department. The Minister is seeking approval for its continuation.
In accordance with the Assembly decision and the Terms of Reference (ToR), the Board is subject to a review within the first 18 months to determine its continuation and in what form. The Advisory Board commenced a performance review in late 2024, and published the Health and Care Jersey Advisory Board, Board Review Report in April 2025. This review complied with the requirements of its ToR:
80. The Board shall arrange for periodic reviews of its performance and, at least once a year, review these Terms of Reference, including its membership, to ensure it is operating effectively and in a manner which supports staff to do their best work for Islanders.
The review found the Board to be:
• Effective in fostering collaboration between Executive Directors (EDs) and Non-Executive Directors (NEDs).
• Strong in governance, with structured agendas, reporting, active committees, and transparent accountability.
• Committed to culture and openness, through public meetings, online resources, and staff engagement.
• Valuable strategically, in oversight of quality, safety, performance, finance, and workforce issues.
Areas for improvement include:
• more informal discussions,
• possible use of external coaching,
• better teamwork and agenda planning,
• and stronger public communication and engagement.
It is worth noting that these areas for improvement are largely self-selected and arise from a survey conducted by Board members as part of the review process. In January 2025, members of the public who had consistently attended Board meetings were invited to participate in a survey. The survey aimed to identify areas for improvement, enhance transparency, improve engagement, inform decision-making, and build trust. Whilst only two responses were received, the feedback will be incorporated into the Board improvement plan1.
The Health and Social Security Scrutiny Panel would have welcomed a HCJ staff survey as part of this review. A large part of the Board's remit and crucial to the success of any health care system is a healthy workplace culture, good staff wellbeing and good staff retention. The Board has established a People and Culture Committee, and the review report states that The Board is committed to fostering a positive and inclusive culture within HCJ'2. Much is made of the Board's crucial role in shaping the organisation by establishing, modelling and promoting values and standards of conduct for HCJ and its staff, and the many recent mechanisms that have been put in place to address staff culture. Therefore, the absence of consultation with staff to review the Board's cultural and operational impact seems remiss and a missed opportunity.
Leadership
The Board does not currently have a substantive Chair, which accounts for the budget underspend. The position was previously held by:
• Professor Hugo Mascie- Taylor from November 2023 to 31 December 2023
• Tom Hayhoe from 28 February 2024 to 3 April 2024
Following Tom Hayhoe's resignation, the MHSS determined that the timeframe for the States Assembly debate on the continuation of the Board was too short to initiate further recruitment. Some of the NEDs agreed to a contract variation to provide an additional 2.17 days of service per NED per month starting 1 April 2024 to provide for additional capacity in the absence of a Chair.
The report states that this arrangement is working well and will continue until the States Assembly have determined if the Board should continue to operate.
Following this, there are two options to consider:
- Continue with the current arrangements (described above).
- Recruit a permanent Chair with consideration to the role and time commitment required.
Feedback from the stakeholder survey proposed a stronger leadership presence through the appointment of a permanent Chair.
The Panel believes a permanent Chair should be appointed should the Advisory Board continue in its current form. Good governance practice requires that Boards are
1 The Board Review Report (April 2025).pdf 2 The Board Review Report (April 2025).pdf
structured to provide clarity, accountability, and consistency in leadership. The appointment of a Chair provides:
Clear Accountability
A designated Chair ensures there is a single point of accountability for the effective operation of the Board. This avoids dilution of responsibility which can arise when the role is shared or rotated among NEDs.[3]
Consistency and Continuity
A permanent Chair brings stability to Board leadership, supporting consistent agenda- setting, follow-through on decisions, and continuity of relationships with stakeholders. This is particularly important in health and care governance, where complex and long- term issues require sustained oversight.
Effective Facilitation of the Board
The Chair plays a central role in facilitating balanced debate, ensuring all voices are heard, and managing conflict where it arises. These skills are best developed and exercised within a permanent leadership role, rather than on a rotational basis.
Independence and Assurance
An independent Chair reinforces the separation between executive management and the Board, providing stakeholders with assurance that decisions are subject to appropriate challenge and oversight.[4]
External Credibility
Regulators, partners, and the public expect to see a clear governance structure with a recognised Chair. This strengthens confidence in the maturity and professionalism of the Board's arrangements.
Strategic Leadership outside of the Board's meetings
The Chair has responsibilities beyond chairing meetings, including working with executive leaders on Board development, supporting succession planning, and ensuring actions are progressed. These functions require continuity and authority that a rotating NED model cannot provide.
The establishment of a permanent Chair is therefore a fundamental feature of sound governance. It ensures clarity of leadership, strengthens accountability, and provides external confidence in the Board's effectiveness. Relying on NEDs to act into this role on a rotational basis would risk fragmentation, loss of continuity, and weaker assurance for stakeholders.
Partnership Working
Recognising that health and care needs are rarely met by a single provider within Jersey's health and care system, the Board has invited and heard from various other providers and services, including:
• Chair of the Safeguarding Partnership Board
• Director of Public Health
• Chief Inspector, Jersey Care Commission
• The New Healthcare Facilities Team
• End of Life Partnership Representation
The aim is to understand how these providers contribute to the broader health and care system and how HCJ can collaborate to enhance overall service delivery.
