President’s Statement December 2018

Sir, the States gave its unanimous support to our Partnership of Purpose policy letter almost one year ago to the day and we have been making great progress.  This set out the future of heath and care services for the Bailiwick and as we reach its first anniversary, I wanted to take this opportunity to focus on what has been achieved and to look ahead to the next twelve months.

However, I should like to begin with the issue of orthopaedic waiting times. HSC has been very open about the ongoing issues experienced in orthopaedics and I should like to sincerely apologise to those who have been affected.  Earlier this year, as part of phase 1 of our plan, and as I advised in my last statement to the Assembly, a number of measures were taken to successfully bring waiting times for orthopaedic outpatient appointments to within an eight week waiting time. As expected, and also as previously advised, this has increased inpatient waiting times, but now we have outpatients under control we are commencing phase 2 of our plan.

It should be noted that orthopaedic waiting times have been a problem for many years, with 49% of patients waiting for their inpatient treatment outside the contractual waiting time of 8 weeks at the beginning of 2016 which had increased to 53% by March this year. Increased pressures have arisen since 2017 and changes to service provision have also become necessary as a consequence of Royal College reviews. In addition, an unprecedented number of emergency and trauma patients earlier in the year have led to a higher than normal number of postponements in elective surgery.  These pressures have been compounded by the limitations of the current hospital infrastructure.

Demand is increasing at such a pace that we are struggling to keep up with orthopaedic demand and the pressure on the surgeons, theatre teams and infrastructure requires immediate action. Referrals for orthopaedic inpatient surgery have increased 22% in the last year. In the week ending 25 November, 38 new patients were added to the inpatient waiting list whilst 24 patients were treated. 

Part of the demand is linked to an ageing population who naturally have increasingly complex medical issues often necessitating post-operative intensive care. In the past these patients would not have been considered for surgery. Obesity, is also a factor, which I will come to in a moment.

We intend to reduce the backlog through a number of measures which has already begun, including using off-island partners, increasing theatre utilisation and bed capacity.  As a result of taking the above action, we expect to see significant improvements in the New Year and we will update the community as progress is made.

It should be noted that HSC’s newly established Client Team has provided better health intelligence than we’ve ever had before enabling us to understand the situation better and come up with workable solutions. As I have said many times before, it is only possible to truly transform if you have the data on which to base your decisions and members will hear more about how we are making greater use of health intelligence as we develop the new model of care in just a moment.

AND the Committee continues to push ahead with many significant areas of transformation of our services that will improve our ways of working.  I just touched on the problems with the current hospital infrastructure. Over the last year we’ve been developing a Business Case for the modernisation of the site and a policy letter will come here early next year setting out a phased programme of improvement works.  This in turn will be an enabler for further transformation and will seek to ensure that acute services are part of an integrated system of care provided from a hospital that is safe, flexible and modern for the future. 

In addition, we are developing proposals for a Principal Community Hub at Les Ozouets that will bring together community services and make them more accessible and working closely with ESC to make sure that it fits in with their plans for the site.

The Committee is delighted that this year has seen the formation of the Health Improvement Commission to lead on certain health promotion activities in the Bailiwick, including the Healthy Weight Strategy and the Drug and Alcohol Strategy; important foundations for an effective health improvement strategy for the Islands. It’s importance is underlined when we look at orthopaedics. Obesity contributes to the increased requirement of complex joint replacements and research has shown that overweight and obese patients are at a greater than 40% and 100% increased risk of knee replacement surgery, respectively, compared to patients with normal weight ranges.

There has been much activity in public health with several new initiatives.  The introduction of free contraception for under 21’s has been incredibly successful in reducing unintended pregnancies in young women under the age of 18 years.  Early results are show a predicted reduction in under 18 conceptions of at least 75%, making our rates amongst the best in the UK and Europe.  

Also aligned with the aspirations of the Partnership of Purpose to ensure fair access to care, we will shortly be making cervical cancer screening free for all women.  Evidence of the financial barriers to accessing cervical screening were supported by data from the Orchard Centre, where 80% of women accessing this service for free through the Centre said that they could not afford the cost in primary care.  

The Committee is also progressing a review of the future structure and funding arrangements of primary care, incorporating the Emergency Department, to ensure that cost does not prevent people getting the treatment they need.  An important issue that was also picked up by the SMC during its review of in-work poverty.

HSC has also led on the first population needs assessment focusing on older people, which invited feedback from older people and over 200 stakeholder groups about what is important for older people in the Islands.  The Needs Assessment has highlighted how much valuable work already goes on in our community to support older Islanders but a number of urgent and needed projects have been prioritised, which will guide our future work.  

