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Statements regarding the Ethical Framework

16 April 2020


Good afternoon.

Over the past few weeks, Government has put a number of measures in place to prepare our Island for COVID-19 and the expected increase in cases. More than one hundred GPs have begun direct employment with Health and Community Services.

This has increased our Health Service’s capacity and resilience, placing us in a stronger position to manage the pandemic. Substantial investments in PPE have also been made since the central Coordination Group was developed.

This Group monitors supplies and distribution for all who require PPE across the Island, ensuring all frontline workers who need it, have it. A delivery of 10,000 antibody testing kits arrived this week to detect immunity to the virus. These tests will be used as part of our plan for an Island-wide testing programme and to inform Public Health policy.

The Jersey Nightingale Hospital will create an additional 180 beds for coronavirus patients who will be provided with acute, enhanced and ongoing levels of medical care, including oxygen provision.

Finally, the Urgent Treatment Centre, which was opened on Tuesday of this week, is being used to manage and treat minor injuries and illnesses. These measures, alongside preparations the Government is making within Health and Community Services, are supporting our medical staff and will help save more lives.

The Government has committed an approach that learns from other countries further ahead in their pandemic curves. However, we are having to put preparations in place should Jersey’s health service ever be unable to meet the demand arising from a spike in cases from COVID-19.

Today, The Minister for Health, Deputy Richard Renouf, and the Medical Director for Health and Community Services, Patrick Armstrong, and I, will tell you about how critical care in Jersey may be impacted as the COVID-19 pandemic progresses.

This is not easy for us to say, and it won’t be easy for you to hear.

Critical care is the medical treatment that is given to critically-ill patients who have, are at risk of, or are recovering from, conditions that may be life-threatening. Currently, we continue to offer the same level of critical care that you would expect, to all patients in our critical care units. And we are planning to continue to offer that same level of care for the foreseeable future. 

As an Island with a single hospital there are, however, limitations to our critical care and acute medical care facilities. These could potentially struggle if the rate of infection dramatically increases too quickly. Under a worst case scenario, there may be limitations to the treatment we can provide and our healthcare professionals would be presented with difficult clinical decisions about who gets critical care and who does not.

Whilst we are taking every step to try to ensure that this scenario does not arise, we also recognise that we do need to support our health care professionals in making these decisions. Therefore, the Government has been asked to support an ethical framework with the guiding principle being that patients who are most likely to benefit from critical care interventions do so.

The Health Minister, Medical Director for Health and Community Services, and I, want to outline what might happen and how it could impact patients, Islanders and healthcare professionals should this scenario occur.

The changes we may see would be particularly challenging for our frontline health and care staff, for patients in need of critical care, and for their relatives.

I would now like to hand over to the Minister for Health and Social Services, Deputy Richard Renouf.


Thank you, Chief Minister.
Jersey has excellent healthcare but as the Chief Minister described, we are an Island with a single hospital and limitations to our critical care facilities.

As part of our preparations to keep Islanders safe we have put in place contingency plans so that, if we are under pressure, we can provide, to the greatest extent possible, the healthcare we would want to give.  Part of this planning is the 180 additional beds in the temporary Nightingale Hospital that will help us cope better if our situation worsens.

We recognised that we would need to staff these additional beds so we put out a call out to healthcare professionals who have stepped away from the profession for various reasons and asked them if they would be willing to come back and help. We have been humbled by the response and the generous spirit of those who have stepped forward – thank you.  We have also had offers of help from different professions across the Island, - dentists, pharmacists and other care givers, thank you all.

And I cannot continue without mentioning all the GPs on the Island, who, recognising the difficult days ahead and the difficult clinical decisions to be made, have come together to work alongside us in Health and Community Services. They are already making a huge difference to the care we are able to deliver to Islanders.

However despite all of these plans, as your Minister for Health, I must be frank with you and give a difficult message, which I would not want to have to give to you.

If the situation arises, and not every one of our patients can be treated in critical care, then clinical decisions will have to be made about who would benefit the most from receiving critical care.

This doesn’t mean that our patients would not receive appropriate care or not have their care needs met. But, in that situation, we would have to ensure that every patient’s needs are considered on a fair and equal basis so that we can do the most, for the most. This is why we have prepared an ethical framework for application in those difficult situations.