In September 2024, three providers Jersey Hospice Care, My Voice, and LV Care Group, were invited to present at part A' of the Board meeting to share their experiences of commissioning processes and system-wide collaboration.
No reference is made in the review of the Advisory Board to the plans for the Health and Care Partnership Board, or the need for greater partnership working with the health and care sector that can only be achieved by a dedicated Partnership Board. The Panel would welcome clarification as to whether the partnership working that has taken place to date via the Advisory Board will continue if the Partnership Board is established. If so, how will duplication be avoided and if not, how will the work of the Partnership Board be communicated with the Advisory Board and vice versa. No mechanisms for this have been explained in the proposition and there is no suggestion of shared membership between the Boards beyond the potential appointment of a NED from the Advisory Board to the Partnership Board, acting in the capacity of Vice Chair, however this is only suggested in the ToR not prescribed.
The report concludes that:
The Board has demonstrated a strong commitment to driving improvement and
delivering change across various aspects of health and care services. Through strategic planning, rigorous oversight, and fostering a culture of transparency and accountability, the Board has effectively addressed key areas such as quality and safety, operational performance, financial management, and workforce development. By leveraging benchmarking, adopting evidence-based practices, directing specific areas of work, receiving regular reports and listening to the views of partners in the wider health and care system, the Board has ensured continuous improvement and enhanced service delivery, ultimately benefiting
patients and service-users and the broader health and care system.' Minister's conclusions:
• The Board has delivered on its original objectives and is a critical governance tool for Health and Care Jersey.
• It should continue in its current form and membership, with minor changes:
• Reduce minimum meetings from 6 to 4 per year.
• Chair responsibilities to be shared.
• Appointment of a senior independent director only if required.
• The Board will remain non-statutory for the time being, with legislation deferred until both the Advisory Board and proposed Partnership Board are considered together.
The Panel supports continuation of the Advisory Board but would welcome formal external review, to include staff consultation, on the Board following this trial period and believes a Chair should be reinstated. Whilst not a requirement of its terms of reference, independent review would help inform effective Board practices, ensure transparency and aid public confidence in the Board mechanisms. The Panel would also suggest a more robust public consultation, alongside publication of the Board improvement plan referenced in the report. The Panel would also like clarification of the relationship between the Advisory Board and the Partnership Board and in particular whether there are any plans for joint working or reporting mechanisms between the two Boards.
2: Establishment of proposed non-statutory Health and Care Jersey Partnership Board
The MHSS proposes establishing a non-statutory Health and Care Jersey Partnership Board to strengthen integration across Jersey's health and care system.
Rationale and Background
• During October and early November 2024, the MHSS consulted with key health and care stakeholders on the proposals to develop a better integrated health and care system, including establishing a Partnership Board.
• The Consultation Feedback Report [5]states that the proposal received strong support for a system-wide structure, subject to more detail and clear terms of reference;
8. Broad support to restructure the wider health and care service, involving the creation of a Board to deliver a properly integrated, seamless, interconnected health and care service - subject to more detailed understanding of the Board's terms of reference and the structure of the overarching Jersey Health and Care Department. [6]
• It is explained that the public was not consulted as the focus was on design public consultation will follow when specific initiatives are developed.
Development Process
• Initial plans to make the Advisory Board a sub-committee of the Partnership Board were rejected by a small number of key stakeholders7, prior to the
publication of high-level proposals in October 2024, as this was perceived to lead to blurred accountability. This option did not form part of the wider consultation process. The revised consultation proposals proposed two distinct boards:
• Advisory Board (governance, oversight of HCJ), and
• Partnership Board (system-wide integration with non-governmental partners).
• Draft terms of reference were published in March 2025, consulted on, and refined based on feedback.
Purpose of Partnership Board
P.52/2025 states that the Partnership Board is a Board of;
health and care service organisations (government and non-government) whose purpose is to come together to plan how to improve the health and wellbeing of people who live in Jersey through joined up care. They will work to achieve their purpose through considering how best to: a. tackle complex challenges (for example, how to support islander to stay well, how to provide fair, affordable access to care, how to address barriers to joined up care) and resolve day-to-day emerging barriers to the delivery of safe, effective, affordable, joined-up services to Islanders b. making recommendations to the Minister, and c. overseeing the delivery of agreed solutions8.
Assembly Approval
Approval is required under P.170/2010 as the Board will:
• include remunerated members,
• access sensitive information, and
• help shape Government policy.
Consultation
From 3rd April to 1st May 2025, the MHSS consulted with key stakeholders on the draft ToR for the Partnership Board.
The stakeholders were:
• Home Care and Care Home organisations (Jersey Care Federation members and Jersey Care Commission registrants)
7 P.52/2025 Health and Care Jersey Advisory Board and Partnership Board 8 P.52/2025 Health and Care Jersey Advisory Board and Partnership Board
• GPs
• Primary Care Board
• Pharmacists
• Third Sector providers
• Dentists (Jersey Dental Association)
• HCJ executive leadership team (including public health)
• HCJ senior leadership team
• Ambulance Service senior leaders
The ToR was also provided to the Health and Care Advisory Board, Council of Ministers, the Health and Social Security Scrutiny Panel and the States Assembly.
