Submission - Jersey Care Model - Family Nursing & Home Care - 30 January 2020

Scrutiny Panel review of Jersey Care Model

Bronwen Whittaker CEO

January 2020

Terms of reference

The Panel invites submissions on some or all of the following terms of reference.

1. To determine whether the Jersey Care Model is appropriate for the Island.
2. To assess how the proposed Jersey Care Model will be delivered and by whom.
3. To consider the implications of the Jersey Care Model on the delivery of health services.
4. To assess the potential impact of the new care model on patients; in respect of the quality of service provided and any financial implications.
5. To examine the possible effects of the proposals on the current and future health sector workforce.
6. To understand the proposed Jersey Care Model in the context of the future hospital and other health facilities on the Island.

1. Background

Family Nursing & Home Care (FNHC) is a Jersey charity committed to providing high quality, integrated nursing and home care in the community from pre-birth to end of life. Our services touch the lives of more islanders than any other charitable organisation, helping children, their families, the sick, the elderly and the dying. We have teams of experienced and highly qualified nurses operating a range of services including, Health Visitors, School and Children's Nursing, District and Specialist Nursing as well as Home Care

FNHC has a well-developed, highly skilled workforce that specialises in health care in the community. This together with our track record of reliability, financial stability and the enviable brand' and reputation held within the local community should position us well in the investment and development of community health services

2. To determine whether the Jersey Care Model (JCM) is appropriate for the Island.

FNHC supports the propose new JCM and feel that the new JCM is appropriate to meet the islands needs

The new JCM is designed to provide a more sustainable Health and Social Care system that focuses on care in the community and care closer to home. Arguably most patients who require care and support would prefer to have services delivered in their own or close to their home with services that support maintaining independence. In particular for the care of children, it is important for families to be able to have choice and to keep children at home and or in education.

FNHC provides community nursing service and Home care which covers pre-birth to end of life and therefore FNHC supports the overarching principles and concept of the new JCM. FNHC however does feel that there will be some challenges to implementing the model over the coming years.

FNHC  would  wish  to  highlight  that  in  order  to  meet  the  needs  of  Islanders  there  would  be  a requirement for current resources and funding to be apportioned differently. In addition to this there will be a requirement for double running cost over a significant transition period and in the longer term there will need to be investment in the community. This resourcing challenge will have to be coordinated across Child and Adult services jointly.

The other area of challenge that FNHC would wish to highlight is workforce sustainably and the islands ability to grow our own staff, as well as attracting high quality skilled permanent staff from other jurisdictions. As both require funding and will impact on the ability to deliver the JCM, FNHC would like to recommend that this model is stress tested in the community.

To ensure this model is successfully implemented and delivered work will need to continue on supporting changes in the culture and working practices on Jersey.

3. To assess how the proposed Jersey Care Model will be delivered and by whom.  

To successfully deliver the new JCM there will need to be changes to practice and service delivery and this will require cultural change and for professionals to work in different ways and with

different partners. This will not just happen, there will need to be structures and processes for making these changes and sustaining this activity.

In addition to this and to support the successful deliver of this new model, the public will also need to access and utilise services very differently

A major feature of the care model is for more care to be provided in the community. This will require the commissioning, extension and development of more services to be provided within the community.

In order to achieve this community and voluntary / charitable bodies will need to work together to form new and different partnership.

Currently there is no overarching structure to bring these organisations consistently together in a structured or planned way to develop strategies and partnerships that will support the model going forward.

There is however, a real opportunity to develop primary care services that work across a number of organisations configured in multi-disciplinary teams. Equally there is opportunity to nurture coordinate and develop the voluntary and charitable organisations who currently play a significant role in the delivery of community and primary care services.

Patients with long term conditions and complex care can be safely supported within the community provided there is capacity, the right skills, expertise and sufficient work force to safely deliver services.

4. To consider the implications of the Jersey Care Model on the delivery of health services.

The  implications of  this  model  are  the management  and  pace  of  change. As  stated  previously professionals will need to work in a very different way, patients will need to access services differently and services may have to be provided by different groups of skilled professional e.g. extending roles of GP's, nurses, therapists and pharmacists. These groups of staff will need time to train and upskill. Equally this model will offer greater roles for skilled unqualified staff e.g. Health Care Assistants and the Voluntary Sector. In addition to this more support will be required for carers and families who wish to play a role in supporting the delivery of care at home.

