Work with private providers, charities and communities to deliver better care, closer to home, for longer.
Jersey does not have a shortage of goodwill in its care system.
Across the island, GPs, hospital teams, care providers, and charities are working hard – often under sustained pressure – to meet rising demand.
And yet, despite that effort, the system feels increasingly strained.
Waiting times persist.
Delayed discharges remain a feature of hospital life.
Families struggle to access timely support.
This is not a failure of commitment.
It is a failure of system design.
The Problem
Three structural issues are now clear:
• Demand is rising faster than capacity, driven by an ageing population and more complex needs
• Care capacity exists, but is fragmented, across public, private, and voluntary providers
• Incentives are misaligned, meaning organisations behave rationally – but the system as a whole does not
The result is familiar:
• hospital beds occupied by patients who could be cared for elsewhere
• pressure building across the system
• costs rising without corresponding improvements in flow or outcomes
In a small island, these inefficiencies are not hidden.
They are visible every day.
A Clear Direction
If we continue to treat care capacity as something the public sector must deliver alone, we will continue to fall short.
The reality is this:
Jersey already has a mixed economy of care. The question is whether we design it properly – and invest in it strategically.
But there is a second, equally important shift:
The future of care cannot be built primarily around institutions. It must be built around people’s homes – supported by technology, families, and community networks.
Residential and nursing care will always be essential.
But if they become the default, the system will become both unaffordable and less aligned with how people want to live.
Three Practical Mechanisms
1. Commissioning for Outcomes, Not Organisations
We need to shift from funding organisations to commissioning joined-up outcomes across the system.
This means:
• defining clear pathways (e.g. hospital → community → home)
• commissioning services across those pathways
• holding providers collectively accountable for results
For example:
• reducing delayed discharges
• improving patient flow
• supporting people to remain independent at home
If each part of the system is funded separately, fragmentation will persist.
If outcomes are shared, behaviour begins to align.
2. Invest Strategically – But Rebalance Toward Home-Based, Technology-Enabled Care
Jersey will need to increase residential and nursing care capacity – and government may need to invest, including on a commercial basis, to enable that.
But that cannot be the dominant model.
Home-based care – when properly supported – is both more aligned with people’s preferences and better value for money.
The challenge is that it is more complex to organise.
It requires:
• reliable domiciliary care services
• support for informal carers and families
• strong coordination across services
And increasingly, it requires technology.
This includes:
• wearable devices that monitor health and detect early deterioration
• remote monitoring that allows clinicians to oversee patients at home
• digital tools that support communication between families, carers, and professionals
Used well, this does not replace care. It amplifies it.
It allows:
• earlier intervention
• greater independence
• and more confidence for families supporting care at home
But technology only works if people are supported to use it.
Empowered Islanders – supported by families, communities, and professionals – are central to a sustainable care system.
And as before:
Capacity without workforce is not capacity.
Training, education, and workforce development remain essential to making this model viable at scale.
3. Align Incentives Across the System (through Partnership Leadership)
At present, organisations often face conflicting pressures:
• hospitals under pressure to discharge
• community services under pressure to absorb demand
• providers managing financial and workforce constraints
The system works as designed – but not as intended.
This is where the Health and Social Care Jersey Partnership Board becomes critical.
It provides a structure through which:
• system-wide priorities can be agreed
• incentives can be aligned
• and partners can move from discussion to delivery
If used effectively, it can drive:
• expansion of home-based, technology-enabled care
• better use of institutional capacity
• and a more coherent system overall
If not, fragmentation will persist.
But read my cautionary note about the Partnership Board https://bernardplace2026.com/partnership-in-health-right-direction-hard-realities/
Further Measures
Alongside these core changes, we should also:
• Strengthen the role of GPs as system partners, particularly in managing care at home
• Improve data sharing and visibility across care settings
• Support innovation in home-based and intermediate care models
• Work more closely with the third sector, which often supports people earlier and more flexibly
• Ensure long-term planning reflects both demographic change and the shift toward home-based care
Over time, this approach supports:
• a stronger local care economy
• reduced reliance on institutional provision
• and a more resilient system overall
Closing
Jersey does not need to build an entirely new care system.
But it does need to change its centre of gravity.
From hospital to community.
From institution to home.
From professional-only care to shared, supported care.
From analogue to digital
If we get this right:
• care becomes more personal
• the system becomes more efficient
• and Islanders are more empowered in their own lives
If we do not, we will continue to spend more – without solving the problem.
This is the kind of practical reform I will argue for – building a care system that works with people, not just around them.
And I would genuinely welcome your view:
What would make it easier for people to receive care at home in Jersey?
Contact me on bernardplace2026.com or bernardplace2026@gmail.com
