Communications in the General Hospital and availability of beds

1240/5(2910)

WRITTEN QUESTION TO THE MINISTER FOR HEALTH AND SOCIAL SERVICES BY DEPUTY G.C.L. BAUDAINS OF ST. CLEMENT

ANSWER TO BE TABLED ON TUESDAY 6th JUNE 2006

Would the Minister inform members –

(a ) w h  ether he is investigating communications procedures across various departments within the

General Hospital to determine whether any disconnection exists and, if not, would he undertake to do so; and

( b ) of available bed numbers within the General Hospital and at longer stay wards such as at Overdale

Hospital and also give details of projected numbers for the next five years?

Answer

 ( a ) A district General Hospital is an extremely busy and highly complex organisation. Even a cursory

examination  of  the  Jersey  General  Hospital's  internal  telephone  directory  would  give  one  an appreciation of this complexity and high division of labour that exists between the various clinical and non-clinical departments, functions, and activities. Communicating effectively and meaningfully to a highly  diverse  workforce,  which  includes  consultants,  nurses  and  midwives,  manual  workers, technicians and administrative staff, is a challenge which is characteristic of such organisations and is a task that is never completed as it is always possible to work harder and to improve further.

I n this context, a number of important exercises have just been completed –

1. the management structure hasbeen subject ofwidespreadconsultation both within the Jersey General Hospital and within other departments ofHealthandSocial Services. Thewayinwhich this exercise has been conducted has drawn compliments from a number of staff. An important outcome from this review has been anaffirmationofthe Chief Officer's practice ofholdingthree "road shows" eachyear, in three different locations, (nineevents altogether), in order that he can be accountable to his staff and can answer their searching questions;
2. Executive Directors communicate organisation widemessagesusing the intranet facility.  This has proved increasingly affective asmoreandmoredepartments, and more and more staff within those departments, have access tothe latest technologies. Importantly,following a recent meeting of theManualWorkersJointConsultativeCommittee, internet access will be "rolled out" to manualworkers as far as it is practical;
3. the HealthandSocialServicesDepartment is committed to ensuring that it's staff aremadeaware of any changes to theirworking practices proactively via the intranet rather than having toread about them in the local media. As the Department seeks to become a better employer, this professional courtesy represents best practice;
4. senior managers andsenior clinicians meet regularly with various workgroupsthroughtheHealth and SocialServicesDepartments' consultative machinery. Specific consultative machinery exists for medical staff, nursing andmidwifery staff, and manual workers. A latter development has been the establishment of a jointWorkingPartycomprisingofnursemanagersand nursing and midwifery staff side representatives toimplement the Job Families Agreementwhich is a highly complex  and all  embracing agreement which has the  effect  of radically  transforming  the remuneration andcareerpaths for the nursingandmidwifery professions.

H  ealth and Social Services encourages all staff to communicate widely and responsibly. Communication

should never be simply "top down" from the Chief Officer. Communication should flow "up and down and

across" the Department if the organisation is to be healthy, continue to be relevant, and able to operate in a timely and professionally manner.

G iven this level of communication, albeit not perfect, it suggests to me that there is no "disconnection"

within the Jersey General Hospital. If the Deputy is aware of any specific matter that might suggest such a disconnection' then perhaps he would contact me.

( b ) The number of available beds within the Jersey General Hospital is 294 (this number includes the

Critical Care Unit, Special Care Baby Unit and Maternity beds). The number of beds in the longer stay wards at the Overdale hospital is 141 (this number does not include respite beds). Further long stay facilities exist at St. Saviours' Hospital for older people with mental health problems. The number of these beds is 95 (this number does not include respite beds).

B e d s r epresent a very high cost in the provision of health and social care thus it is important that numbers

are always kept under review. Some of the factors which influence the number of beds in any health care system include –

(i ) w  h ere patients prefer to be treated elsewhere, for example, receiving appropriate treatment in care in

their own homes as opposed to being in an institution of some kind;

(i i ) w here care is more effectively given elsewhere. The best and most effective form of surgery for

many patients takes place on a "day surgery" basis. To add to its current day surgery facilities, a £6.9 million development is taking place at the Jersey General Hospital which will allow patients to arrive, receive surgery, and return to their own homes without the need for them to be accommodated in a bed on a ward;

(i ii ) w  hen technology has changed the type of treatment a patient needs. The States of Jersey is to invest

significantly in the ICT infrastructure of the Health & Social Services Department. The affect of this new technology, amongst other things, will be to expedite care as a result, medical records, and x-rays (and other relevant items of information) can be transmitted electronically and save the need for some surgical patients to languish in beds;

(i v ) w  hen chronic disease management improves. I will be bringing forward proposals for restructuring

of health and social care in the latter months of this year. One of these proposals will include the development  of  more  effective  and  efficient  ways  of  providing  care  and  treatment  to  those patients with longer term conditions. Currently, these patients are often re-admitted to the Jersey General Hospital when they experience an acute episode simply because GP-led primary and community services are insufficient for these patients to be treated in their own homes;

(v )  w h en waiting times reduce further. While this is a complex matter, it can be said that when a general

hospital has long waiting lists, then healthcare professionals often spend an inordinate amount of time prioritising and re-prioritising patients who are on that long waiting list but whose conditions deteriorate as a consequence. Short waiting times means that healthcare professionals can manage their patients before their conditions worsen. In this way, healthcare professionals can manage their patients' rather than manage the waiting lists'.

 A  n exercise currently underway is to measure the impact of these variables, an indeed others, on bed

numbers. The number of beds which the Health and Social Services Department thinks it will need in the future, provided that other non-hospital options are available, will be presented to the States later this year.