To be clear no-one wants to reach that point, and it’s not certain that we will, and of course we hope we never will. But it is right that we prepare. We owe that to our staff, to our patients, to our family, and our friends.

Our Medical Director, Mr Patrick Armstrong, will now talk through the ethical framework in more detail and explain how clinicians will apply it if the circumstances require.


Thank you, Minister.

As the Chief Minister has outlined, we have introduced a significant number of changes to put us in the best possible position to manage COVID-19 in Jersey. We have more than tripled our critical care capacity.

In the UK, there are approximately 10 critical care beds to every 100,000 people.
In Jersey, we have almost 2 and a half times that capacity. The new joined-up approach between Health and Community Service’s and Jersey’s GPs also means that patients continue to be treated in the community, as well as in the new Urgent Treatment Centre.
GPs can provide more support to care homes and they are now starting to work in ambulances.

We have totally reorganised the way the hospital is set up to prepare us for any increase in the number of patients admitted. All this means that we can support people with the virus much earlier and hopefully with that earlier intervention we can reduce the number of people ending up needing critical care.

While we have no treatment for the actual virus, we can support patients during the course of the illness by providing oxygen therapy, intravenous fluids, nutritional support, other vital organ support – for example, for the heart and the kidneys – as well as antibiotics in the event that secondary pneumonia is developed.

By supporting people in this way, we can reduce the need for critical care.

Public Health has introduced all the measures we have seen over the past few weeks –social distancing, self-isolation and Stay at Home, to flatten the curve in order to prevent too many people from being infected at the same time.

This is so that our Health Service can cope with the number of patients admitted to hospital and treat them more effectively.

While information from Public Health colleagues about the curve having flattened in Jersey is encouraging, we have to accept that there is a risk that demand could increase and could exceed capacity.

If that happens it would be cruel and unfair to leave individual clinicians to make ad-hoc rationing choices during a period of surge without support, protection and good guidance.
Therefore, as clinical professionals, we have asked Government to support an ethical framework to guide decision-making should we reach that awful position.
This is good governance and part of good planning.

There are, I believe, two main reasons for the ethical framework. Firstly, it provides you, Jersey’s residents, with the assurance that if demand exceeds capacity, we have put in place a framework which will dictate how resources are used and that the decisions taken are fair, equitable, ethical and legal.

Secondly, the ethical framework provides reassurance that individuals will not be left to make difficult decisions about who gets what treatment in isolation.

Instead, decisions will be made by a group of clinicians, supported by other clinical and non-clinical peers who are there to support and provide oversight to the frontline staff.
It should ensure that as a government, employer and community, we will stand by those who potentially need to be making very difficult decisions before, during and after the event.

As things stand at the moment, everyday our critical care colleagues take decisions on who may benefit from critical care treatment or not.

This process will continue and the same standards of care will continue until such time that demand exceeds capacity, should it happen at all. However, in the exceptional demand situation, decision-making is made against a higher threshold of ability to benefit.

The higher threshold of care will be decided by the critical care team as they are the only ones who can describe that threshold. But that decision will be overseen by a separate central triage committee who will make sure any change in threshold is in line with the ethical standards described in the framework.

This same group will also oversee any appeals made in relation to individual patient decisions, again to make sure that individual patient decisions are in line with the principles of the framework.

I want to be clear that the framework recognises that every human life, regardless of age, sex, race, ethnicity, religion, political affiliation, social or economic status, or disability – either physical or mental – is considered equal.

Decisions to provide a treatment such as ventilation will be based on how likely an individual patient is to benefit from that critical intervention and return to their former or near to their former quality of life.

I also want to be clear that just because it is not possible to provide a particular type of treatment, due to a lack of availability, that does not mean no treatment at all.

We will continue to provide whatever care we can as is appropriate and available.

The aim would be to do the most for the most.

Few other health systems have published a framework for decision-making on the utilisation of critical care in the face of COVID-19, in the transparent way we are trying to do in Jersey but we believe it is the right thing to do.

Finally I would like to thank my colleagues for all that they are doing, in going the extra mile to care for the health of our Islanders I know how hard you have all been working to prepare for this challenge.

I will now hand back to the Chief Minister.


Thank you, Patrick.

 I know that what you have heard today will be distressing. Yu will understandably be concerned for your own health, and for your families and friends, as I am for mine.

I promise you that we will do all that we can to save as many lives as possible under whatever circumstances we may face.

Thank you.

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