A newly-published performance report has revealed that Jersey's Health Department is falling below its set standards in 20 of 37 areas.
The Quality and Performance Report is aimed at 'providing assurance and evidence' that care groups are meeting quality and performance across the health service.
It shows that high standards are reached in many areas - such as:
- Home births - 5.3% average until June 2020, above the 5% standard
- Average length of stay in the maternity ward - 2.3, meeting the 2.3 standard
- Not attending outpatient appointments rate - 6.5% so far this year, below the 8% target
- Average time spent in A&E - 170 minutes, below the 240 minute target
- Average length of stay for emergency inpatients - 5.8 days, below the 8 day target
- Length of stay in Orchard House - average of 27 days so far this year, below the 28 day target
However, other areas are not reaching the standards set.
Around 40% of outpatients and 47% of inpatients in Jersey are having to wait more than 90 days for a first appointment.
The standard set is around 25%.
They have reduced from more than 70% a year ago, when health services were hit hard by the coronavirus pandemic.
Group Managing Director Rob Sainsbury says the focus is on patients who needed urgent treatment.
"We are working in order of priority. We have established a patient-tracking list now that is part of the process that we identify, so that we prioritise patients according to need and according to length of time that they wait and we're making some good progress in that area."
Orchard House admissions continue to increase, including for under 18s.
Four under 18s were admitted to the adult acute ward in June 2021.
"There is a lack of off-island placements available at this time, so that can also impact on this pathway.
"This is quite an unusual position for us to be within and something that we're focusing on as one of our top priorities." - Rob Sainsbury.
More than 40% of Jersey Talking Therapy clients are waiting more than 18 weeks to start treatment.
The target standard is less than 5%.
That has been impacted by services being temporarily suspended because of the COVID crisis, leading to a backlog.
"That is part of our improvement plan in this area." - Rob Sainsbury.
The percentage of deliveries by C-section is at an average of 34.5% so far this year.
That is above the set target of below 22%.
Blood loss after delivery is also a concern, with the percentage of women that have an induced labour also higher than hoped.
"We're actually seeing a reduction in the caesarean section rate. It's still indicated red because we'd like to reduce it slightly further, but we do need to take into consideration women's choice and facilitate that choice.
"We set up a group to really look at some of these indicators and put into place some KPIs (key performance indicators) which come out through our care group report monthly which we report to the board.
"The work on that is ongoing. I think by the end of the year, we should see some significant improvements." - Dana Scott, Head of Midwifery.
The theatre utilisation rate has been consistently below the 85% standard between June 2020 and June 2021.
It has increased to 71.6% from 24.9%.
Director General Caroline Landon says that, and waiting times, are not where they want them to be.
"I would expect in the next quarterly report to see an improvement in our waiting list numbers, both outpatients and inpatients, recognising that there is still a lot of need out there and there are still patients who are not presenting to primary care and therefore not coming through in secondary care, so there is always that unexpected demand out there.
"I would also absolutely expect in the next quarter to see improvement around theatre utilisation. We have a lot of focus on that work and we recognise that theatres is one of our most expensive resources, and we need to use it properly.
"It has the biggest impact upon our waiting list."
67% of patients are assessed within 15 minutes of getting to A&E. The standard is 90%.
The number of patients spending more than ten hours in A&E is also a concern.
"The team are working to improve that area, however what is really important here is that we are seeing a high proportion of our patients who are commencing treatment within 60 minutes of attending the department." - Rob Sainsbury.
The percentage of emergency inpatients being discharged before midday is regularly falling below the 25% standard.
It was at 13.1% in June.
"This (discharging before midday) really helps our A&E Department when we need to transfer somebody to the ward.
"That's part of our patient-flow improvement plan that we'll be addressing this." - Rob Sainsbury.
Other areas for improvement highlighted are responding to complaints within 28 days, and addressing bed occupancy and admissions in Beech Ward and Cedar Ward.
Jersey's Chief Nurse says the high number of reported patient safety incidents is indicative of an open and transparent culture.
More than 2,000 were reported between June last year and June this year.
Rose Naylor says she wants to see the numbers rise even higher.
"We really want people to feel encouraged and supported to raise concerns or generate incident reports when they think things have either not gone as they should or they think they've had a near miss in relation to patient-care delivery."
There was a lot of criticism in the lead-up to the publication of this performance report, after Ms Landon and Mr Sainsbury told the Public Accounts Committee said they were hesitant to release the report because of concerns that the detail may be 'sensationalised' and stop patients seeking help.
Ms Landon offered an 'unreserved apology' for that after unveiling this report to the media.
"The words we used were clumsy and ill-chosen and we'd like to apologise unreservedly to media colleagues for that.
"Those comments were not from a place of ill-intent. At best they were protective, at worst paternalistic and we do not wish to be like that."