Organisations such as FNHC are central and well placed to continue and extend the provision of community nursing and home care along within the community. FNHC can also play a pivotal role in supporting smaller organisations to deliver ongoing support to islanders.

A further impact of the JCM, is the way in which services are currently funded, the future funding model and charges that may be passed onto patients. This is particularly relevant and challenging for primary care and home care services. New models of funding need to be put in place which protect the most vulnerable in society, equally these funding models need to be simple, non-bureaucratic with the ability to work in practice.

A positive impact of the JCM should be the ability to deliver improved outcomes for patients that are evidence based, cutting edge and demonstrate best practice. The current Health and Community Services ( HCS ) model is challenged by multiple data sources and inconsistent data quality which does not necessarily reflect patient outcome. Within the new model there is a real opportunity to address information systems data intelligence and quality of data.

An opportunity that could be created through the impact of delivering this model is the ability to bring work into Jersey from other jurisdictions. This in turn could support the long term financial model as this has the potential to income regenerate and attract workforce.

5. To assess the potential impact of the new care model on patients; in respect of the quality of service provided and any financial implications.

To assess the potential impact of quality of services provided by the new model, we will need to be able to demonstrate improved outcomes for patients. There are a number of ways this can be achieved, one of which is to  benchmark against other jurisdictions, others are through patient satisfaction and feedback mechanisms. Whichever methodologies are selected there will need to be a quality framework developed as part of a performance monitoring and management system. The framework will need to cover all parts of the system or pathway as this will be required in order to deliver improved outcome for patients.

Equally quality can be measured and monitored through external mechanisms. This is where the role of the Care Commission, the Charity Commission and the Children's Commissioner can be used to register, regulate, and quality check services. Regulation could proactively utilise patient experience, voice and feedback, as part of the models governance system. A robust governance systems will need to also manage reduce and mitigate risk, provide clinical oversight and monitor complaints and incidence. Running alongside any clinical governance system will be requirement for corporate governance. This will include robust financial management to ensure that funding allocation provides maximum benefit, adds value and that costs are monitored year on year supported by a 3-5-year plan.

6. To examine the possible effects of the proposals on the current and future health sector workforce.

The new JCM is dependent on a skilled and sustainable workforce this extends beyond the HCS and must consider the wider implications for social services and the voluntary sector. Being able to recruit and retain a suitably skilled workforce is more challenging for Jersey as an island and more work needs to be undertaken in relation to workforce/succession planning across the whole system. Equally of importance  is  Jersey  having  the ability  to  grow  its  own  staff  and  support  islanders  to  take  up employment opportunities within the wider HCS care sector

Parts of the new JCM are reliant on the delivery and extension of services e.g. 24-hour community nursing. Our ability to recruit into such has areas and across all disciplines has not been tested and therefore would need to be stress tested prior to implementation of a full working model. There will be a requirement for the skilling up of existing staff and for staff taking on a higher level of skills and or extended roles in order to deliver care.

This may require greater training and education facilities on Jersey along with the development of new partnerships with other jurisdictions

In order to attract staff, Jersey needs to be an attractive island to work and live in terms of lifestyle and opportunity. Attracting staff with the right skills and making Jersey an affordable place to live and work will be an important factor in retaining staff.

7. To understand the proposed Jersey Care Model in the context of the future hospital and other health facilities on the Island

Whilst a new hospital for Jersey is really important for securing a new and up to date world class facility, Jersey must be mindful not to put all the focus and attention on the hospital and hospital services as this would maintain the status quo. The new model offers a different approach which clearly requires a modern hospital provision however, the hospital should be viewed as an integral part of the system not a central focal point for service provision. Therefore it should be acknowledged that it is vital and important to plan for and build a new and appropriate hospital provision, but at the same time it will be important not to change or lose sight that the focus of the new JCM is a community based care model with a smaller acute care provision.

The new JCM brings care in the community into the forefront and work needs to be undertaken to ensure that the public have the same level of confidence of care in the community as they do at present in hospital care