The strategic review of the terms and conditions of nurses, midwives and other health and care workers employed by the States of Guernsey has progressed well.  The review, which has considered a full range of issues such as the competitiveness of pay in relation to the cost of living on the island and any workplace cultural issues affecting recruitment and retention, has involved meeting directly with staff in focus groups to explore relevant issues.  The review, which will help us to look closely at the barriers to the recruitment and retention of staff, will report before the end of the year.

The Committee is also pushing ahead with drafting a new Capacity Law to ensure that there are safeguards and processes in place protect people who may not have the capacity to make their own decisions.  This remains the legislative priority for the Committee and many other areas of HSC’s work relies upon having this Law in place. However, we are concerned that progress is slow due to pressures on law officer time.

Other areas of activity include our vital work on developing proposals for appropriate, proportionate and robust regulatory standards across health and care to safeguard the well-being of Islanders, and a policy letter on this is due to be published imminently.  

Significant progress has been made this year on HSC’s digital transformation programme and we have been mapping out our approach to ensure that not only is it clinically led but also robustly defines our requirements for any future Electronic Health Record. In addition, work on the upgrade to our IT infrastructure through the deployment of a new Wi-Fi system and Local Area Network across our estate is progressing well. We’re now thoroughly testing applications and medical equipment in parallel with a re-wiring of the estate with some 19.5 miles of cable before rolling out the new solution during the course of 2019.  

A range of service improvements introduced in 2018 have also led to new key clinical initiatives with the benefit of early identification of problems and early treatment.

A Familial Hypercholesterolemia (FH) genetics testing pilot supports our focus on prevention and early intervention.  FH is a genetically inherited condition which can lead to exceptionally high cholesterol levels and early development of cardiac disease, unless mitigated by early diagnosis and medication & lifestyle interventions.  In addition, recent work to establish Heartflow as a non-invasive diagnostic tool in 3D heart imaging will help specialists achieve a more accurate treatment pathway for patients, as well as improving patient safety and comfort.

We continue to focus on the ‘Safer Everyday’ initiative launched in January, which emphasises patient care, the sharing of best practice across HSC and improving the governance of our clinical processes.  Most notably, there has been a 30% reduction in falls this year.  Wards have been equipped with adapted beds and new systems for recording medications that have been administered in relation to fall risks.  A ‘Thinking Differently, Working Differently’ conference held in November looked closely at patient safety and importantly how service users can become more closely involved in their care. 

Finally, the Committee believes that there is huge value in the rolling out of Mental Health First Aider training across the States of Guernsey and would like to explore this next year. As a start, we would like to work with MIND to organise sessions for States Members. We need to lead by example.

Sir, 2018 has been another busy year for HSC and, again, I have only scratched the surface in my update to the Assembly today.  Be assured that we won’t be resting on our laurels and we’ll be taking our relentless pursuit and focus on delivering the Partnership of Purpose into the next 12 months and beyond. 

Population Management

I wrote this speech during debate on changes to the new population management regime.

Sir, Deputy Ferbrache, whilst focusing on the hospitality industry and what sounded like his recommended alternative pub crawl, did say that the care sector has been affected by the new regime and indeed I have had representations from that sector about the impact of the current system.

I think it is fair to say the Care sector is under-represented on the Population Employment Advisory Panel. At present it falls under the public sector, represented by a public sector employee and it is my view that consideration needs to be given to there being a separate representative for health and care. The demand for care support is going to increase over the coming years and the importance of this sector is only going to grow.

Now This may well become easier to arrange under the proposed Partnership of Purpose, with the coming together of public, private and third sectors in health and care delivery, which can provide one voice for that sector and I would welcome discussions with Home Affairs in the future.

In terms of the propositions before us, I do support propositions 3 and 4, which goes a bit further than my amendment in the last term, without which, I should add the short term permits would’ve been even more inflexible than they are now. But the position back then was very different from that of the Committee for Home Affairs is now, which Deputy Mark Dorey has highlighted. I welcome the change as it considers the likelihood of the risk, which previously was one of zero-tolerance.

However, I do not think propositions 3 and 4 go far enough, particularly for the care sector, where continuity is crucial and the 9m on 3m off scenario is not relevant. I am therefore tempted to support propositions 5 and 6. 

However, I hear Deputy Leadbeater rightly speak about human rights issues and I am scratching my head over how someone on a short term permit can keep on coming back for as many years as they like whereas someone on a medium term permit has to go after 5.

I agree with Deputy Ferbrache that the NEW regime is past its sell by date. But the question is should we change it without understanding the consequences.

I am genuinely in 2 minds on propositions 5 and 6 but I think what will persuade me is to receive assurances that the review will be thorough and take into account the state of the economy right now as I really don’t think the issue will be resolved whether we approve propositions 5 and 6 or not.

Mobile: 07781 139385

Email: heidi@heidisoulsby.com