JERSEY appears to have an “over-investigated” population due to an “exorbitant” number of adults having diagnostic tests, a board which provides independent oversight of health services has said.
The Health and Care Jersey Advisory Board – which sat this week for its second quarterly meeting of the year – charged the Health Department will providing more detail on why so much time and money appeared to being spent on testing at the secondary and tertiary level.
One of its non-executive directors, Baroness Dame Clare Gerada DBE, said that there seemed to be a lack of coordination between primary and community care.
Drawing on data provided by the Health Department, the former president of the Royal College of General Practitioners questioned why, for example, there was so much testing for irritable bowel syndrome at the Hospital.
“IBS should not be appearing at all in secondary care,” she said.
Baroness Gerada was responding to a report submitted to the Advisory Board which found that rising demand for outpatient and diagnostic services now exceeded hospital-based capacity and so required a redesign of the ‘pathways’ that patients took.
Advisory Board chair Carolyn Downs added that the “exorbitant” number of people having diagnostics was also driving up waiting lists.
“The percentage of the population waiting over a year for an appointment is extraordinary for an island of this size,” she said.
Speaking to the JEP, Baroness Gerada said: “I have been coming to Jersey for five years now and I love it here, and on the whole, people are healthy.
“Of course, there are those who are unhealthy but you don’t see a lot of street drinking or serious illness wandering around in the street. We also know from other metrics that people in Jersey are healthy, yet the number of people being referred for investigations is enormous.
“I simply cannot marry that disparity. Why is there such a high number of patients having investigations, which has a knock-on impact because it is not good to have an investigation if you do not need it.
“It means that costs are escalating and people who need investigations are waiting more than 52 weeks to see someone.”
She added: “We need to start examining properly, using data, whether it is the same patients having lots and lots of tests, whether people are being over investigated, or whether there are different pathways that can be used.
“Also, if a patient waits a long time to see somebody, your natural inclination as a practitioner – because you feel so bad about it – is to do something, even if it doesn’t need to be done.
“We need to be getting some proper data, even going into the street and carrying out surveys to find out how many people are currently under the care of the Hospital.
“We do not currently know because the hospital IT system doesn’t record every single diagnosis. I suspect we are over-diagnosing, but I don’t think that’s the problem: I think the problem is over investigating.”
Baroness Gerada said that she did not know if it was down to the Island’s particular relationship between primary and secondary healthcare but pointed out that, in Jersey, only hospital doctors could send patients for an MRI and the Island lacked holistic care pathways.
She said: “For example, why does gastritis end up in an endoscopy? What’s going on? I am not blaming anybody, but we need to have a look at the whole system, right from what happens in the GP consulting room to what is happening with specialists at the Hospital.
“And the reason we need to is because the people of Jersey are spending a lot of money on things that they do not need to.”
