Question
Following the Minister’s response to Written Question 385/2023, will she provide the number of
staff employed within the Public Health Team from 2019 to 2023, broken down by year, and further
provide resourcing costings and staff costs, broken down by pay grade, as well as an organisational
chart for the Team for 2019 and 2023?
Answer
The period requested covers the COVID-19 pandemic, which required additional and temporary
resources in the Public Health Team to support the emergency response. For the purposes of
answering this question, those posts that are substantive, established and funded have been included.
Posts funded through the Jersey Care Model (JCM) and Building a Safer Society (BASS) have also
been included. Posts associated with the pandemic response and recovery, i.e., those that were funded
through emergency funds, have been excluded.
Public health services are critical for keeping the Island safe, preventing disease, reducing health
inequalities, and improving the population’s health, through for example, managing outbreaks of
infectious disease, developing alcohol policy, delivering child nutrition programmes, or supporting
efforts to improve air quality.
Pre 2020, the public health function had a limited capacity to deliver its responsibilities in the form
of a small Strategic Public Health Team, delivering the bare minimum public health activity, based
on our outdated Public Health Law, the Loi sur la Santé Publique (1934). A small number of
supporting public health functions- namely some public health intelligence work and child health
services - sat within Statistics Jersey and HCS respectively.
Today, the public health function consists of a range of duties which are either statutory, or are
designed to support care & health services, protect health, or promote health. The public health team
not only develops policy and strategy, but also commissions and delivers services, as well as
responding to immediate risks to health, such as infectious disease outbreaks or other unexpected
events.
The health system in Jersey is now meeting unprecedented challenges, resulting from the impact of
an ageing population and the impact of increasing numbers of people with long-term conditions
driven by lifestyle factors such as obesity and high alcohol consumption. Currently there are about
135,000 hospital admissions per year in Jersey. The proportion of GDP spent on health is continuing
to rise dramatically in most countries: in the UK healthcare spend has increased from under 10% of
2GDP in 2018 to just under 12% in 2022. It is generally accepted that it is essential to reduce
3preventable diseases if rising costs and impacts are to be contained.
The cost-effectiveness of preventing ill health (public health measures) means it is generally a much
more efficient use of resources than waiting until diagnostic and curative treatments are needed from
4primary or secondary care. Studies show that on average for every £1 spent £14 will be saved. This
1 Public Health Intelligence (2022) Government of Jersey Hospital Admission Rates 2021-2022
2 World Bank (2023) Current Health Expenditure (% of GDP)- United Kingdon
3 UK Department of Health and Social Care (2023) The Hewitt Review: an independent review of integrated care systems
4 OECD (2006). Future budget pressures arising from spending on health and long-term care. OECD Economic Outlook 79:145–156
(http://www.oecd.org/eco/outlook/oecdeconomicoutlookspecialchapters.htm).
is particularly the case for Jersey, where initiatives to prevent disease have not generally been
developed to the same extent as in other parts of the British Isles. Without prevention measures, the
costs of health care and negative impacts of ill health will continue to rise at unsustainable rates.
2019
In 2019, Jersey’s public health functions were dispersed across a number of departments:
• the Strategic Public Health Team led by the Medical Officer of Health (MOH) were located
in Community and Constitutional Affairs (CCA), which became part of Strategic Policy,
Planning and Performance (SPPP);
• some Public Health Intelligence reporting functions were provided from within Statistics
Jersey.
• the Child Health Team were located in HCS.
In 2019 a paper was commissioned to consider future challenges and look at Strengthening the Public
5Health Capability . This review strongly recommended that a public health function was needed in
Jersey that had sufficient financial and workforce resources to protect and improve public health. At
the time, this aligned to the developing Jersey Care Model (JCM), with a recommendation that future
specifications should feed into both the short-term health and wellbeing transformation and onwards
to sustainable funding. The then Corporate Strategy Board approved the proposal to develop
specifications for future strengthening of public health capability aligned to the developing Jersey
Care Model (JCM).
