Covid-19 Legislation - Health
This Briefing Paper focuses on the strategies, policies and procedures brought in to address the evolving needs and demands within Jersey’s Health Service as the number of positive cases of Covid-19 increased through 2020 and 2021.
On 11th February 2020 the World Health Organisation ("WHO") officially named the 2019 Novel Coronavirus and the disease it causes. It became known as coronavirus disease ("Covid-19") and severe acute respiratory syndrome coronavirus 2 ("SARS-CoV-2").
The terminology is referred to in Article 1 of the Covid-19 (Enabling Provisions) (Jersey) Law 2020 where Covid-19 not only means SARS-CoV-2 but also "any disease that is directly or indirectly caused by that virus, including the disease known as Covid-19".
As the seriousness of Covid-19 became apparent, advice was issued to Islanders (on 30th January 2020) including how to help prevent the spread of Covid-19 and confirming that a cross-Government review group had been established to determine the response required.
An initial step was to establish Covid-19 as a notifiable disease; which was achieved by the Notifiable Disease (Amendment No.2) (Jersey) Order 2020 (which came into force on 7th March 2020). This added Covid-19 to the Schedule of Notifiable Diseases established under the Notifiable Diseases (Jersey) Order 1988. Both Orders were made under the Loi (1934) sur la Santé Publique ("the 1934 Law") which requires any doctor who has treated a person with a notifiable disease to inform the Medical Inspector, thereby ensuring that cases are recorded and centralised.
A pandemic was confirmed by WHO on 11th March 2020, defined as a disease that is spreading in multiple countries around the world at the same time. As the number of Covid-19 cases ebbed and flowed, the Island's response had to be adapted. Various pieces of legislation were introduced, amended, extended, suspended and repealed as discussed in a previous briefing paper Covid-19 Legislation in Jersey and it is not intended to revisit that legislation in depth here.
This Briefing Paper focuses on those strategies/policies/procedures brought in to address the evolving needs and demands within the Island's Health Service as the number of positive cases of Covid-19 increased.
From 20 March, anyone with symptoms was required to self-isolate and arrange a polymerase chain reaction ("PCR") test at one of the Government testing centres. As of November 2021, testing remains a requirement, though isolation regulations depend on vaccination status. As notification was mandatory for Covid-19, records of new cases were maintained providing an indication of the spread of cases in the Island.
In addition, testing was carried out on any new admissions to enclosed communities (e.g. the General Hospital and Care Homes) as well as regularly on workforces considered at higher risk of catching or transmitting the virus. The workforce testing programme was subsequently expanded to include more sectors which were categorised into A+, A, B and C with the regularity of testing reflecting the considered level of risk of each group (e.g. Group A+ tested every week or two weeks).
The testing programme was referenced in the Covid-19 Strategy (June 2020) as follows:
"Our Island wide testing programme has expanded significantly in recent weeks, with three new test centres and a mobile testing station now established. We continue to test all Islanders that are referred with COVID symptoms and have supported GPs to be able to test patients in surgery. To identify people that may be infectious but without symptoms, we screen hundreds of people each day, including essential workers, hospital patients and care home residents.
We have also completed two rounds of our community antibody survey, which later in June will provide us with further evidence of the prevalence of COVID-19 in Jersey. Our Essential Worker Antibody Survey will similarly afford extra insights into the prevalence across those groups that were working during the stay home period."
The testing programme has been adapted and enhanced throughout the pandemic to provide as much data as possible regarding the spread of the virus.
Community lateral flow antigen testing became available in July 2021. This test identifies individuals who have the virus but are not symptomatic, thereby providing further information on transmission. Such individuals then have to self-isolate for the mandatory period - which was initially 14 days but subsequently reduced to 10 days.
Private Testing Centres
In May 2020 a private testing centre was established resulting in concern over the lack of regulation of such enterprises. Subsequently a proposition was brought to the States requesting that a regulatory regime be introduced to govern the quality, supply and use of Covid-19 testing by private entities and requiring the Minister for Health and Social Services lodge the necessary legislation. The resultant Covid-19 (Control of Testing) (Jersey) Regulations 2020 ("the CoT Regulations") came into force on 15th July 2020 providing oversight and control of testing services by on-Island private providers. As stated in the report accompanying the draft CoT Regulations such businesses were to be licensed through the Control of Housing and Work (Jersey) Law 2012 and guidance as to what constituted as acceptable testing service would be provided by the Medical Officer of Health.
The CoT Regulations addressed an anomaly under the 1934 Law in that it did not make explicit provision for providers of testing or diagnostic services to notify the Medical Officer of Health of a person with a positive result for a notifiable disease. This was highlighted in an oral question in the States and CoT Regulation 13 provided that service providers had a duty to notify the Medical Officer of Health immediately of any test result indicating that a person is infected with Covid-19 or where there is reasonable reason to suspect that they are.
