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Locums, "black days" with no spare beds, and a '66-step process' to hire new staff have all created major challenges in keeping Health in budget – but there is hope on horizon in the form of new measures and investment to secure more beds.
Since a 'Change Team' was introduced last year, the island's Health Department has been attempting to get its finances back on track.
After giving a rundown to Express of the challenges facing the department in December, Obi Hasan, who is leading the financial transformation, kindly sat down again this month to give an honest account of the challenges and triumphs so far, and the work that remains ongoing...
The department is, so far this year, running at a £5.4 million deficit – which, Mr Hasan admits, doesn't sound very optimistic, after running at a £32.5 million deficit for 2023.
The Health department's goal was to save £3 million last year.
This is in contrast with savings made elsewhere, as part of the financial recovery plan, and Mr Hasan has said over the past months that he is cautiously optimistic.
"We are still losing money, but we are doing well and we deliver the savings," Mr Hasan said.
"But of course, we now need to deliver a lot more of those savings and that's what I mean about ramping it up.
"The reason why the savings were delivered, if we had not delivered the saving our deficit would not be £32.5 [million], it would be £35.7 [million]. So we would have another £3.2 million on top.
"As you are delivering the savings, of course there are still cost pressures you're managing within the within the business or within the organisation that can appear from other places - and you're constantly trying to manage those."
The Financial Recovery Plan, laid out last year by the specially-hired Change Team in order to bring the Health department's finances back in order, sets out a number of measures that aim to make the department more efficient. If these measures are successful, they will improve conditions both for patients and for staff.
The three-year programme started at the end of 2023, and is due to continue throughout 2024 and 2025, saving a total of £25 million.
The first three months functioned as something of a "proof of concept", according to Mr Hasan – and the mood was generally positive, with changes such as improved MRI waiting times facilitated by the Change Team.
Pictured: Chris Bown was brought in to lead the Change Team
Broadly, the plan is split into seven work streams, themselves falling under three major areas – workforce, the biggest saving area at around half of this year's planned £12 million savings; income generation, which is to create around £3.5 million; and "non-pay", which is worth £2.5 million of savings this year and encompasses large contracts like medication supplies.
So far this year, £1.82 million of savings have been delivered by Health in the first quarter, against a target of £1 million.
Mr Hasan described a number of pressures on the department last year.
During winter, he said, the department had seen "black days" – meaning there were no free beds in the system.
Pressures in the winter also meant that the department had to use many more agency staff than it had hoped, which cost twice as much as substantive staff.
Mr Hasan explained: "There are no beds at all and patients are coming in, [but] there are no beds. Where do we put them? So we have to clear beds very quickly.
"It requires additional beds being open, more overtime being done, and that happened a few times during the winter period, which is where the very expensive additional hours and cost pressure came from."
He added: "Those are all things that you have to manage as you go along. In a normal organisation that's stable, where you have a bit of contingency, you have a bit of headroom to play with, you can manage that.
"But in an organisation like HCS that's already very financially stressed, anything like that just becomes another overspend, you cannot absorb it because you're already running so hot."
These pressures have included expensive oncology drugs which, Mr Hasan explained, "can be very hard to predict", as a single treatment could cost half-a-million pounds.
Health has recently invested £2.5 million pounds to create 21 extra beds, which will be permanent additions to the Hospital's frontline wards – the Acute Assessment Unit and the acute ward, Corbiere Ward.
Of these 21 new beds, 12 are already in place, with nurses hired to help staff them.
The beds are expected to have a knock-on effect as acute patients won't need to be placed on surgical wards, freeing up the space for surgeries.
This means that more private surgeries that will be able to go ahead, and Mr Hasan expects the Health department will see additional income from these.
Although hiring can be an issue and some agency staff have been used, the ambition is to bring in substantive staff.
But recruitment takes a significant amount of resource, explained Mr Hasan.
With well-documented staff shortages in the department, recruitment, retention and overtime are all examples of areas where efficiency would be welcome.
The priority, Mr Hasan said, is to replace agency staff with substantive staff.
Locums are very expensive for the department, costing up to twice as much as permanent staff.
Mr Hasan said that the Health Department needs to take over its own hiring processes, rather than waiting for a slow change of wider governmental processes.
Pictured: It can take many months to hire new staff, meaning the Health department still uses too many agency staff.
The process of hiring a new member of staff currently has 66 steps, and can take up to 305 days or 10 months.
These steps include filling out a form to get permission to post an advert when someone is leaving – but departments can't actually post the advert until the predecessor has left.
"When I was a recruiter, we would be going and speaking to people all the time," Mr Hasan said.
"And even if there was a sniff of somebody thinking of leaving, we'd one, try to retain them if they were good, [and] two, we would immediately start to start regarding the market.
"Let's start looking before anywhere near the person actually resigns. When the person resigns and then there is a period of their notice period, we'd be actively recruiting."
But at HCS, "we can't go out until the person has resigned", he said.
There are also plans to charge private patients more for their appointments and to improve the systems that record them.
Mr Hasan said: "Another idea here is that we will be charging more for private patients because currently, we do a lot of work but we don't charge them for it because our systems are so weak that we don't record properly who's a private patient."
Pictured: The use of Jersey's second MRI scanner is held up as a recent success - bringing down waiting times and bringing in income from private patients.
The department could be losing out on several million pounds this way, Mr Hasan estimated.
A new system to correct these errors and make sure that insurance companies pay is due to be introduced.
Private patients are expected to make the department an extra £600K in 2024, and another £2 million in 2025.
The next step, by the end of 2024, will be for Health to hit its planned £12 million savings – which should take out a significant chunk out of the £18 million deficit it has forecast.
But the bigger picture is Jersey's ageing population.
The Disease Projections Report, issued in February by Public Health, forecasts a 52% rise in dementia cases to 1,250 by 2043, while 1,680 islanders will experience heart failure, an increase of 42% from the 2023 figure.
The island "very much" needs to think about the economic future of health, according to Mr Hasan, and an "absolutely crucial piece of work" is underway looking at health economics.
The department will need to look at the system as a whole, with community partners, GP practices and the Health Department, he said.
Mr Hasan explained that "it does need to be sponsored by government".
He said: "The FRP already talked about this, but this is a vision that we need to work on going forwards because that's where the sustainable solution comes from and government needs to sponsor that.
"I do believe there is appetite in government to sponsor that, but it's a matter of joining these conversations up and getting people to work together.
"My very strong advice, having done these system-wide programmes, in my experience, is that you do need to put a proper management team and resource around this, with proper programme directors."
Without proper resource and organisation, organisations risk getting sucked into data and firefighting, he explained.
The HCS Advisory Board is due to meet tomorrow, with more finance updates on the agenda.
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