HSSD runs 'lean, mean service'

I would however like to comment on one of the vital points that he says merits repeating:

'We're expensive as a provider, we need to move to being a commissioner when it's appropriate to do so.'

I know of no evidence that HSSD is expensive as a provider. It fact there is a lot of evidence to the contrary.

In March of this year the latest statistics relating to the number of hospital doctors in the England were published. In England there are 104,501 hospital doctors for a population of 54 million. If we had the same number in proportion to our population we would have about 120. In fact we have only 54. A small percentage of our medical care is so specialised that it has to be sent off island, however adjusting for this would only reduce the number of doctors by a relatively small number.

Just two examples are interesting. If we had the same ratio of pathologists as the UK we would have four and in fact we have one. In Jersey they have four gastroenterologists and we have one.

A recent survey of nurse staffing at the Princess Elizabeth Hospital against safe staffing levels in the UK indicated that we need to increase the number of nurses by 70.

We need to employ 25 more social workers to protect vulnerable children.

In 2010 HSSD had a budget of £107m. If that figure had increased with inflation it would have been £128m. in 2014 but in fact HSSD spent £111m. So the spend in health was cut in real terms by £17m.

HSSD is now having its services benchmarked against other jurisdictions to see how our spending does compare with other authorities. I suspect that we will find that actually HSSD runs a very mean and lean service, especially considering that we do not have the economies of scale that the NHS has.

Again, I have not seen the evidence that we need to move to being a commissioner when it is appropriate to do so. We already commission services from the UK and local organisations. It may be the case that we should commission more services but I would want to see hard evidence before doing so.

I believe that some of the contracts that HSSD have in place to commission services are not fit for purpose and do not deliver good value for money. The one contract that has been subject to scrutiny is that with the Primary Care Company Ltd ,and that was examined by CICRA (the Channel Islands Competition and Regulatory Authority). They said that PCCL made a profit of over £2m., which was money that HSSD could have used to deliver better patient care.

Problems exist with the monitoring of commissioned services and need to be addressed.

A major problem for HSSD is that at the present time it does not have enough staff to prepare business cases for essential equipment in a timely manner, or to monitor contracts. There does need to be an increase in staff and expertise before it even considers commissioning more services or exploring such doubtful issues as Social Impact Bonds.

Commissioning services seems to have the benefit of moving services away from the close scrutiny of politicians and getting other providers to take the risk. Occasionally we might strike it lucky and find a provider that has more expertise than we have. It is more likely that they will not and will inflate their price for the risk that they take.

We, in our turn, will have to put in place more civil servants to specify exactly what services we wish to commission and how we will judge the outcomes. It will be much more difficult than at present to take action if a service fails to deliver, and because the services will almost inevitably dovetail into other services delivered by HSSD or other providers, there will be the risk that disputes occur.

We are years away from having the ability to commission more services.

Before we make too many more changes in the way we run our services on island we should heed the advice of the nationally acclaimed 'King's Fund' when they said last November:

'The reconfiguration of clinical services represents a significant organisational distraction and carries with it both clinical and financial risk. Yet those who are taking forward major clinical service reconfiguration do so in the absence of a clear evidence base or robust methodology with which to plan and make judgements about service change.'

DEPUTY MIKE HADLEY,

La Rocque,

Le Bouvee,

St Martin's,

GY4 6BQ.