Consultation Feedback Report
The Panel has reviewed the Health and Care Partnership Board Terms of reference consultation Feedback report.
The feedback report lacks defined terms of reference or a clear methodology. As a result, it cannot be considered a robust piece of work, and there is no assurance that the evidence presented has not been selectively applied to support a predetermined agenda.
The Panel would have welcomed the stakeholder feedback to be published in its entirety, and for this to be communicated as the intention of the consultation to the stakeholders from the outset to allow transparency. As it stands heavily edited statements are reproduced without any citation and therefore provide little robust analysis of the ToR. As explained in the opening sections, the information is not quantitative as the consultation was conducted via face-to-face discussions and email correspondence, and is not necessarily verbatim, but instead a representation of the content and intent of what was said'. This therefore suggests that as it is published on this basis, and with a disclaimer of sorts, that the content was not necessarily shared with contributors prior to publication, particularly as the comments are not attributed to any one stakeholder, therefore the validity of the feedback published could be questioned. It is not clear what may have been omitted or whether a bias may be present in what has been included.
Feedback is reiterated without explanation of why it has either been adopted or rejected, or how this has been incorporated into the ToR or future plans, such as the Role Specification or selection process. This is detailed in the Revised Terms of Reference for the Proposed Health and Care Partnership Board Appendix: Amendments to Terms of Reference document provided to the Panel and Public Account Committee following a request from Scrutiny for clarification on how feedback had been addressed within the ToR. This explains what amendments were made to the ToR following the consultation process. However, without full publication of the consultation feedback, there is no way of assessing what feedback was adopted and what was disregarded.
Panel liaison and Public Hearings
During a briefing to the HSSP on the 10th October 2024, the Panel queried whether the issue of Provider Capture had been considered when devising plans for the Partnership Board. Provider Capture occurs when governance structures, advisory groups, or oversight boards are disproportionately influenced by service providers (e.g., hospitals, clinics, professional associations, or large health organisations), to the extent that decisions reflect the interests of those providers rather than the wider system or the patients and public they are meant to serve. It is a specific form of regulatory or institutional capture, where the actors being overseen (providers) gain undue influence over the bodies that are supposed to scrutinise, regulate, or coordinate them, a particular concern in Jersey, where sectors are limited and sourcing providers from outside of the Island can be complex and restricted.
This can occur for instance where there is a representation imbalance in boards or committees that are dominated numerically or informally by provider organisations, with limited voices from patients, carers, or communities. This can result in information asymmetry, where providers often hold the technical expertise and data, which can skew discussions and decision-making in their favour. It can lead to dependency – where governments or commissioning bodies rely heavily on major providers to deliver essential services, making them reluctant to challenge and can create cultural influence with strong professional hierarchies (e.g., clinical dominance) that may marginalise alternative perspectives.
The MHSS and Officers acknowledged the risk but stated without evidence or mitigation that they did not see this as a significant issue. However, the Panel feels that robust processes must be in place to mitigate this.
In addition to briefings provided to the Panel on the proposals during the initial stages of development, the MHSS undertook the required consultation to comply with P170/2010 Shadow Boards and Ministerial Boards: approval by the States.
(ii) that Ministers should, before finalising any proposals to establish bodies of this nature, consult the Public Accounts Committee, the Privileges and Procedures Committee and the relevant Scrutiny Panel to ensure appropriate oversight of the proposals;
To comply with the requirements of P170/2010 the Minister should consult with Public Accounts Committee (PAC), Privileges and Procedures Committee (PPC) and the Health & Social Security Scrutiny Panel.
The MHSS and Officers met jointly with PAC and the HSSP on the 10th June to present plans to date. Following this meeting a joint letter was sent to the MHSS from the Chairs of the PAC and HSSP seeking further information on a number of areas of the ToR that raised concern or was felt required clarification. The outstanding concerns are expressed in these comments.
Collaboration between the two Boards
The Advisory Board ToR (R.106/2023) that governs the current Advisory Board predates the Partnership Board proposal. It contains no provision regarding interacting with a future Partnership Board. The Partnership Board draft ToR includes a generic clause that the Board will take account of and avoid duplicating the work of other forums' but it does not name the Advisory Board here nor prescribe any formal joint working, reporting lines, or liaison mechanisms between the two Boards, stating only that they will work alongside' and effectively' with one another.
In the consultation feedback on the Partnership Board ToR stakeholders suggested options such as seconding one of the Advisory Board's NEDs onto the Partnership Board, however no formal collaboration mechanism appears in the draft ToR itself beyond that it is envisaged that this [the Vice Chair] will be non-executive director from the existing advisory board'.[7]
Community Partners
A full person specification is yet to be developed for any member of the Board, the intention being that these will be produced following Assembly adoption, however, the proposition states that the 10 Community Partners, who will be selected from the following sectors:
- Community Nursing
- Community Pharmacy
- General Practice
- Home Care
- Nursing, Residential & Care Home
- Community Dental
- Allied Health professional
- Third Sector service provider (not commissioned by Government)
- Other
- Other.
and will have very specific responsibilities' that include:
communicating and liaising with other providers in their sector / profession to provide to the Partnership Board with relevant, sector specific information and insight, and acting as ambassadors championing the delivery and implementation of the Board's decisions and solutions across their sector / profession – but they are not sector representatives and are not required to facilitate cross-sector consensus.'[8]
This places the Community Partners as ambassadors, and states, significantly, that they are not sector representatives and will not be required to facilitate cross sector consensus. Therefore, the Panel questions what accountability these partners will have to work consistently as a representative for their sector and represent the views of their cohort if there are no specific requirements for them to do this.
