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Guernsey is a self-governing dependency of the Crown (a ‘Crown Dependency’). It is an autonomous jurisdiction with its own parliament, government and judiciary and forms part of the southernmost British Isles archipelago —the Channel Islands.

The Bailiwick of Guernsey includes three island groups each with their own elected legislative assemblies: Guernsey (with Herm and Jethou); Alderney and Sark (with Brecqhou). Guernsey is the largest with an area of 63.4 km2.

The Bailiwick is not part of the NHS. Healthcare in Guernsey and Alderney operates on a mixed-model where primary care is provided by general practitioners in private practice with consultation fees that are paid by the patient or via private insurance. Secondary care, by contrast, is funded through social insurance and general taxation with Guernsey also providing secondary healthcare for Alderney residents. Sark is independent in its healthcare arrangements.

The role of the Director of Public Health/Medical Officer of Health is a broad one and involves statutory roles, for example in relation to public health law, as well as strategic and operational responsibilities covering the breadth of Public Health functions.

The Public Health Vision is for all Islanders to be supported to be as healthy as they can be as we move towards managing Covid-19 as an endemic disease in the Bailiwick. This includes a consideration of the wider determinants of health.

The Public Health mission is to work effectively to protect, promote and improve the health and wellbeing of all Islanders focusing on Covid-19 recovery and working to reduce inequalities.

The Public Health Department sits under the mandate of the Bailiwick of Guernsey’s Health and Social Care Committee, but the Director of Public Health/Medical Officer of Health reports to the Chief Strategy and Policy Officer for the States of Guernsey giving a direct in-reach into central government.

The Public Health Team is managed centrally by the Director of Public Health/Medical Officer and a small senior management team. There are 80 members of staff spread over seven teams and five sites.

The Public Health workforce manages operational, strategic, and advisory functions across the full range of areas including:

• Health protection, including infectious disease control (including managing the COVID 19 pandemic response), population screening, vaccination and chemical and radiation hazards
• Health improvement, including working with the local charity the Health Improvement Commission to promote healthier lifestyles
• Healthcare public health, including conducting health needs assessments and service reviews - recent examples include reviews of rheumatology and renal services for Guernsey and Alderney residents

The Public Health team has responsibility for the development and implementation of a number of strategies, including the Combined Substance Use Strategy — drugs, alcohol and tobacco (in conjunction with Third Sector partners); the Healthy Weight Strategy and the Mental Health and Wellbeing Strategy. Linked to this are a suite of JSNAs and Health Needs Assessment that are conducted by the Public Health Team to inform services. The team also work across government investigating how ‘Health in All Policies’ can be best achieved in our geographically remote location where the population is small and resources are limited.

Operational services include:

• Healthy Minds: a Primary Care Mental Health & Wellbeing Service that offers brief therapeutic interventions for mild-moderate anxiety and depression
• The States Analytical Laboratory: which undertakes chemical, microbiological and crop biological testing
• The Orchard Centre: a free open access sexual health clinic, which also provides specialist HIV services and treatment programmes for viral hepatitis
• Quitline: a free stop smoking service
• Health Visiting and School Nursing services: a universal service offered to all families with children, delivering the 0–18 Healthy Child Programme to improve the health and wellbeing of children and young people
• Controlled Drugs Licencing: creating import licences for medicinal cannabis and other controlled drugs

All of these are supported by a Health Intelligence Team which collates and analyses local data to inform and underpin public health and States of Guernsey projects and strategies.

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