President’s statement June 2018

Sir, I made my last statement at the same meeting we debated our Partnership of Purpose policy letter and since then work has happened at pace. I covered much of this during the P&R debate, so I won’t focus specifically on those transformational workstreams today, other than to say we are making great progress on the priorities set out for this year and expect to finalise many in the next few months.

Now, today I have chosen to concentrate on just a few areas that will be of public interest. They demonstrate in various ways positive change and an exciting insight into the future that we are making a reality now.

First off, the Committee was delighted to see Mr Keith Robins recently awarded an MBE in the Queen’s Birthday Honours for his services to vulnerable children. Keith has worked for us as a social work assistant for 30 years and together with his wife Karen has been a registered foster carer for 33 years. In this time, they have provided a welcoming, stable home coupled with unconditional love, nurture and care to over 100 foster placements. 

Now whilst the vast majority of people are seen within contract waiting times, HSC has been very open about the recent problems experienced in parts of radiology and orthopaedics. And I should like to take the opportunity to apologise to those who have been affected.

Delays in routine MRI and Ultrasound, which currently have 9-10 week waiting times, have been the result of unprecedented and unplanned long term sickness of specialist radiologists, difficulty in obtaining the necessary skilled specialist locum cover and demand increasing 20% in the last 2 years. 

I should like to make it clear here and now that delays are not due to cuts. The Committee has invested in a series of locums to manage demand and set up a system for off-island review of particular scans. However, whilst things have stabilised, it has been difficult for the small team of staff to eat into the backlog. We are therefore now investing a further £60,000 in order to address this and bring the wait back on target. In addition we have extended the types of scans that can be sent off island for reporting, which will allow extra capacity to speed up results. While this investment will place additional strain on HSC’s budget for 2018, with radiology already £250k over budget, it will make a real and tangible difference to Islanders and the services that they receive.

Delays have primarily arisen in orthopaedics due to a combination of difficulty in recruitment of the necessary specialists, Critical Care Unit capacity and demand increasing by 35% in the last 5 years. 

In addition to now having the full and increased complement of 4 surgeons, we have worked with the MSG to put in place an action plan that should see outpatients back within contract waiting times by September and we will then focus on inpatients. In addition, we have recently received approval for a muscular skeletal extended scope practitioner which will reduce unnecessary referrals to secondary care.

The problems experienced by radiology and orthopaedics are symptomatic of the real and growing demands on our services as well as the problem over the lack of resilience that having a relatively small and isolated service gives us. 

And we are not alone. Whilst Jersey is a bigger island it too in health and care terms is small and like us has a lack of resilience in terms of being able to call on a neighbouring authority when needed. It is against that background that at a meeting of the Guernsey-Jersey Political Oversight Board on Monday it was agreed to introduce a shadow Channel Islands Health Authority to promote joint working and to support the improvements to the provision of health and care services in both communities.

Recent months had already seen renewed vigour in joint working with Jersey with consideration of a pan Channel Islands’ Children’s Commissioner, pan-island Safeguarding Partnership Board, incorporating both adult and children safeguarding and pan-island Health and Care Regulation. However, it became apparent during our discussion that we needed to be more ambitious than that, if we were to really be able to leverage the benefits of joint working. Further details on the shadow Channel Islands Health Authority will be provided in the next few weeks.

Working together should not only result in better value for money but enhanced services.

Looking at the here and now, this year’s budget included funds set aside from efficiency savings made last year for reinvestment in transformational services. Whilst this has happened in a number of areas, it has not been to the extent we would have liked due to the increasing strain on the acute services budget. In particular, we have budgeted over £500,000 for a comprehensive re-ablement project in community services. This will support people coming out of hospital to recover faster, reduce delayed discharges and also reduce the pressure on people being admitted in the first place. This is a keystone to the transformation of community care and we can’t put it off, so are now going to make a bid to the T&T Fund to enable it to begin.

However, this is only part of the picture. Members will be well aware of the commitment by the UK government to put in an extra £20 billion per annum for the NHS alone, a 3.4% per annum increase over 5 years. Whilst of course this was a political statement on the back of the NHS’s 70th anniversary, personally I think this was the wrong approach. You really can’t decide what health care needs without considering social care. As was pointed out when the announcement was made, it is like filling a bath with the plug pulled out.

We are in a better place than the UK, but we can’t hold back the tide of rising demand over the coming years. I am saying this as President of a Committee which has to date proven it can make efficiencies without making cuts and is turning around the tanker. And we are not the only ones saying this. KPMG did last year and more recently, the Royal College of Physicians in their review of general medicine. We reluctantly accepted our current budget to help out Education, Sport & Culture but we can’t do that any longer. We need a budget that enables us to continually transform. To do otherwise is to cut off our nose to spite our face.

Now, last week I announced that the Committee would be bringing forward the review of the drug and alcohol strategy, which will include a joint strategic needs assessment, review of medicinal cannabis and, more fundamentally a review into the interaction of the health and justice systems.

Interest in cannabis seems to have reached, shall I say, something of a high recently, with considerable interest from various parties in growing it for commercial purposes.  Although no formal licence application has been made, we have been working with the Committee for Economic Development in providing a joined up response to those who have approached us and we will do what we can to support innovation where it benefits the Bailiwick.

And it is on innovation that I would like to finish.

There is an increasing emphasis across medicine on using genomic information to inform clinical care and, in turn, improve health outcomes. By understanding the genetic makeup of patients and diseases, it is possible to provide personalised medicine, guiding tailored treatment strategies which best meet the needs of patients. This approach has the potential to be a real game changer and in line with the spirit of transformation, shift the model of care from reactive to proactive as well as developing highly effective diagnosis and treatment using the latest science. 

Familial hypercholesterolaemia, or FH, is an inherited condition which leads to exceptionally high cholesterol levels. If left untreated it can lead to early heart disease and reduce life expectancy by 15 to 30 years. FH is the most common genetic disorder of the heart and it is estimated that there might be between 130 – 250 individuals affected in Guernsey. 

However, with early diagnosis and effective treatment people with FH can have a normal life expectancy. The key is early identification, ideally in childhood, so that appropriate measures can be put in place to prevent the development of cardiac disease. But currently diagnosis is typically made in adulthood often after a heart attack, say, that prompts the checking of cholesterol levels. And this is too late. 

Now however, through screening, it will be possible to detect the condition and start treatment far sooner. 

States-funded genetic testing will be offered to confirm index cases from which bsequent family members can be tested and identified at an early stage.  This focus on prevention and early intervention with primary and secondary care colleagues working together to improve outcomes is a practical realisation of the aspirations of the Partnership of Purpose and may indeed be the case for a future CI Health Authority.

Yes transformation is a reality. It’s not easy and it is a continual process not a big bang, but it really is happening.

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