The 2019 expenditure (staff and non-staff) on strategic public health activity was £812,000, and there
was a headcount of 7. In addition, £945,000 was spent on child health, with this service sitting within
HCS.
2020
In March 2020, the Strengthening the Public Health Capability Review was concluded, and funding
provided for in future years via the JCM.
In order to respond to the global pandemic, the public health team in SPPP was significantly enhanced
with additional staff and other resources, with emergency funding provided. During 2020, the
COVID Test and Trace team were part of Justice and Home Affairs (JHA), whilst the COVID
Vaccination team were part of HCS. Public Health Intelligence was expanded to provide daily
pandemic reporting. Previous written questions have considered the resourcing during this time, so
this is not repeated here.
The 2020 expenditure on public health functions was reported as £487,200 and there were 7
substantive staff, however, during 2020, 4 staff members were seconded to the Covid Team and
therefore the budget only covered 3 substantive staff.
5 Middleton, J and Southon, P. (2020), Strengthening Public Health and Public Health Law in Jersey
2021
6A review of the Government Response to the COVID-19 Pandemic by the Comptroller and Auditor
General in April 2021, concluded that the proposed expansion of the public health function as part
of the JCM should ensure that the function is properly equipped to address future health protection
emergencies.
Following the retirement of the previous incumbent in 2020, the new Director of Public Health
(Medical Officer of Health) took up their role in July 2021.
The continuation of the pandemic required ongoing support through emergency funding. In October
2021, responsibility for COVID Test and Trace moved from JHA to public health in SPPP.
Final specifications for strengthening the public health capability were included in the JCM business
case as part of Government Plan 2021.
The 2021 expenditure (staff and non-staff) on public health functions was £816,000 and there were
8 staff.
2022
A Ministerial Decision (MD-TR-2022-260) was made to move the Health Promotion Team from
HCS to public health in SPPP.
7The Jersey Independent COVID Review , conducted in 2022, found that the States entered the
pandemic with out-of-date legislation and a poor public health function and made the following
recommendation:
There is a need to review the expansion of the public health function proposed as part of the
Jersey Care Model to ensure that it is properly equipped to address future health protection
emergencies. This includes the need to strengthen the public health protection function and
the public health intelligence function, which has been critical to inform decision making and
the wider public during the pandemic. This will also allow us to monitor the indirect impact
of the pandemic on health and recommend action to address health need.
The COVID Safe team were stood down as of December 2022, as part of the de-escalation of COVID
measures. The COVID Testing team were stood down as of 31 January 2023 when the drive through
testing centre was closed.
During 2019-2021 a number of small food and nutrition strategy pilots were carried out using the
Government Plan 2020 budget for Reducing Preventable Diseases (RPD), with the full suite of RPD
delivery being delayed as a consequence of the pandemic. By 2022, Public Health could begin to
implement food and nutrition policy, services and health promotion activity for children, young
people and families.
The 2022 expenditure (staff and non-staff) on public health functions was.
• £894,000 Strategic Public Health and JCM/BASS - including 21 staff.
• Food and Nutrition Strategy and Programmes- £800,000- including 4 staff.
• Health Promotion Team- £200,000- including 3.5 staff.
6 Comptroller and Auditor General (2021) Government response to the Covid-19 pandemic- Management of the
Healthcare Response
7 Jersey Independent Covid-19 Review (2022) High Expectations
2023
The Child Health Team were transferred from HCS to public health in SPPP (service transfer) at the
start of 2023 as part of Government Plan 2023, now referred to as the Child Immunisations Team.
8In July 2023, the Health Protection Review was published that highlighted the need for additional
public health resource, making 30 recommendations for improvement including a strengthening of
the health protection workforce.
The 2023 budget (staff and non-staff) as at the end of September 2023 for public health is:
• £1.01m Strategic Public Health and JCM/BASS – including 21 staff.