The Panel also queries how the Community Partners activity as ambassadors championing the delivery and implementation of the Board's decisions and solutions..' will be encouraged, measured and assessed, and what methods will be used to ensure that the Board's decision and solutions will be effectively communicated, and crucially how the Board will avoid creating a linear flow of information that only includes the voices of these 10 individuals which may not adequately reflect their sector, and may prove partisan or misrepresent the sector. The Panel also notes the potential strain on the Partners, particularly those from third sector organisations, and feels the expectation and responsibilities should be clearly defined in the ToR in order for Members to decide if these representatives are the best construction for the Board.
Selection of Community Partners
Appendix 2 of the proposition: Appointment, removal suspension of Members states in paragraph 4, that;
The selection process for Community Partners will be on a sector-by-sector basis and may vary between sectors. The Minister must approve the selection process for each sector. Prior to approval the Minister must consult relevant providers about their sector's process (for example, GPs will be consulted on the selection process for the Partnership Board's GP Partner)'
During a Quarterly Public Hearing on the 20th May 2025 the process of Community Partner selection was discussed with the MHSS;
We have made it clear all the way along that we want the external providers, the representatives, to be elected by their representative sectors. I have said all along that for the state to appoint somebody from the GPs or to appoint somebody from the charitable sector over the heads of people in that sector would be entirely wrong. It would do away with all the basic principles we are working to. The people who represent those sectors will be selected by the sectors themselves'.
The Panel feels that there is insufficient detail and clarity in the proposition on the selection of the Community Partners and would like to understand why the selection process will differ between sectors - as this is not explained, nor what this will look like in operation and if this will impact the criteria for the Partners. There is also a significant lack of clarity regarding the basis of the Board members' authority. If members are not appointed as sector representatives, it is unclear from where their mandate is derived. Conversely, if they are intended to act as representatives of specific sectors, it raises important questions as to how they can demonstrate that they are legitimately and consistently reflecting the views and interests of the groups they purport to represent.
Children's Health as a Board Priority
In its letter of the 11th June the Panel sought assurance that children's rights and children's health will be explicitly prioritised by the Board and asked how this will be ensured in practice. The letter asked if there will be a dedicated representative focused on children's rights, who is not a Government appointee, to provide independent oversight and advocacy.
The MHSS's response was to explain that;
one of the 10 Community Partners will be drawn from the Community Nursing sector, and one from General Practice. Community Nursing and General Practice are significant, non-government providers of services to children and will ensure a focus on children's health and wellbeing needs.
Furthermore, as provided for in the Terms of Reference, others may be invited to attend Board meetings in an advisory capacity for all relevant agenda items. We would anticipate that this will include other providers of services to children and / or organisations that work to protect the interests of children whenever relevant.'
Again, the Panel feels that insufficient thought has been given to how children's health will be prioritised. It is not suggested that the Person Specification for the representatives from Community Nursing and General Practice will explicitly state that this representative will need to ensure that children's health is part of their remit on the Board, nor that a Paediatric specialist from these sectors be prioritised in the selection process. There is a risk therefore, that without this being explicit in the ToR, that these requirements could be disregarded during the selection process.
Effectiveness/Risk
The Panel notes the risk assessment that has been included in the proposition in relation to the selection and appointment of members, and welcomes the areas of risk identified, and particularly the budget allocation for external support with performance review to aid in assessing the effectiveness of the Board.
The Advisory Board, with is clinical remit to assess quality, safety, performance, and the development of services, ensures accountability through a robust framework of clinical governance, setting standards, and monitoring compliance. The monthly Quality and Performance Report (QPR) provides assurance on the extent to which HCJ meets quality and safety standards. The Board has emphasised the importance of adhering to National Institute for Health and Care Excellence (NICE) guidance and has overseen the implementation of policies to ensure compliance.[9]
The Panel questions whether the Partnership Board, with its broader remit, and less defined performance metrics, will be equally accountable and able to measure its performance similarly. When this was discussed with the MHSS at the Quarterly Public Hearing on the 20th May 2025 he asserted that he;
personally have not given a huge amount of thought to monitoring it, because it strikes me as basic common sense that if you have a formal structure for people that are working together anyway to come together and make collaborative decisions you are going to get better outcomes than having things as they are at the moment, which I consider in some areas to be fairly random. I can give a number of examples of areas where a lot of time has been wasted because there was no formality around the process.'
