I LOVE Jersey. I love the weather (mostly).

I love the people. I love the food.

When I skipped to work on 3 November 2003, the sun was shining with a gentle breeze. The pain of the NHS off my shoulders, neck and bum.

The NHS was breaking. I left because Whitehall politicians were trying to micromanage us. Setting hospital targets with the carrot of financial gain if we achieved them, or penalty, if we did not.

Healthcare became about money and not healthcare. Jersey was not the NHS, then.

The morale of the Hospital was amazing.

Smiles from the Hospital staff. This was reflected in the exceptional care of the patients. It was like the NHS when I qualified in 1985. The staff would willingly help other wards out when there was a staff shortage. Sadly, this rarely happens now due to whole-Hospital staff shortages.

I became a big fish in a small Jersey pond. I knew my subject and what is best practice for gastroenterology. It needed modernising. I had meetings with a couple of managers, and within 12 months I had up-to-date endoscopy equipment. This would never have happened in the NHS, or the current climate in Jersey. The cameras were narrower, Teflon-coated with greater manoeuvrability, and therefore, gentler for the patients. The managers facilitated the service, then.

I encouraged modern endoscopy healthcare practices on the Aubin Ward endoscopy unit by appointing forward-thinking nurse leaders. It is the best (and happiest) ward in Jersey General Hospital (but I would say that wouldn’t I).

I wanted to introduce bowel-cancer screening to Jersey in 2005. This was delayed by the lack of political will and support. This vital service was eventually introduced in February 2013 with the driving force of Linda Diggle from Public Health. This won an Island-wide quality award in 2014 but, more importantly, has saved many lives.

I became busier and busier. Patients with complex bowel disorders, and those who had difficult endoscopic anatomies, returned to Jersey for their care. Waiting times for outpatients and endoscopy inevitably increased despite working 60 hours a week to try to keep up. I was drowning under the pressure. Eventually, when I went down for the third time, management listened to my pleas for help. They brought in an outside endoscopy team at a cost of a third of a million pounds. The waiting list went from nine months to four weeks, but rapidly rose again after they left.

I was eventually allowed to appoint a second colleague in 2011, Dr Moses Duku.

He knew Jersey having worked here in 2003 as a fledgling gastroenterology trainee.

When he completed his training, and qualified as a consultant, I invited him back to Jersey. He remembered the good quality care here, the beautiful island, and not being the NHS. Thankfully, he applied and was appointed. He is excellent.

Soon after, the interim Hospital director determined that the Hospital was not fit for purpose. And we all know what has happened since: many thousands of man-hours of consultations, planning, designing, and three planning applications, not to mention over £100m spent and not a brick laid. The last plan being approved by the previous States Assembly and passed by the independent planning inspector for a single-site hospital. All the time the previous head of Scrutiny using delaying amendments to stop the process, which the “Cancel of Ministers” has now cancelled.

The Hospital is crumbling. There is a budget of £5m to maintain it, but it cost £9m to repair the sewage leaking into the maternity ward. It cost over £12,000 to install one disabled toilet on Aubin ward. I think the £5m is an underestimate, but it will certainly pay for the proverbial wallpaper for the cracks.

And then Covid. “Luckily,” as an island we could isolate but, sadly, we could not keep it out completely despite our best efforts.

I realised that the “lockdown” would store up problems.

Patients were scared to come to the Hospital and to see their GP for fear of contracting C-19, and stoically underplaying their symptoms not wanting to bother their overwhelmed GPs. The dammed-up sickness tsunami would eventually reach our health shores. And it has done so with profound consequences both locally and globally, causing long waiting lists with diseases and cancers being more advanced at presentation.

Healthcare workers have died, become burnt out, and retired early or have left healthcare completely because of the pandemic.

Not just doctors and nurses but, just as importantly, healthcare assistants, porters, domestics, operating-theatre technicians, physiotherapists, occupational therapists, pharmacists, radiographers.

There is a global shortage.

We have lost people to hospitality because they are paid more to clean tables than clean bums. The consequence is “bed blocking”, the inability to safely discharge patients from hospital back to the community.

There are beds out there but not enough healthcare workers to look after them. We regularly have 20 to 30 patients stuck in our hospital beds. This causes cancelled elective operations such as joint replacements, even privately funded ones.

Our consultants have been accused of being greedy and having no appreciation of taxpaying patients suffering long public waiting lists but can be seen quicker, privately. I can categorically say that our consultants are NOT greedy. They work extremely hard with several close to “burnout”, which I suffered before I retired.

The disparity between public and private waiting lists is simply the laws of supply and demand. There are many more public patients than private patients. At least 70% of operating lists must be public patients. There are disproportionally more non-private patients for the operating theatre slots than private, hence the waiting list disparity. And NOT because “greedy” consultants are inflating their public waiting lists. The private-practice income generated pays for a significant percentage of the Hospital’s running costs, which is why there has never been a separate private hospital in Jersey.

My “burnout” was caused by the weight of work and worry. Worried by lengthy waiting lists. Worried about patients with possible cancers waiting too long. Worry about breaking bad news to patients. It is not any easier despite 39 years of practice.

