Health service reforms

WQ.138/2025

WRITTEN QUESTION TO THE MINISTER FOR HEALTH AND SOCIAL SERVICES

BY DEPUTY J. RENOUF OF ST. BRELADE

QUESTION SUBMITTED ON MONDAY 24th MARCH 2025

ANSWER TO BE TABLED ON MONDAY 31st MARCH 2025

Question

"In relation to the Minister's reform of the health service, will he publish any information used to inform the development of the proposals, and advise –

1. what formal goals were established for the reorganisation of the service;
2. what analysis of the strengths and weaknesses of the current structure was conducted;
3. what data was used to establish a baseline against which to measure success of the reorganisation, and the proposed criteria and process for measuring success;
4. any alternative options for the reorganisation that were considered; and
5. what potential improvements in patient outcomes have been identified and how they will be measured?"

Answer

Based on extensive discussion throughout our health and care system and with the Health Advisory Board, I have proposed two key changes to improve efficiency and deliver better quality care:

1. Proposed establishment of a Partnership Board: a Board of health and care service providers (government and non-government) whose purpose is to come together to plan how to improve the health and wellbeing of people who live in Jersey. Also, to create a forum where all major contributors to the health service are able to contribute, more equitably, to policy development and decision-making. The Partnership Board proposal will be brought to the Assembly for full consideration.
2. Strengthening internal arrangements: bringing GoJ health and care resources (public health, policy, ambulance) together into a single Health and Care department, in addition to refocusing or restructuring a small number of existing roles to focus on services across the whole system (especially Digital and Finance), as distinct from primarily focusing on government's service provision alone.

1. Formal goals: To strengthen joint working to help identify and address barriers that hinder / potentially hinder delivery of draft principles set out below, improve efficiency and deliver a more seamless service.
2. Analysis of strengths and weaknesses of current structure: This is evidenced in discussion with providers across the system and in the Comptroller and Auditor General's 2018 and 2021 reports on Governance Arrangements for Health and Social Care.
3. Baseline against which to measure success of the reorganisation, and the proposed criteria and process for measuring success: To be determined in discussion with the Partnership Board if/when established.

(d) Alternative options considered: The following were considered:

• do nothing

• further embed existing split model with public health, policy, system wide advisory functions and Partnership Board operating from the Cabinet office (acting as equivalent to Department of Health) and provision of services in separate government department (acting as equivalent to NHS)

• establishment of an independent arms-length providers organisation outside of government (as per Isle of Man)

• incorporation of key external providers into GoJ and / or independent arms-length body

(e) Measure of improvements in patient outcomes: measure for improvement against the draft principles and patient outcomes are to be determined.

The resources available to all Ministers require us to look at and learn from other jurisdictions and to listen to our local experts i.e. the health and care professionals who are delivering services to Islanders. We cannot undertake detailed, comprehensive analysis of all options due to associated costs. To do so extensively would also be unnecessary as Jersey has a range of individual, specific problems which differ from elsewhere, but which, in many cases, can be addressed by accessing the extensive skills and knowledge already present within our existing local service

As stated previously by Deputy Renouf when voting in favour of the Health and Care Advisory Board (P19/2023) – The key question - "is a simple one: does this proposal make it more or less likely that the Health Department and the Government is able to deliver better healthcare to our people?".

In relation to the current proposals, the answer goes without saying. DRAFT principles (subject to discussion with partners)

Fair, affordable access: The plan looks to provide all Islanders to have fair, affordable access to the core health and care services they need, whilst not creating an unsustainable financial burden for the Island. This will require safe, effective services that are necessary to people's health and wellbeing. This may limit patient choice and may also mean that some Islanders pay to access some services, as happens in some instances, today.

Prevention first: We will require more investment in services that help Islanders stay healthy and well. This will involve supporting Islanders to use prevention services, and incentivising providers to provide them.

A working Island: We need to support Islanders to stay economically and socially active. It is good for them, good for the economy and essential if Government is going to raise the monies needed to provide health and care services and mitigate the effects of our aging population. Safe, efficient, effective and affordable health and care services will help attract future employers and employees to Jersey.

Right service, right place, right cost: We want people to access the right service, and we want that service to delivered efficiently, in the right place at the right cost. This may mean some services being delivered across the Island (including in people's homes) and some being brought together into single centres. In Jersey, no-one needs to travel far.

Best use of people, data and technology:  

• Our health and care workforce needs to be supported to act at the top of their profession. In order to capitalise on their skills and knowledge and make best use of equipment and facilities we must invest in connecting all the data currently accumulating in remote silos, right across the service.

• Appropriate investment will help Islanders to care for themselves and help health care professionals to assist them.

Strength in partnership

A small Island workforce cannot do everything. We need to build strong, effective partnerships with other professionals and organisations (on and off-island) who have the knowledge, skills and capacity to support us to deliver safe, effective services. According to all the health professionals consulted, the current plans will make that a great deal easier.