This issue strikes at the core of the Panel's concerns with the MHSS's proposition. While the MHSS asserts that improved outcomes are a matter of "basic common sense," such outcomes cannot be assumed. The establishment of the Partnership Board may
formalise existing tensions, such as those relating to the balance of resources between the private and public elements of the health system, but the effectiveness of the Board in resolving such conflicts will depend heavily on several factors. These include its composition, the robustness of its processes, the clarity of its relationship with HCJ, and the quality of personal and professional relationships both within the Board and between the Board and Ministers.
The Director of Health Policy then went on to explain that;
The terms of reference for the Board provide for a number of things. First of all they provide that there must be an annual review of the Board and the Board's performance and its effectiveness. Within that £70,000 budget, we have allowed some money for that review to be taken independently rather than a self-review process, which is very common among boards, but because of the nature of this Board we feel that it would probably benefit from some independence. The terms of reference also require the Board to produce an annual work plan. Within that annual work plan there will be key performance indicators or statement of intended impact. Of course, because it is working through recommendations it cannot necessarily put hard and fast key performance indicators against it. The annual review process will need to report against that'.
The Panel welcomes the consideration of an external review of the Board's activity, but feel it is imperative that proportionate performance indicators alongside a statement of intent should be in place from inception to ensure the value and intent of the Board is inherent and adhered to, in order to avoid mission creep or a subsequent dilution of intention.
A further fundamental concern relates to resourcing. The Partnership Board will be tasked with advising the Minister on complex and significant matters of health policy, yet it has been allocated minimal dedicated resources. In particular, the absence of a secretariat, research capacity, or analytical support places the Board at risk of operating as little more than a discussion forum, with recommendations driven by individual opinion rather than rigorous, evidence-based analysis. In this respect, the Board appears to occupy an ambiguous position - it is expected to provide policy advice informed by sectoral expertise but lacks the necessary policy-making and analytical infrastructure to discharge this role effectively.
Associate Community Partners
The Panel notes that in addition to the Community Partners, the Chair of the Partnership Board may appoint other health and care providers to act as Associate Community Partners. These will be non-voting members and may attend on a standing or ad-hoc basis (it is not stated how the frequency of attendance will be decided) and engage in working groups.
The Panel is concerned that the examples used include end-of-life providers and community mental health providers. Given recent concerns regarding the adequacy and capacity of mental health provision12 in the Island, and the recent lodging of Assisted Dying legislation, the Panel feels community mental health providers and Palliative care
12 Health and Care Jersey – Advisory Board Part A – Meeting in Public Minutes
[10]professionals should be included within the Community Partners and their sectors considered essential in supporting the intended purpose of the Board to plan how to improve the health and wellbeing of people who live in Jersey through joined up care'.
Management of Conflicts
The Panel understands that a register of conflicts of interest will be kept and changes to this will be minuted. In its joint letter to the MHSS dated 11th June 202513, the Panel and the PAC questioned how the Board will identify and manage conflicts of interest and vested interests, to maintain integrity and public confidence. In response the MHSS stated that;
As per the presentation to Scrutiny, it is an acknowledged risk that there is potential for individual Board members to have conflicts of interest, and for there to be conflict between Board members. It should be noted that these conflicts of interest probably exist, with, or without, the existence of the Board and, at present, must be managed without the formal apparatus that the Board will provide to deal with them.'
Whilst there is standard apparatus referenced in the ToR to address conflicts, the policies and procedures referenced that relate to the reporting and management of conflicts are yet to be developed, therefore scrutiny of these to assess their adequacy is not possible at this time.
Appendix 2 of the proposition: Appointment, removal suspension of Members states in paragraph 6.c. that;
if the person has a conflict of interest that would call into question their ability to undertake the role. Where the person has a financial interest in, or may financially benefit from the delivery of health and care services in Jersey, the Minister must be satisfied that the person has demonstrated their ability to set aside their interest in the pursuit of decisions which are in the best interests of all Islanders. The Minister will consult the Chair when making that decision (if appointed).'
The Panel would like clarification on the processes and decision making that would be undertaken in order for the MHSS to be satisfied that the person/s in question have demonstrated their ability to set aside their interest, how this will be recorded and regularly assessed, and the process revisited if conflicts arise throughout their tenure.
Given the intended Board membership, and to ensure credibility and public confidence in the Health and Care Partnership Board, the Panel would welcome that a robust, transparent conflict of interest (COI) framework be established and formally adopted. This should be aligned with recognised governance best practice (e.g., NHS Boards1415, UK Charity Commission [11]guidance).
The following mechanisms should be in place:
- Comprehensive Conflict of Interest Policy
• A written COI policy approved by the Minister and published online.
• Clear definitions of direct, indirect, financial, and non-financial interests.
• Explicit coverage of situations where Board members are representatives of organisations in receipt of grant funding.
- Mandatory Declarations
• Annual declaration of interests by all members (covering employment, board positions, consultancy, ownership, or funding relationships).
• Standing agenda item at the start of each meeting for members to declare any new or relevant interests.
• Maintenance of a publicly accessible Register of Interests updated quarterly.
- Recording and Transparency
• All declarations recorded in meeting minutes.
• The register and minutes should be published online for scrutiny by the Assembly, Scrutiny Panel, and the public.