CoT Regulation 15 provided a consequential amendment to the Consumer Safety (Jersey) Law 2006 to ensure that Covid-19 testing kits were included in the meaning of "consumer goods".
Note: This briefing paper does not include information relating to the Safer Travel Policy and, therefore, testing at the borders.
A contact-tracing strategy was introduced in March 2020, intended to identify individuals who had been in recent contact with someone who had tested positive for Covid-19.
Contact-tracing plays a fundamental role in the control of notifiable diseases such as Covid-19. If an individual tests positive for Covid-19, their direct contacts are traced, tested for the virus and, if positive, required to self-isolate. Direct contacts who are asymptomatic are identified, thereby reducing their ability to further transmit the virus. The importance of providing details for contact-tracing at hospitality venues was considered sufficiently crucial to be made mandatory as the pandemic progressed.
Augmenting the Healthcare Workforce
Various measures were adopted with a view to ensuring as robust a workforce as possible during the pandemic. As the virus spread, it was accepted that there would be increased pressure on the workforce, with particular emphasis on frontline staff. Whilst this involved recruiting new staff, redeploying existing staff, using volunteers and limiting more routine work in preference to urgent work, the following measures aimed to increase workforce capacity.
Temporary return to the profession
In March 2020 the Government called on health workers who had retired or had been inactive in the previous three years to return to the profession temporarily to prevent the health service becoming overwhelmed during the pandemic. Health workers from many different disciplines were sought to assist in a variety of areas with their deployment dependent on their expertise and the on-going needs.
"We have a strong and dedicated team of health service workers who need your help. We want to prevent our health service becoming overwhelmed during this epidemic. I call on those of you who have relevant experiences in health care settings to please come forward and strengthen our fight against this virus. If we come together now, we can lessen its impact and help save lives." (The Minister for Health and Social Services)
Rapid Registration of Medical Practitioners
The Medical Practitioners (Registration) (General provisions) (Jersey) Order 2014 was amended by the Medical Practitioners (Registration) (General Provisions) (Covid-19 - Temporary Amendments) (Jersey) Order 2020 ("the 2020 Order") to allow for the rapid registration of medical practitioners, if required, in the light of the pandemic. The amendments enabled the Jersey Care Commission ("the Commission") to register doctors in Jersey if they had been registered under emergency provisions by the General Medical Council in the UK and further allowed the Commission to decide whether the particulars and documents ordinarily required for registration were still reasonably required under the circumstances. The circumstances being when the Commission had been advised that an emergency existed in Jersey due to the outbreak of Covid-19. The 2020 Order came into force on 26th March 2020 but was repealed on 30th September 2020.
Integrated Healthcare System with GPs
Unlike the UK, GPs in Jersey operate as independent businesses in the private sector. To assist with the global pandemic, Jersey's Government entered an agreement with the Island's GPs on 9th April 2020 to bring them into the public sector temporarily, resulting in 106 GPs being employed directly by Health and Community Services for a period of 4 months. Details of the agreement can be found at GPs agreement (FOI).
The Minister for Health and Social Services announced:
"This agreement gives Health and Community Services more capacity and more flexibility to adapt to changing needs and puts Jersey's healthcare system in a stronger position to tackle COVID-19."
Amendments to the Cremation (Jersey) Regulations 1961 ("the 1961 Regulations")
As previously indicated, it was envisaged that the pressure on medical practitioners would increase as the pandemic took hold. Ordinarily no cremation is permitted unless the application to cremate is accompanied by a certificate of medical attendant and a confirmatory medical certificate. The purpose behind the modification or suspension of certain of the 1961 Regulations was to reduce the burden on medical practitioners (on a temporary basis) regarding the authorisation of cremations. This was achieved by removal of one of the certificates and examinations required of the body prior to cremation in respect of Covid-19 deaths.
Augmenting Healthcare Provisions
The Covid-19 (Mental Health) (Jersey) Regulations 2020 temporarily amended the Mental Health (Jersey) Law 2016 and the Covid-19 (Capacity and Self-Determination) (Jersey) Regulations 2020 temporarily amended the Capacity and Self-Determination (Jersey) Law 2016. Both Regulations, however, could only come into force if the Minister for Health and Social Services made an Order declaring the existence of "an extraordinary period". The Order could only be made if the Minister was satisfied that the impact of the disruption caused by the Covid-19 outbreak in Jersey was sufficiently significant to merit amendments/modifications coming into effect (i.e. the disruption to the provision of aspects of the services). Given that no "extraordinary period" was declared, the Regulations were never used and were repealed on 30th September 2020.
