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Domiciliary Care services under intense pressure

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Monday 07 November 2022

Domiciliary care services at HSC are under intense pressure due to a combination of increased demand for, and increased complexity of, community care due to the aging population and number of people living with long term conditions alongside recruitment and retention issues.

This is in line with the issues facing the Department of Health & Social Care in England and the devolved Governments.

Immediate action has been taken by HSC to manage the current pressure on Adult Community Care Services.

To manage this pressure, a Multi-Disciplinary Team (MDT) review has been carried out to assess the demand for community care services and to change the delivery model for a period to ensure resources are deployed effectively.

For some service users in our community (55 individuals), this will mean that they will see a reduction in the care package that they receive each week, or in 7 cases, their care packages will be withdrawn.

Withdrawing care, whilst difficult, will not put individuals at risk. We are having to target our resources where they are most needed, but we will keep the situation under review as the demand and complexity changes whilst we navigate this difficult period.

Deputy Al Brouard, President of the Committee for Health & Social Care said:

'It is with regret that we have had to change our delivery model for domiciliary care. Whilst this is an operational decision that has political support, it is not a decision that has been taken lightly and is one that has been taken after all other options have been exhausted.'

Karen Leach, Associate Director, Adult Community Care Services said:

'Our Community Care services have never been busier or more in demand. This is because of the continuing need to provide care to people who wish to live at home and the increasing complexity and frailty of many of the people we care for.

Our teams of staff have had to make the very difficult decision to reduce or withdraw service users' packages of care. The MDT has determined care packages using evidence informed decision making but withdrawing or reducing services is not what we want to be doing when we come to work every day. We are dedicated caring and compassionate workers who want to provide the best service that we can.'

The decision to review all care packages will give certainty for service users which is preferable to contacting service users daily and/or weekly to change the services that staff can deliver at short notice.

Dermot Mullin, Director of Operations said:

'The pressure on community care services, and the health and social care system as a whole is the worst I have ever experienced. Whilst cancelling or reducing services is a difficult decision to make, it's the right one whilst we are experiencing high demand coupled with global recruitment challenges.

We are living through unprecedented times and none of us who came into health and social care would ever have expected to be making decisions on these issues. Community care services are just one part of the whole system experiencing service delivery challenges. The Corporate Management Team regularly discuss pressures in Children and Family services, community services, mental health, adult disability the acute hospital and of course our services in Alderney at the MMH.

Care is at the heart of what we do, and we regret that individuals will potentially experience disruption to their care pathway because of the staffing challenges in all parts of the system. Last winter was difficult but we managed to get through it but this winter could be set to be even more difficult primarily due to the reducing numbers of health and social care practitioners and support workers available to attract or recruit.'

Karen Leach said:

'Our teams deliver on average 34,842 episodes of care each month - over 24 hours a day 7 days a week.

We have a waiting list for around 200 hours of care and, prior to this change in delivery model, around 70 domiciliary care visits were being withdrawn each week due to staffing levels.

Our team are aware of the important role they have in people's lives. This will be worrying to read but we felt it important to make people aware of the facts and the difficult position facing our services due to many factors beyond our immediate control. We will continue to do all we can to provide care for those in most need.'

Within this some rounds are provided by 1 carer, and some require 2 carers depending on complexity of care required.

Internationally, the personal cost of working in health and social care through the pandemic, changes related to Brexit, the rising cost of living including accommodation & travel costs have affected the availability and decisions of health and care staff when choosing to either stay in this sector in Guernsey or move to the islands for work.

The lack of community care resources and staff shortages is also having an unprecedented impact at the PEH hospital. This unfortunately means that patients who are deemed medically fit and ready to be discharged often have to stay in hospital longer than they need to. The PEH is an acute environment and not the best environment for these patients. It can also have a knock-on effect resulting in the postponement of elective surgery when beds are unavailable.

We know that discharge from the care of the hospital is sometimes daunting but for those patients who are considered fit and are discharged home, we would like to remind them that they can seek support from the GP or from the Emergency Department for any concerns that their GP cannot manage.

Care workers are on the UK Home Office shortage occupation list: Skilled Worker visa: shortage occupations for healthcare and education - GOV.UK (

HSC is actively recruiting for staff in all areas, but particularly in Adult Community Care Services. Anyone interested should contact Lynda Potter or look here: Careers with the States of Guernsey - States of Guernsey ( or Working for Health and Social Care | Facebook

Finally, HSC would like to reassure service users and their families that these decisions are evidence based and service users will not be harmed by these decisions. However, if anyone has concerns about the care they, or a family member, receives then please do contact the Customer Care Team on 01481 220000 to discuss this in the first instance.

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