- Exclusion from Decision-Making
• Members with a conflict must recuse themselves from discussions and decisions relating to that matter.
• The Chair should have explicit authority to request recusal where a potential conflict is identified.
• Recusals should be formally minuted to provide an auditable trail.
- Independent Oversight
• The Board Secretary (or equivalent officer) should be responsible for managing the Register of Interests and monitoring compliance.
• Regular review of COI handling by an independent governance lead or auditor would ensure transparency and consistent application.
- Sanctions for Non-Compliance
• Clear consequences for non-declaration or breach of the policy, up to and including suspension or removal from the Board.
Coverage of the Framework
The policy should explicitly cover:
• Situations where a Community Partner is present during performance reviews, funding discussions, or contract assessments.
• Conflicts arising from family relationships, secondary employment, or advisory roles.
• Non-financial conflicts (e.g., advocacy positions, public campaigning, or personal beliefs that may bias judgement).
Representation of commissioned services
A specific concern arises from the proposed inclusion of representatives from commissioned service providers - organisations that receive grant funding from HCJ- to sit on the Board. While their operational insight may be valuable, there is an inherent risk of perceived or actual conflicts of interest, particularly where the Board may be required to:
• Review the performance of these same organisations
• Make recommendations on funding allocation, contract renewal, or service redesign
• Advise on policy decisions that could directly impact their own operations and funding.
Value
In paragraph 47 of Part 3: Financial and resource implications, the proposition states, regarding financial considerations for the funding of the Partnership Board, that funds will initially come from the existing budget allocation for the Advisory Board;
Whilst the Partnership Board can be funded from within existing HCJ governance budgets, it is nevertheless the case that there needs to be a clear and compelling rationale for this investment. The Minister (and key stakeholders) are satisfied that that rational is evidenced by:
- the improvements delivered by whole system structures in other jurisdictions, and
- the ongoing challenges associated with delivery of both simple and complex changes or policies in Jersey which require engagement or participation of multiple providers'.
The Panel is concerned that by establishing a Board that represents a selection of the health and care sector and justifying the associated cost with delivery of both simple and complex changes of policies that require engagement or participation of multiple providers' may provide justification for the MHSS to avoid consultation on significant departmental changes.
The Panel would like clarification on the Partnership Board's limitation of authority, and the weighting and consideration for policy change that would require consultation outside of the Board with comprehensive engagement with stakeholders and/or the public as appropriate. It is concerned the establishment of the Board will sanction significant strategic decision making to be undertaken by the Board in isolation, as justified by its purported sector representation, thereby ignoring the benefits of broader consultation, especially considering that the Community Partners are not expected to seek consensus from their sector, or act as sector representatives.
Costs
The Panel notes that some respondents stated that the proposed levels of renumeration for the Community Partners (£200 per day) and the Partnership Board Chair (£420 per 5 day) was too low and that:
The Minister acknowledges this criticism but also recognises the need to strike an appropriate balance between renumerating providers for their contribution (even though many providers already participate in unstructured or ad hoc meetings and working group for no renumeration) and placing disproportionate costs on existing budgets which are under significant pressure'.17
The Panel would like to understand what benchmarking, if any, was undertaken to align the remuneration of the Community Partners to equivalent Board membership, or whether the costs were instead intentionally aligned to the Advisory Board underspend – which is unsustainable. Without adequate benchmarking the role of Community Partner may prove undesirable and result in a low level of applications and difficulty in recruiting into the positions.
The Panel also notes that the proposition states that supplementary payments may be paid to Community Partners should locums be required to cover their practice during their Board activities. The example provided is Community Pharmacists, but this could also apply to GPs, the Community Dental representative and possibly further members of the Board. If locum support is unavailable or not easy to source, then loss of earnings may need to be considered. These supplementary payments have not been detailed as they are not known', however, an estimation of these costs based on liaison with the relevant sectors would not have been a complex undertaking and would have allowed for the financial implications of these supplementary payments to be adequately reflected in the proposition, even as a contingency to give a depiction of the potential annual costs. If parity is provided to all Community Partners, this could match or exceed the published annual remuneration.
The Panel also notes that few similar constructions within Government have remunerated external Board members, and whilst the Panel does not disagree with remuneration of Board members, feel that this should be on the basis of clear expectations, performance criteria and a robust selection process that ensure the right representatives are selected, and do not see evidence for this in the proposition.
Comparative Models
A Partnership Board typically brings together representatives of government (commissioners, regulators, or health departments) and non-government providers (hospitals, primary care, voluntary sector, and community organisations) with the aim of:
• Supporting system-wide integration of health and care services.
• Aligning strategy, planning, and resources across different organisations.
• Promoting collaboration rather than competition between providers.
17 17 P.52/2025 Health and Care Jersey Advisory Board and Partnership Board
• Giving patients, service users, and the public a stronger voice in shaping services.
In practice, such Boards exist in various forms:
• NHS England: Integrated Care Partnerships (ICPs) and Integrated Care Boards (ICBs) – statutory bodies within ICSs.
• Australia: Primary Health Networks (PHNs) – partnerships between federal/state funders and local providers.
• Canada: Ontario Health Teams (OHTs) – alliances of local health and social care providers.