Expansion of Healthcare Facilities
In a similar way to augmenting the workforce, various measures were put in place to enhance the existing healthcare facilities.
Provision for Emergency Development
The Planning and Building (General Development) (Jersey) Order 2011 was amended by the Planning and Building (General Development) (Amendment No. 5 - Covid-19) (Jersey) Order 2020 (10th April 2020) to allow for emergency development by the Government of Jersey where, for example, a change of use of land which might be reasonably required to deal with the Covid-19 outbreak in Jersey or the aftermath of that outbreak. Such developments included provision to establish both a temporary hospital and a temporary morgue.
On the 8th April 2020 the decision was taken to build a temporary "Nightingale" field hospital. The purpose behind the build was to provide additional facilities to cope should there be extra demand for individuals requiring hospitalisation. The temporary hospital, built at Millbrook Playing Fields and referred to as the Nightingale Wing of the General Hospital, provided a 180-bed in-patient emergency facility. The Nightingale Wing was opened by the Earl of Wessex, Prince Edward, on 11th May 2020 via video link in a virtual ceremony. The original lease was extended until March 2021 when it was agreed that the Nightingale Wing be decommissioned and dismantled.
It was considered necessary to establish a temporary mortuary (known as "The Sanctum") which was blessed by the Island's faith leaders on 17th April 2020. The Sanctum was available as an alternative facility should the number of deaths from Covid-19 exceed the capacity of the existing mortuary services.
Provision of a Coronavirus Helpline
The Coronavirus Helpline ("the Helpline") was launched by Health and Community Services in February 2020. The Helpline was initially open seven days a week between 8am and 11pm providing advice to individuals who has symptoms, wanted isolation advice or had any queries about the virus. As the testing programme expanded, the Helpline was used to book PCR workforce testing. Similarly, vaccination bookings were made through the Helpline as the vaccination programme was rolled out. By May 2021 the Helpline hours had reduced as the number of calls had fallen.
"During phase 1 of the vaccination programme, the helpline has been imperative for booking vaccination appointments for islanders who didn't have access to the internet. With phase 1 is nearing completion and most older islanders having now received both vaccination doses, as well as limited to no community spread within recent weeks, the demand for longer opening hours isn't as great". Deputy Richard Renouf, Jersey's Health Minister
The Vaccination Programme
Use of vaccines in Jersey
Coronavirus vaccines were rapidly developed and approved for use in the UK - being given a "United Kingdom temporary Covid-19 authorisation". On 5th December 2020 the Emergency Powers and Planning (Medicines and Vaccines - Covid-19 and Influenza) (Jersey) Order 2020 ("the Vaccine Order") came into force clarifying the position under the Medicines (Jersey) Law 1995 to allow both the use of these vaccines in Jersey and the development of a vaccination plan. The Vaccine Order expired after 3 months and subsequent Orders were made which extended the timeframe until 4th September 2021.
Vaccinating Healthcare Workers
In advance of the vaccination roll out a Peer to peer vaccination programme was launched where healthcare workers were asked to act as volunteer vaccinators to their colleagues in key roles e.g., frontline staff as soon as the vaccine became available.
The Vaccination Centre
Fort Regent was converted into a mass vaccination centre by Reservists from the Jersey Field Squadron supported by Fort Regent staff in December 2020. A mobile unit was also available for home visits if attendance at the Fort was problematical. Changes to the vaccination programme have been made over time to encourage take up of the vaccine (e.g. "walk in" appointments at the Fort and "Rock up" clinics at different places on the Island).
Prior to the Covid-19 Pfizer vaccine arriving in Jersey on 8th December 2020, healthcare professionals (who were registered, practiced or retired from health work) were urged to apply for vaccination programme roles. The Minister for Health and Social Services called for recruits:
"We are urging current or retired healthcare professionals to come forward and help deliver the crucial Covid-19 vaccination programme.
'This programme will not divert resources from the General Hospital as we have widened our net to seek out those in health and care work who do not have other commitments elsewhere.
'Our medical professionals have worked tirelessly since the first Covid-19 case was found in Jersey and I understand that this vaccination programme will ask more of them. I hope that, like me, they will understand how vital this programme is to our Covid-19 response and come forward to be part of this historical moment in healthcare."
Volunteers also joined the vaccination team as part of the support team.
The Health and Social Security Scrutiny Panel ("the Panel") is undertaking a piece of work on the Government's response to the Covid-19 outbreak, in particular focussing on the responses of the Minister for Health and Social Services with a review launched on 30th March 2020. The Panel will also review any propositions brought forward and publish its comments.