MORE than 30% of the entire Government of Jersey workforce is employed within the Health Department: a total of 2,475 people in December 2021.

The scale of the department, which includes approximately 200 doctors, 700 nurses and midwives and 400 healthcare assistants, is one reason why it is a major focus for watchdogs such as the Comptroller and Auditor General.

Probably more significant is what the Comptroller and Auditor General, Lynn Pamment, identifies as a period of ‘unprecedented demand pressure and change’.

Jersey’s ageing population is cited in Ms Pamment’s latest report as a key factor, as well as the ‘outdated healthcare estate’ – something that revolves largely, though not exclusively, around the lack of progress made since the need for a new hospital was first identified in 2012.

Ms Pamment’s report on Deployment of Staff Resources in Health and Community Services acknowledges that a relevant and overarching long-term clinical or service strategy should be the starting point for any workforce problem.

But such strategising is easier said than done, with the CAG acknowledging ‘significant uncertainties’ over both the Island’s future care model and the Our Hospital programme.

The report notes: ‘Both of these programmes will have an impact on staffing levels and on skills and staffing structures required to implement healthcare in the future in Jersey.

‘The speed at which changes are implemented and the order in which they are implemented will also have an impact on what changes are needed and by when within the workforce strategy.’

Impact of Covid

Issued just a few days after it was announced that the majority of the government-led central measures to combat the Covid-19 pandemic were to cease, the C&AG report highlights the impact of the pandemic, not least on management arrangements within Health.

A centralised ‘command and control’ structure was introduced in 2020, in keeping with major incident management.

The report notes that since the ‘command and control’ arrangements were relaxed, the departmental structure had changed, however the impact of the pandemic continued to be felt.

‘Significant pressure’ being felt by the department stemmed from a number of factors, the report concludes. These include:

•The ability to recruit and retain staff in a challenging market for health staff since the pandemic.

•Inpatient bed pressures caused by a high level of ‘medically fit for discharge patients’ not being able to be discharged from inpatient care into the community.

•A lack of relevant data and management information to drive policy development and implementation.

•Uncertainty as to the long-term strategic health plans for the Island (including the future care model and the Our Hospital project).

•Sometimes poor working relationships between senior clinical staff and staff in management positions.

Ms Pamment, in her report, said: ‘Since the Covid-19 pandemic this patient flow in Jersey has been challenging with bed occupancy levels of up to 100%.

‘Where there used to be 10 to 15 ‘medically fit for discharge’ patients in the hospital at any one time, there can now be up to 50.

Patients medically fit for discharge can currently account for up to 25% of the inpatient capacity.

‘The impact for both the patients and the healthcare system is negative, with Jersey General Hospital capacity and staff under greater strain.

‘The result is that some medically ill patients who need to be admitted as ‘urgent’ or ‘emergency’ (particularly late at night) cannot always be immediately accommo-dated on medical wards. Instead, they are sometimes temporarily admitted to available surgical beds, which are intended for patients undergoing planned surgery.’

This, she added, can lead to a shortage of beds and additional pressures for staff who are required to move patients from ward to ward.

‘In summary, the current inpatient bed pressures are putting all parts of Health and Community Services under stress. Developing a workforce strategy and making changes to Health and Community Services arrangements in such a complex and stressful operational environment are particularly challenging,’ she said.

Recommendations

Ms Pamment adds a list of issues to be addressed in order to deliver and implement an effective and comprehensive workforce strategy, including:

•Ensuring completeness and accuracy of workforce and clinical data and information.

•The future direction of the care model and the Our Hospital programme.

•Finalising the structure of the department and future clinical operating models.

•Resolution of policies in key areas affecting the workforce, including terms and conditions for particular staff groups, oncall policies and arrangements for medical staff and a private patient strategy.

•Effective project management of the future workforce strategy project, and having the capacity to develop it.

A total of 21 recommendations are made, covering both workforce strategy development and arrangements for medical staff.

The former set include:

•Establishing a project board to oversee the development of the ‘Our People’ and ‘Health and Community Services Workforce’ strategies.

•Clarifying the planning assumptions that should underpin the Health and Community Services Workforce strategy in respect of the future care model and the Our Hospital programme.

•Reviewing and seeking to harmonise terms and conditions for staff.

•The development, publication and implementation of a private patient strategy.

•A greater level of human resources support.

The second group of recommendations, covering medical staff, includes the following:

•Improved staff engagement, particularly in relation to the incorporation of the ‘Be Heard’ staff survey, due to take place this year, into the department’s business plan for 2024.

•Reviewing arrangements for staff appraisal and contracts.

•Reviewing the future use of locum and agency staff.

•Enhanced arrangements for clinical supervision.

•Better management information to monitor private patient activity and income against standards, targets and tolerances.

The Health Department’s reaction to the report is awaited, however should the recommendations be accepted, the C&AG will hope for greater success in implementing them than with a previous report.

Today’s report harks back to the 2017 report on private patient income, and lists eight recommendations that were not implemented.

These include having a long-term plan for private patients, bringing in specific indicators to monitor progress and better arrangements to ensure compliance and effectiveness.

More than 40 Health Department staff helped the CAG with her report through interviews or written submissions. All specialities within the department were included, however the report did not consider arrangements across the Island’s wider health and social care system, nor did it cover off-Island providers of healthcare.

‘I have followed up on relevant recommendations made within my predecessor’s 2017 Report on Private Patient Income: Health and Social Services Department Follow-up. That report followed up on recommendations made in 2015. In summary there has been limited progress in implementing the recommendations contained in the 2017 report,’ Ms Pamment said.