Worry about the absence of support when a close member of staff received threatening and abusive emails from a patient (whowas later convicted and bound over). She had to approach the police herself. The hospital system did not help at all. Where is the care for carers? The politically motivated and very poorly evidenced cancellation of the Overdale project continues to cause me serious concern about the Island’s future healthcare provision. My own healthcare.

I asked AI/ChatGPT the question, “How many hospitals are needed in an island 9-by-5 miles with a population of 110,000?”

Answer. One. The lack of transparency of the costs of the new hospital facilities is transparently clearly more expensive.

Not only to build, but also more expensive to staff and run. We will have to pay for it somehow. Maybe stealth tax increases in long-term-care contributions.

I have found the people of Jersey to be very well-educated about health, but Covid has increased their health anxiety. Patient expectations are much higher because of social media, “Doctor Google,” and “Health Mail.”

They have become more sceptical, cynical and untrusting of a doctor’s opinion, and a few demand unnecessary, and dan- ‘‘ gerous, tests. For example, CT scans hold a 1-in-2,000 risk of causing cancer, and therefore, cannot be requested lightly. These expectations and demands put pressure on waiting lists, and stress on healthcare providers.

I am not saying that we should not be questioned, far from it. Questions keep us on our toes. You should leave a consultation knowing what is going on.

I am able to ask “Do you have any questions?” in four different languages, as well as “Hello. How are you?” and “Pass wind”.

Health and Community Services have spent £25m in hospital consultant locums this year alone, and a similar amount in bank and agency nurses, radiographers, operating-theatre assistants, and other paramedical staff. The doctor locums are being paid at least double the rate of substantive permanent staff. Locums have no incentive to develop services, nor to get to know our patients’ individual healthcare needs.

If we could translate these monies across the pay scales, then perhaps we can attract and retain hospital staff. This is why Australia, Canada, America and the Middle East, are successfully tempting our doctors, nurses and healthcare workers.

The consequence of staff shortages is longer waiting lists for MRI scans, sending patients to UK for cataract operations and bringing in another outside endoscopy team for nearly £800,000, to name a few headline examples. How are we going to be able to staff multi-site health facilities? Has anyone actually looked at the cost of running these hospitals? Recruitment of healthcare workers is not an issue for Jersey, but retention is.

Disgruntled NHS workers see our jobs and recognise that we are not the NHS and take a second look. Whereas in the recent past the pay differential offset the cost of living here, this has been eroded over the past 19 years, following the NHS’s “Agenda for change” in 2004. The terms and conditions here are not good enough to keep good people here. They frequently say how much they love the Island but leave because it is unaffordable.

Now I’ve retired I am sleeping better. I remain in close contact with my friends and colleagues at the Hospital. They are firefighting against the pressure of waiting lists. They feel unsupported by managers with deaf ears. Managers being appointed from the NHS and our own frontline staff, taking them away from patient care.

Many managers at the Hospital are good.

Some not so. A minority are bad. Many have been appointed from the NHS with an NHS mentality. From a system which is broken. The bad managers do not listen to clinicians’ concerns about patient care, ignoring their ideas for best practice for their patients. Ideas to reduce waiting lists.

Lucy Letby has made this very clear. I expect that managers will be made formally accountable after the inquiry, as doctors and nurses currently are. Hopefully, managers will facilitate healthcare workers, and not hinder and ignore.

In defence of managers. They are doing the bidding of their political masters. Masters who have little or no idea of how to run a quality health service, except perhaps the current Health Minister. Treasuryhas told them to make £20m savings next year, 2024. But how can they save money when most departments and wards are run by locum agency staff being paid up to three times that of regular staff? When they themselves are under fire from FoI requests, ordered to meet politicians with very little notice, needing to cancel meetings with clinical staff? One way to save money, I have been told, is to see fewer patients and cancel operations.

This cannot be allowed.

This is our immediate future for Jersey.

Losing services, travelling to UK (or France) for non-urgent operations, or have operations and procedures cancelled or performed by locum doctors who have no real ownership of their work. Working in a crumbling Hospital, run by managers scared of politicians who have little idea of how to run healthcare, and do not listen to the concerns of frontline staff.

We must move away from NHS mentality.

Their system is broken.

The new hospital board has excluded the interim chairperson from the appointments process. Surely, this cannot be right? This board must be independent of political interference, in statute. Otherwise, it is a States Assembly puppet board.

We are going down the path of the faltering and failing NHS with meddlesome politicians who are deaf to healthcare workers with no long-term plan. Healthcare workers have ownership, dedication, in a vocation for the long-term and do not change every four years. They have care and compassion without ego. They are popular for doing a job which is satisfying and rewarding, but are frustrated by bad planning, deaf managers and ignorant politicians.

The morale of the Hospital is a shadow of when I started 20 years ago. There are happy bright spots which I hope are not extinguished, and used as a model for rekindling its spirit.

We have an opportunity to follow a better healthcare model. We need managers to facilitate and not hinder. We need less direct political interference from people who know little about healthcare provision.

We need to care for the carers. We need to treat each other with courtesy and respect. What’s the alternative?

•Dr David Ng was a medical consultant serving Jersey for 20 years, heading up a prize-winning island bowelcancer screening programme, and gastroenterology service. He was a member of the Our Hospital Project team between 2018 to 2022.

One way to save money, I have been told, is to see fewer patients and cancel operations. This cannot be allowed