Health care in Jersey – a quarter century of under funding, political neglect and uncertain catch up.

 “The White Paper only reflects what the NHS was doing 25 years ago”

General Hospital Clinical Directors

“Doing nothing is not an option” – this quote from Health Minister Anne Pryke in respect of reforms to Jersey’s health system and the White Paper for change, was how the Chair of the Scrutiny panel opened her questioning to a group of seven senior clinical directors from the General Hospital. Back came the answer – for 25 years Jersey’s government has been under funding health provision and only now have they woken up to the magnitude of the task ahead. Doing nothing has clearly been official policy for the last 25 years.

The Scrutiny panel listened intently this morning to a condemnation of policy failure, oblivious that the collective responsibility rested equally with them and the Minster of Health as loyal supporters of a governing group that has been running the show all those years.

Interestingly there was not one “Jersey boy” amongst these Doctor-managers. They were all health professionals from outside the island with a somewhat jaundiced view of how Jersey politicians have been behaving. Their candid evidence was refreshing. Rarely do we hear from the managers who actually run the system on a daily basis and know its limitations, since as professionals and civil servants they do not speak out politically.  Instead, we are all too familiar with the representatives of Jersey’s political class, versed as they are in the “Jersey Way” of talking up “success” and smoothing over a litany of neglect.

It should come as no surprise that the redesign of Jersey’s health system is being carried out by a new team of professionals from the UK, revealing that the experience of managers from elsewhere is crucial to the island’s functioning. Sitting like the fairy at the top of the tree is the Health Minister.

Overheating the low-tax, low spend model

At the heart of the problem is the low tax low spend model that has been pursued and is now facing something of a scissors crisis, between diminishing revenues and rising demand. Public expectations are also rising as to the level of treatment.

One of the Directors having been in post several years, could recount that each successive year’s budget had been based on the previous year and that meant there was no point asking for more resources to develop services. Only now was there a coherent plan for the future.

The pressure on the Hospital would continue, even if that growth in demand for services was lessened by the development of community based nursing. The Hospital as a physical building needed to be either replaced or refurbished, as it was falling apart and unsuitable for adaptation to modern services. At present the General hospital has only 2 disabled parking spaces.

The cost of building a new hospital will be considerable and place additional demands on the States’ capital budget. The evident cooking of books and failure of private-public finance initiatives in the UK, mean that only state funding is feasible for such a large project.

Recruitment of staff

Much is heard about the problems of recruiting nurses to the island because of the high cost of living, but what is less well known is that sub-specialist doctors are relatively easy to attract. Driving them here is the turmoil in the NHS and reductions in funding, together with the opportunity for practitioners to work as generalists in their field, without being confined to ever more narrow specialisations as is the case in the NHS.

The nursing shortage it was suggested could be addressed by assisted housing needs as well as crèches. Given the divisive housing laws and shortage of funds for social housing this forms another aspect of the scissors crisis.

It was recognised that insufficient nurses was a potential weak link in the organisation generally. Without the infrastructure of a Hospital building and suitable staff, services could not be delivered

The impracticalities of Independence

Whether independence for Jersey is official government policy or just kite flying, the practical realities of dependence on the UK were made clear by the men with their feet on the ground.

All doctors and surgeons need insurance and this will only be provided by insurance companies if they are satisfied that identical standards of governance are being applied in Jersey as in the UK, otherwise they will refuse to insure. To achieve those seamless standards requires a modern hospital.

Since Insurance companies are driven by financial considerations, the cost of cover is becoming prohibitively expensive and may necessitate a Crown indemnity programme. Is Jersey’s government capable of underwriting all liability for negligence?

Synergies through cooperation with Guernsey were possible and imminent, but both Jersey and Guernsey remain islands with inherent logistical difficulties. Patients did not like being off island for a long time and this generated the need for multi capability hospital provision. There needs to be 24 hour acute cover in both islands, however specialists could be pan-island and consultants brought over as required.

GP’s – stuffing their mouths with gold

Earlier in the morning there appeared before the Scrutiny panel two representatives of Jersey’s general practitioners. It was evident that as a group their financial well being had been taken into consideration when designing the White paper and new community based services that were to be developed. They expressed none of the open criticism that came from the clinical directors.Instead there were tales of new groups of GP's opening clinics in purpose built buildings and successful business models.

Whereas Jersey’s politicians were blind, it was the clinical directors that could see Jersey’s health system had to undertake 25 years of catch up and there was no knowing if the community based services plan would deliver, could be funded or ever assure projected financial savings.