Deployment of Staff Resources in Health and Community Services

Background

The health and care system in Jersey is going through unprecedented demand pressure and change due to factors including an ageing population. The outdated healthcare estate is an additional challenge to providing efficient and effective healthcare. Two major programmes of work have sought to address these challenges, the new Care Model and the ‘Our Hospital’ project.

The Department of Health and Community Service’s (HCS’s) clinical and non-clinical management teams need to work closely with the frontline workforce to ensure that staff resources are deployed effectively and efficiently and in such a manner as to support delivery of the new care model principles and enable the effective use of the new hospital.

At 31 December 2021, 2,475 staff were employed within HCS, up from 2,371 as at 31 December 2020. This represents over 30% of the entire workforce of the Government of Jersey.  The HCS workforce included 208 doctors, 713 midwives and nurses and 392 healthcare assistants.

Like all HCS staff, medical staff are crucial to the delivery of the changes required to achieve the new care model.  More than ever during this period of change, clinical staff (including medical consultants) and staff in management positions have a joint responsibility to work closely together to provide the best possible healthcare within the resources available to them.

Job Plans are part of a consultant’s contract of employment. They are an annual agreement that set out duties, responsibilities and objectives for the coming year. Effective consultant job planning is a key mechanism through which senior managers and consultants can agree, monitor and deliver effective services to patients and service users.

Scope

The review has evaluated:

• the progress being made in finalising and implementing a workforce strategy for HCS
• the effectiveness of the implementation plans supporting the workforce strategy
• the effectiveness of the proposed arrangements to monitor and report on progress being made in implementing the workforce strategy; and
• the effectiveness of the specific arrangements for the HCS medical workforce, including:
  • consultant and other medical staff engagement
  • the clinical management of consultants and other medical staff
  • the performance management of consultants and other medical staff
  • consultant and other medical staff job planning
  • arrangements in respect of locum medical staff, including clinical supervision, performance management and job planning; and
  • arrangements for management and oversight of the ratio of public to private patient activities.

The review has considered arrangements within HCS and not the wider health and social care system on the Island.  The review has also not considered deployment of staff resources in contracted off-Island providers of healthcare.

The review has encompassed all specialities across HCS.

As part of the review I have followed up on previous recommendations made by my predecessor in her 2017 report Private Patient Income: Health and Social Services Department Follow Up where the recommendations are relevant to workforce planning and management.

Conclusions

The Health and Community Services Department is under significant pressure currently.  Factors that are contributing to this pressure include:

• the ability to recruit and retain staff in a challenging market for health staff since the COVID-19 pandemic
• inpatient bed pressures caused by high level of ‘medically fit for discharge patients’ not being able to be discharged from inpatient care into the community
• lack of relevant data and management information to drive policy development and implementation
• uncertainty as to the long-term strategic health plans for the Island (including the future care model and the Our Hospital project); and
• sometimes poor working relationships between senior clinical staff and staff in management positions.

In order to deliver and implement an effective and comprehensive workforce strategy, issues that need to be addressed include:

• ensuring completeness and accuracy of workforce and clinical data and information
• the future direction of the care model and the Our Hospital programme
• finalising the structure of the Health and Community Services department (for example, the number and composition of Care Groups)
• agreement of future clinical operating models at specialty level
• resolution of policies in key areas affecting the workforce, including:
  • terms and conditions for particular staff groups
  • on-call policies and arrangements for medical staff; and
  • a private patient strategy
• ensuring that enough specialist workforce planning capacity is available to support development of the strategy; and
• effective project management of the future workforce strategy project.