Note of Policy Centre Jersey discussion meeting on healthcare, 11 July 2023

On 11 July 2023 the Policy Centre held a discussion meeting on the challenges in providing an effective healthcare service in Jersey. Professor Hugo Mascie-Taylor, author of the Review of Health and Community Services Clinical Governance Arrangements within Secondary Care and interim Chair of the Health and Care Board, opened the discussion. Rosemarie Finley, Chief Executive of Family Nursing and Home Care, and James Le Feuvre, Chair of the Jersey Health and Care Partnership Group, commented on the presentation and added their thoughts following which there was an open discussion. 28 people attended the meeting – members of the Council’s Advisory Committee and invited guests from the charity sector and the States Assembly.

Summary of comments by Professor Hugo Mascie-Taylor

• It is known what needs to be done in Jersey. There is no need to reinvent the wheel. Rather, best practice from around the world should be drawn on.
• The issue is about culture – openness, transparency, accountability, benchmarking performance. Bad behaviour is not called out. “There are no consequences” was a common comment.
• Data is not available because some people don’t want data.
• Policies need to be systemised and standardised and linked together. This is done almost everywhere, except in Jersey where there is too much reliance on personal relationships.
• There is no proper planning. People don’t know what they are supposed to do.
• Good clinical guidelines were originally developed in the 1980sand only now are they being introduced in Jersey. This is meeting opposition - “we don’t need it here”.
• There is no strategic leadership from government and no clinical strategy. Consistency is needed.
• Physical structures matter, but not nearly as much as culture issues. Good healthcare services can be delivered in bad facilities, and bad services in the best facilities.

Summary of comments by Rosemarie Finley

• There is a need to start with the social determinants of healthcare issues including the impact of poor housing and education.
• Jersey gives insufficient attention to prevention and protection. The first port of call should be a local practitioner whereas in Jersey the hospital has this role. Most issues can be dealt with locally; if they can’t be then the hospital should handle, and if the hospital does not have the necessary expertise a UK resource should be used. (See slide below.)
• Jersey has most of the expertise that is needed but it is not joined up.
• There is no strategic plan for healthcare as a whole and historically no attempt to understand needs. Accordingly, proper decisions on where to put money are not made. A system-wide board is needed, looking at everything.
• Inspections and benchmarking are essential.
• Existing patient records are held separately which is which is wasteful and cause services to operate in isolation rather than around the needs of the patient. Jersey need an Integrated shared care record solution that allows patients shared access to their records.
• Inspections and benchmarking are essential.
• Those who commission services need to understand commissioning. Currently, they do not but hopefully this is being addressed. Commissioning should follow the health needs of islanders.

Summary of comments by James Le Feuvre

• Jersey has a network of strong and effective voluntary bodies, which are under-utilised. They understand the issues and can act quickly.
• The Jersey Care Model has been discontinued but the Partnership set up under the model is continuing and needs to be strengthened.
• Jersey needs to take into account the UK Workforce Plan. Staff come from the NHS to Jersey and are used to NHS procedures. Many will return to the UK and don’t want a move to Jersey to be career damaging.
• It is necessary to overcome the view that everything in the NHS is bad.
• Demarcation issues need to be resolved.
• Volunteering is beneficial for the volunteers as well as the organisations they support – more people should become involved.

Comments made in open discussion

• All health systems are governed by boards with independent members, but there is a resistance to this in Jersey - the “we are different” syndrome. It is not a question of good executives not needing independent directors, but rather independent directors help make executives be effective.
• The issues identified in respect of healthcare apply to some extent elsewhere in Jersey, eg in education and housing.
• Jersey has a unique democracy in which the Government is only one part. The States Assembly is the ultimate decision-taking body. So the Assembly as well as the government has an important role in policy on healthcare.
• Jersey’s plans for a new hospital are being developed without adequate consideration of healthcare needs.
• Jersey is heavily dependent on the NHS for resources and services.
• Jersey politicians are too “hands on”. They need to take the key policy decisions and let experts get on with implementation.
• Reasons why some people use the hospital as the first port of call include immigrants not being entitled to access the health service for six months and the cost of GP visits for low-income people.
• Jersey has no effective policy-making machinery in respect of healthcare. There needs to be an effective policy making capability.
• Businesses as well as charities are willing to help in supporting good healthcare provision. However, the finance industry seems to seek to avoid getting involved in local issues.
• Culture change has to be both bottom-up, using champions that exist at every level in every organisation, but also with strong leadership from the top. Family Nursing and Home Care is a good example where significant beneficial culture change has been achieved in a short time.
• Airlines are a good analogy. A pilot cannot decide to “do their own thing” but has to follow agreed procedures otherwise the results would be disastrous. But there is too much “doing their own thing” in the Jersey healthcare system.
• Jersey has lots of policy papers – but is very weak on implementation and compliance.
• Jersey need patient-focussed central records which can be built out.

Key takeaways

• It is known what needs to be done in Jersey. There is no need to reinvent the wheel. Rather, best practice from around the world should be drawn on.
• Physical structures matter, but not nearly as much as culture issues.
• Jersey gives insufficient attention to prevention and protection. The first port of call should be a local practitioner whereas in Jersey the hospital has this role.
• Jersey need an Integrated shared care record solution that allows patients shared access to their records.
• Inspections and benchmarking are essential.
• Jersey has a network of strong and effective voluntary bodies, which are under-utilised.
• Jersey is heavily reliant on the NHS; not everything in the NHS is bad.
• Airlines are a good analogy. A pilot cannot decide to “do their own thing” but has to follow agreed procedures otherwise the results would be disastrous. But there is too much “doing their own thing” in the Jersey healthcare system.
• There is no strategic plan for healthcare as a whole and no attempt to understand needs and no clinical strategy.
• Jersey has no effective policy-making machinery in respect of healthcare.
• All health systems are best governed by boards with independent members.

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