The Jersey Care Review of the Model Jersey Care Model HealthHealth and and Social Social Security Security ScrutinyScrutiny Panel Panel 23rdXX October October 2020 2020 S.R.X/2020 S.R.5/2020 1 CONTENTS 1. Executive Summary .................................................................................................. 3 2. Chair’s Foreword ....................................................................................................... 7 3. Key Findings ............................................................................................................. 8 4. Recommendations .................................................................................................. 15 5. Introduction ............................................................................................................. 18 Background and Context ............................................................................................... 18 The Panel’s Review ...................................................................................................... 19 Methodology ................................................................................................................. 20 Report Structure ........................................................................................................... 20 6. Development of the Jersey Care Model .................................................................. 21 The lead up to the development of the JCM .................................................................. 21 P.82/2012 ................................................................................................................. 21 What was the driver for developing the care model? ...................................................... 22 The Timeline for the Development of the JCM ............................................................... 23 The “Stress Test” ...................................................................................................... 25 Covid-19 ................................................................................................................... 26 What engagement has been undertaken with the public? .............................................. 30 7. What is being proposed and how will it change how care is currently delivered? 32 Main Proposals of the JCM ........................................................................................... 32 Focus on Prevention and Public Health...................................................................... 33 Moving Care into the Community ............................................................................... 37 “Community Hubs” .................................................................................................... 40 Primary Care ............................................................................................................. 42 Secondary Care Model .............................................................................................. 48 Shifting care from the community into the home ......................................................... 50 What is the intended outcome for health care and service users? .................................. 57 Is the JCM the right model for Jersey? .......................................................................... 59 8. Delivery of the Jersey Care Model .......................................................................... 63 Responsibility for the delivery of the JCM and Governance Arrangements ..................... 63 Who will deliver the care in the community? .................................................................. 66 External Partners and Commissioning Framework......................................................... 67 What do we know about our voluntary sector? ........................................................... 67 Commissioning Framework and Partnership of Purpose ............................................ 68 1 Implementation of the JCM ........................................................................................... 73 Risks/enablers – Challengers to implementation ........................................................ 77 9. Workforce availability in the Community ............................................................... 83 What do we know about our current workforce? ............................................................ 84 Next Steps .................................................................................................................... 86 10. Finances and Funding Arrangements ................................................................. 91 Cost of delivering the JCM ............................................................................................ 91 How will the JCM be funded? ........................................................................................ 95 Changes to the current funding mechanisms ................................................................. 97 P.125/2019 and making healthcare available to all ....................................................100 11. Relationship between the Jersey Care Model and Future Hospital ..................104 Appendix 1: Panel Membership and Terms of Reference ............................................108 Panel Membership .......................................................................................................108 Terms of Reference .....................................................................................................108 Appendix 2: Adviser’s Report .......................................................................................109 Appendix 3: GP Survey Results Paper ..................................................................... ....129 2 1. Executive Summary In October 2019, the Government published a briefing paper on the Jersey Care Model (JCM), which set out a framework as to how they proposed to change the way that health and care is delivered in Jersey in the future. At that time, it was advised that the framework would be “stress tested” by an external consultant, developed and brought to the States Assembly for debate in 2020. The Panel launched its review of the JCM in December 2019. Due to the on- going pandemic and enormous impact on the day-to-day running of the Health and Community Services Department, the timetable for bringing the JCM to the States Assembly was delayed. The JCM is now due to be debated on 3rd November 2020. In Chapter 7 of our report, we examined the key proposals of the JCM and how they would change the way that care was currently delivered. We found that the main objectives of the JCM are aligned with what was previously proposed within P.82/2012 – “Health and Social Services: A New Way Forward” and are widely accepted amongst the public and key stakeholders. However, we also found that there was a lack of detail as to how the provision of care will change under the JCM and the impact the new model will have on service users, the workforce and the overall care system in Jersey. These findings made it hard to accurately assess how appropriate the model is for Jersey. Whilst there is reference to some services in the JCM and reference to activity changes in Appendix 4 of the Strategic Outline Business Case, the whole care model in the community has not yet been defined. Therefore, whilst independent services might change, at this stage it is impossible to determine how the whole service will operate together. Furthermore, without the full details of how care will be moved into the community, the Panel and its advisers cannot be confident of the financial implications of this ambition. As a result, the Panel recommends that the Minister for Health and Social Services should ensure that a review of each individual care settings is undertaken, which includes the case of change, a costed service model and a detailed transformation plan. The review must be made available before the end of Tranche 1 of the implementation plan. Remodelling primary care is a core part of the JCM, recognising that a well-functioning primary care sector is an essential underpinning of the overall model. As part of our review, we conducted a targeted survey with local GPs to hear their views and opinions of the key principles of the JCM and on future working arrangements with the Health and Community Services Department (HCS). The results of the survey are set out in Appendix 3. The results show that a vast majority of GPs felt that they were not sufficiently consulted with about the proposals contained within the JCM. The results also showed that most of the GPs were not receptive to future employment opportunities contracted by HCS and did not believe that HCS 3 understood the on-going demands on practice in Primary Care. Furthermore, the majority of respondents were not confident the Jersey Care Model, as proposed, could be delivered or that General Practice would be adequately supported under the JCM. We found that engagement with GPs is currently not working appropriately and needs immediate attention, so that they feel significantly more involved, listened to and confident in the JCM. We also found that despite GPs support being vital to the success of the JCM, the plans to address, in detail, changes to the primary and community care offer, only feature in Tranche 3 (years 2023-2025) of the implementation plan. Therefore, the Panel recommends that the Minister should bring forward planning of future primary and community