• Food and Nutrition Strategy and Programmes- £480,000 – including 4 staff.
• Child Immunisations Team - £761,000 (Transferred from HCS) – including 5 staff.
• Health Promotion Team- £170,000- including 3.5 staff.
Risk and Impact of not increasing the functions of the Public Health Team.
Recommendations in the various reviews conducted between 2020-2022 were based on an
assessment of need in Jersey and were consistent with other parts of the British Isles and other
international jurisdictions, where it is recognised that preventing physical and mental ill health, rather
than treating it as it arises, is cost-effective, with high rates of return on investment.
A comprehensive population wide approach is now described in the 5-year public health strategy
which lists the public health priorities for Jersey. These priorities were developed following a year of
consultation, and they reflect: recommendations from external reviews, ministerial priorities and
public priorities; and build on stakeholders’ plans to achieve maximum impact. There are now high
expectations for public health delivery. The team avoid duplication by working closely with the UK,
Guernsey and other jurisdictions to reduce cost where appropriate.
The key risks of not investing in public health are:
• We would be very ill prepared for another pandemic; and have no clear plan for a health
response to any other type of emergency (nuclear, chemical, biological).
• Vaccination uptake would decline, and the management of infectious disease will become
disjointed, risking that preventable infectious such as flu and scarlet fever reach epidemic
levels.
• Our preventable disease levels such as diabetes would rise more dramatically than in other
jurisdictions.
• The financial demands from treating preventable disease would rise more sharply than in
other jurisdictions.
• We would find it difficult to retain the senior public health professionals required.
8 Public Health (2023) Health Protection Review
The consequences of not having sufficient investment prior to 2019, may have contributed to the fact
that Jersey has:
• Higher levels of alcohol consumption.
• Steeply rising levels of obesity.
• No clear comprehensive offer to prevent chronic diseases.
• That 20% of chronic diseases are categorised as preventable.
• Increasing health and care costs.
In summary, investment for public health in 2024 and beyond will establish an appropriate public
health function similar to that seen in the rest of the British Isles. In 2019, a major review
recommended that the public health function needed to be expanded to improve and protect Islanders’
health and act as a brake to stem the rising demand in health and social care services. Failure to
invest will leave the Island unprepared to deal with threats to the health of our population.
Figure 1: 2019 Structure Chart (See full chart online)
Figure 2: 2023 Structure Chart (See full chart online)
Table 1: Costs &Headcount
Strategic Public
Health 2019 2020 2021 2022 2023*as of Sept
Pay 570,000 405,000 635,000 1,192,000 1,390,000
Non-Pay 60,000 40,000 220,000 537,000 317,000
JCM and BASS funds 0 0 -93,000 -835,000 -688,000
Total Spend 630,000 445,000 762,000 894,000 1,019,000
Total Headcount 73 (4)*8 21 21
*4 of the 7 Public Health Staff from the 2019 establishment were seconded to deliver the covid
pandemic emergency response.
Food &Nutrition
Strategy 2019- Pilot 2020- Pilot 2021-Pilot 2022 2023*as of Sept
Pay 22,000 2,200 0 200,000 178,000
Non-Pay 160,000 40,000 54,000 600,000 302,000
Total Spend 182,000 42,200 54,000 800,000 480,000
Total Headcount 44
Child Health Team 2019- HCS 2020- HCS 2021-HCS 2022-HCS 2023*as of Sept-PH
Pay 185,000 175,000 126,000 227,000 134,000
Non-Pay 760,000 706,000 656,000 833,000 627,000
Total Spend 945,000 881,000 782,000 1,060,000 761,000
Total Headcount 53 44 5
Health Promotion 2019- HCS 2020- HCS 2021-HCS 2022-PH 2023*as of Sept-PH
Pay 0 0 0 176,000 163,000
Non-Pay 0 0 0 24,000 7,000
Total 00 0200,000 170,000
Total Headcount 00 03.5 3.5