• Nordic countries – municipal–regional partnerships for joint planning of health and social care.
Partnership Boards have become a prominent feature of health and care governance in the UK and internationally, designed to encourage collaboration across government, provider organisations, and the voluntary and community sectors. Their stated purpose is to align priorities, reduce duplication, and deliver more integrated services.
While they hold significant promise, their effectiveness depends heavily on the clarity of their mandate, the balance of their membership, the robustness of their governance arrangements and crucially adequate resourcing to ensure informed decision making.
It should also be noted that these comparative examples do not align closely with the model proposed for Jersey. In most cases, such bodies are not engaged in making policy recommendations; rather, their primary functions relate to the coordination and commissioning of services to ensure that local needs are addressed. They do not typically exercise broad, policy-making advisory responsibilities, and whilst comparative models are referenced in the proposition as commonplace in many other jurisdictions'[12], and specifically that There are multiple examples of longstanding partnership structures in Europe, New Zealand and Australia' there is no evidence of a comparative analysis to evaluate options critically, revealing strengths and weaknesses that might not be obvious when considered in isolation, thereby providing an evidence base to support the proposition and inform strategic planning for the suggestion of a Partnership Board.
Strengths of Partnership Boards
One of the main strengths of Partnership Boards lies in their ability to facilitate system- wide planning. By bringing together representatives from health, social care, and the voluntary sector, these Boards can help ensure that priorities are aligned across the system. This not only reduces duplication of services but also allows gaps in provision to be identified and addressed more effectively.
Partnership Boards also encourage shared ownership and accountability. Responsibility for decisions is distributed across government departments and provider organisations, fostering a sense of collective commitment to strategic reforms. This shared approach
builds buy-in from partners and can help overcome the resistance often encountered when reforms are imposed from the top down.
A further strength is their emphasis on collaboration rather than competition. By shifting incentives away from siloed working, Boards can promote cooperative solutions that allow for budgets and resources to be pooled in pursuit of population health goals. This integrated model has the potential to deliver more efficient and effective care than systems in which organisations compete for resources or recognition.
Another important contribution is the ability of Partnership Boards to enhance the voice of patients and communities. Involving voluntary and community sector partners brings valuable perspectives grounded in lived experience and service-user engagement. This can help ensure that planning is genuinely person-centred and responsive to local needs.
Finally, Partnership Boards can act as incubators for innovation and flexibility. Their diverse membership introduces a wider range of expertise into decision-making, creating opportunities for novel models of care and pilot projects that test integrated approaches in practice.
Weaknesses and Limitations
Despite these strengths, Partnership Boards face significant challenges. A key limitation is the ambiguity of their authority. Many Boards lack statutory powers, as is the case with the proposed HCJ Partnership Board, meaning their decisions are advisory rather than binding. This can cause frustration if strategic priorities are agreed collectively but not implemented in practice.
The complexity of their membership also poses difficulties. Boards often involve multiple organisations with different mandates, funding arrangements, and organisational cultures. While this diversity can enrich debate, it can also slow decision- making and lead to compromises that reflect the lowest common denominator rather than bold, transformative action.
The effectiveness of Boards is highly variable. In some areas, they emerge as influential strategic leaders, while in others they risk becoming little more than "talking shops" with limited impact. Their success often depends on the skill of the Chair and the clarity of the terms of reference that underpin their work.
Resourcing is another concern. Partnership governance requires significant time, coordination, and administrative support. Smaller providers and voluntary organisations, which may lack the capacity to attend frequent meetings or contribute to complex processes, are at risk of being marginalised.
When the Panel asked about administrative support for the Board at the Quarterly Public Hearing with the MHSS on the 16th September, he said:
As I say, I do not think we can predetermine the complete direction of travel. I think we are going to have to run this for 12 months and see how it goes. It might require some more resourcing, but I do not see that it will require levels that go beyond the resourcing that is available in-house at the moment. The idea is to keep this operational and as lean as we can.'
This response reinforced the Panel's concerns and suggests much of the initial period of the Board instigation will be dominated by planning how the Board will operate and not addressing its objectives.
Questions of equity of voice also persist. Larger institutions often dominate discussions, leaving smaller organisations or community representatives in a more tokenistic role. This undermines the very principle of inclusive and balanced partnership that the Boards are meant to embody.
Common Governance Issues
Partnership Boards also encounter recurring governance problems. Accountability is a particular weakness: if the Board is not a statutory body, it may be unclear who is ultimately responsible for decisions. In some cases, "shared accountability" effectively becomes "no accountability."
Conflicts of interest are also a risk, as provider representatives may prioritise their own organisation's needs over wider system objectives. Strong policies on conflicts of interest, alongside independent scrutiny, are essential to safeguard against this, as well as a shared mission statement that all members co-create.
There is also the danger of overlap with existing structures. Without careful design, Boards can duplicate the work of advisory groups, departmental committees, or regulatory bodies, creating confusion about roles and responsibilities.
Transparency is another key issue. If decisions are made behind closed doors or are not communicated clearly to the public, trust in the process can be undermined. Boards must therefore ensure that public engagement and reporting processes are embedded in their governance.
