With a population of just 93,000 nestled within an area of 119 square kilometers, the British Crown Dependency of Jersey provides a range of social care and health services to its senior citizens. But due to diseconomies of scale and challenges related to maintaining professional and high-quality social care and health services, the island faces unsustainable long-term costs to maintain its services.

The transformation required for this engagement was quite significant and the model itself has been successfully used in a number of other jurisdictions including a group of five local authorities and healthcare partners in the South East Midland area of the UK.

Rapidly changing age distribution

Like many other Western jurisdictions, Jersey faces significant demographic and economic challenges, particularly for the delivery of senior services. Within the next 20 years, the number of seniors (those over 65 years of age) is predicted to increase by 65 percent.

This will clearly create a huge surge in demand that will likely overwhelm the current capacity of existing services, particularly as the proportion of people with multiple long-term conditions rises disproportionately.

Following a thorough Comprehensive Spending Review, the government is seeking to achieve savings of 10 percent over a three-year term. However, with the state and layout of much of the existing healthcare estate demanding significant investment, the jurisdiction is under intense pressure to secure positive and sustainable change for their senior population while operating within a complex and financially constrained system.

"The KPMG team in the UK has adopted a fresh and innovative approach in their work with us and have provided a very strong focus on clinical quality,” noted Julie Garbutt, Chief Executive, Health & Social Services Department. “They have recognized our need to develop a locally owned and well understood strategy that is sustainable and also, in today’s financial climate, can be seen to be affordable."

Building consensus for change

Working with a team of experts from KPMG in the UK, the States of Jersey initiated a holistic program aimed at developing and executing a change program with the potential to create a safe, sustainable and affordable set of senior services. To achieve this, the plan takes a 30-year perspective on the future needs of the island’s senior population rather than simply focusing on achieving ‘quick fixes’ within the system.

From the start, the program placed a strong focus on stakeholder management in order to involve all players in the system from social care and GPs through to private and third sector participants. It has also involved a wide range of government departments and functions that participate in the delivery of social care and health.

The journey – which has taken the States from diagnostic review and assessment through to design and planning and finally into the implementation state – has also focused on extensive public consultation and the collaborative development of business cases, care pathways and infrastructure systems in order to adequately support the transition.

Delivering safer, more sustainable and affordable care

Through the implementation phase anticipated to continue into 2020, the program is expected to deliver a range of critical benefits to not only the government but also the island’s senior population. For example, the initiative should result in greater structural and professional integration through team-style working and the enhanced role of nursing and allied health professionals; the standardization of processes; a more client-centered approach with an expanded range of services tailored to the individual; and greater use of non-institutional social care models such as supported home care and community care for older adults.

It is estimated that the work conducted by KPMG will lead to approximately 50 percent fewer non-elective admissions to hospitals and that approximately 2,400 would-be patients will be catered for in the community where they will be serviced through a combination of social care and health professionals.

"I think the KPMG report asks all the right questions and gives us a clear picture about what might be possible in the future, ” noted Stuart Brook, Former Managing Director of Community and Social Services. “KPMG in the UK draws good practices from their experience in other parts of the world including the UK and Europe, and gives us a strong vision of what services could be like in the future."

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