Finally, sustainability is a recurring concern. Political cycles, leadership turnover, and funding pressures can all destabilise partnership arrangements. Without long-term commitment and stable resourcing, Boards may struggle to maintain continuity or deliver meaningful outcomes.
In principle, Partnership Boards in healthcare have much to offer. They provide a mechanism for integrated planning, shared accountability, and patient-centred service development. They can be innovative, flexible, and inclusive. However, their success is highly variable and depends on clear governance frameworks, balanced representation, and adequate authority to implement agreed priorities.
Without these conditions in place, there is a significant risk that Partnership Boards will become duplicative, slow to act, or symbolic rather than substantive. The Panel is concerned that under the current proposals for the Health and Care Partnership Board in Jersey, these risks may materialise, limiting its effectiveness as a vehicle for genuine system transformation.
The Panel considers that insufficient thought has been given to the strengths, weaknesses, and governance issues associated with Partnership Boards. Without clear authority, robust accountability, equitable representation, and adequate resourcing,
there is a significant risk that the proposed Board will struggle to move beyond process and symbolism, limiting its effectiveness in driving meaningful system change.
Conclusion
The purpose of a board in health and care is to govern effectively and in doing so build patient, public and stakeholder confidence that their health and care is in safe hands19.
The Panel welcomes any initiative aimed at strengthening governance, providing clarity of objectives, and promoting collaborative working within Health and Care Jersey. While the plans for the proposed Partnership Board are commendable in principle, the Panel considers that they are, at this stage, insufficiently developed to support implementation. A central question remains as to the evidence base underpinning the establishment of the Partnership Board.
It is unclear whether the risks of introducing an additional bureaucratic layer have been thoroughly evaluated, or whether the decision was primarily political in naturedriven by ministerial instinct, with consultation and supporting evidence assembled subsequently to justify the approach. The Panel is not persuaded that any rigorous or systematic analysis has been undertaken to demonstrate that the creation of the Board is the most effective or necessary course of action, beyond reliance on assertions of "common sense."
There remain substantial concerns regarding the proposed remit of the Partnership Board, the clarity and legitimacy of its members' mandate, the adequacy of resources to enable it to achieve its ambitious objectives, and the mechanisms through which disagreements within the Board will be managed. Collectively, these issues raise serious questions about the Board's capacity to operate effectively and to deliver on its intended purpose.
The Panel is of the view that the current proposals have placed undue emphasis on ensuring that the Board is created to a deadline at the expense of clarity around its purpose and functioning. Furthermore, the consultation process has not been of sufficient duration, breadth, or strategic planning to allow for robust engagement with key stakeholders, nor has sufficient focus been given to the potential weaknesses of a Partnership Board structure or how the model will scale to a Jersey context, and any consequent mitigation processes.
The absence of role descriptions for the Board members or clarity on the selection process, compound the Panel's concerns, with too much of the detail left to be done following Assembly adoption. Health and Care Jersey continues to face significant pressures, including staffing challenges, funding constraints, and rising demand. These systemic issues cannot be effectively addressed through the rapid establishment of a Board of providers. Rather, they require ongoing, careful assessment of needs and the allocation of resources in a considered and sustainable manner.
The Panel believes that the existing Health and Care Advisory Board can play a vital role in providing guidance on the design of an effective Partnership Board, or any alternative governance structure that can genuinely enhance the operational
19 NHSLeadership-HealthyNHSBoard-2013.pdf
effectiveness of the department. At present, the Advisory Board has not operated for a sufficient duration, nor undergone a sufficiently rigorous review of its processes, to justify the immediate creation of an additional permanent, untested, funded governance structure within Health and Care Jersey.
Accordingly, the Panel recommends that the Advisory Board's remit should be refined, and its partnership functions and cross working with the Partnership Board or any other internal governance function, formalised. The Panel feels the establishment of a Partnership Committee within the Advisory Board, (an option that was rejected on the basis that it positioned the Partnership Board as a subcommittee of the Advisory Board, creating the perception that HCJ service matters were dominate' to whole system matters and compounded existing service providers concerns), should have been explored more thoroughly and included as an option in the stakeholder consultation that informed this proposition.
During the Quarterly Public Hearing on the 20th May 2025 the MHSS stated;
I am quite minded that in the advisory board's terms of reference it would advise on whole system work rather than just H.C.J. They would quite like the opportunity to advise on the whole system, because they are excited by it. They see this as being an opportunity for Jersey to have something quite bespoke. Given the quality of the people on that board, I would be happy to see them advising across the broader health spectrum'.
The Panel agrees with the requirements for systemwide governance and feels that this should therefore be a temporary model, (an option that was not put to stakeholders) operating over a defined period to pilot and refine a governance model; a trial of the Partnership Board for an initial period of 18-months. During this period the MHSS should review the Board's activities, performance and membership, and with the agreement of the Assembly, decide whether the Board should continue to operate under these terms of reference, or amended terms of reference, or be disbanded.
This approach would allow for careful testing and evaluation, ensuring that any subsequent expansion or formal establishment of a Partnership Board is fit for purpose and grounded in robust planning, evidence-based decision-making, and the strategic needs of Health and Care Jersey.