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Statement by the President of the Committee for Health and Social Care

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Wednesday 22 April 2020

General Update

Sir,

Before making this statement I thought I'd look back at what I said in my last one back in November. I spoke about the importance of data and being able to make evidence based decisions, about joint working and making every contact count and how some significant and tangible outcomes were emerging from collaborative working across the health and care sector.

Little did I know then how life would change. Never in my worst nightmares would I ever have imagined that I would be responsible for restricting islanders' freedom of movement, for closing schools or prescribing which businesses could open.

BUT what I said back in November is as relevant now as it was then.

Whilst the Committee's response to this unprecedented situation is being fronted by Dr Brink, Dr Rabey and myself this has been a team effort from the start. I have been impressed and humbled in how the thousands of islanders in the health and care sector have come together to continue to deliver high quality services to our community in the most challenging of circumstances.

From the tireless work of our own frontline staff and those working behind the scenes in the hospital and community to our partners, including GPs, Ambulance and pharmacies and MSG, the last month has been a testament to the dedication and commitment of the entire health and care sector.

We have only been able to do this thanks to the support of colleagues across the States of Guernsey, local businesses, the third sector and individual islanders. The practical assistance, the donations, the good wishes, and most of all the overwhelming support and compliance with the restrictions in place has cemented a whole islands' approach which means that we will get through this. Thank you.

Every decision we have made has been informed by professional expertise and the evidence available internationally, nationally but most importantly locally to ensure that the decisions reflect our community's needs. Extensive modelling and analysis has been undertaken to understand how the virus is presenting locally, the impact of community interventions and to forecast future effects. The comprehensive community testing and extensive contact tracing means that we understand the demographics of cases and the transmission rates and can use this to judge the effectiveness of measures taken and inform future actions.

An understanding of community risk has informed the Directions developed by the Committee under the emergency regulations made by the CCA which I will speak about later when the CCA regulations are discussed.

I have spoken repeatedly over this term about the importance of health intelligence in understanding population health, using this to shape strategic and operational decisions and to encourage positive individual action. We have seen over recent weeks the very real effect that individuals can have on our community's health. In the same way that adopting healthy lifestyles and participating in vaccination programmes benefits both individuals and the wider community, by staying at home and maintaining social distancing, we have flattened the curve and collectively sought to protect both ourselves and the most vulnerable.

But we cannot be complacent. 241 individuals have tested positive for the virus and 10 individuals have sadly lost their lives, with a further four death presumed to be linked to Covid-19. To the friends and families of those who have died, I extend our sympathies, on behalf of my Committee and of this Assembly.

While for many people Covid-19 causes minor symptoms, those with existing conditions are frequently the most affected and this has been felt most acutely in our care homes. HSC has been supporting the sector to ensure safe levels of cover, the provision of equipment and professional advice. Thanks to those who responded to the call to arms when we asked for care workers and the redeployment of amazing community staff, we have ensured continued care across the sector.

We continue to enjoy a good state of preparedness in the hospital as a result of early, decisive action. It has been reconfigured into COVID19 or "hot" and normal zones with a brand new "hot" Intensive Care Unit in the area previously occupied by the day patient unit with over 100 staff trained to support it. A dedicated Medical Cell has developed and implemented new pathways and procedures to safely and effectively manage patients from primary care through to ICU and we continue to explore ways to further increase capacity.

We have, of course, needed to take difficult decisions, including the cancellation of electives and restricting visitors. I know the visiting restrictions currently in force will be having a profound impact on patients and their families. It is not a decision anyone wanted to make. However, it is, at least for now entirely necessary and as soon as we can change that we will. I am grateful for the support of the businesses and third sector in helping patients stay connected to their loved ones through the provision of iPads and our dedicated staff who are working hard to provide the care, reassurances and affection so no patient feels alone.

Our procurement team have been working around the clock to secure everything from Personal Protective Equipment to ventilators, sourcing vital equipment from around the world and arranging for its delivery to and across the islands

Sir, this statement has understandably focused on Covid-19 but it is important to stress that all the normal pressures of a dynamic health and care system continue. Community care continues to be provided, social workers continue to support families and our most vulnerable children and adults, and islanders continue to need treating for acute, time-critical health needs either locally or off-island.

Like all Committees, we will need to reprioritise planned workstreams, deferring those which can be delayed and bringing forward those which will help us mitigate the financial effects of Covid-19 on the economy and individuals. The primary objective of the Partnership of Purpose, achieving a sustainable health and care system centred around the needs of islanders, will be brought into ever sharper focus as we emerge from the current pressures. While the Committee paused submission of its planned policy letter on the future of primary care, as part of our recovery plan for health and care services in the Bailiwick, we will be seeking to accelerate proposals to ensure primary care services are accessible and affordable to all through a comprehensive review of the current grant system and the fee structure. This will include revising the criteria relating to States' grants or subsidies, or to professional privileges, so that access to them is, to some extent, conditional on participation in the Partnership of Purpose. It is only through this collaborative approach, working beyond individual organisational boundaries, that we will be able to deliver the structural changes needed to deliver the services Islanders deserve at a cost we can afford.

As Deputy St Pier and I have set out there is a phased exit plan from current lockdown restrictions which will be implemented over the coming weeks and months informed by the Public Health evidence. Separately, HSC is already considering how as an organisation, we will transition out of the current restrictions. We will not be able to immediately return to normal when this threat has reduced, it will require careful thought in a number of areas, such as how we manage the inevitable backlogs that will have built up in elective surgery. But, I can assure members that the same calm and meticulous approach used in our response to coronavirus will shape how we recover from its effects.

As I said earlier, members have heard me speak repeatedly over the last 4 years about the importance of prevention and early intervention, backed up by evidence, in ensuring a sustainable health service. It is because of that the Committee invested in public health services throughout this term. It is because of that, we were in a good place when Dr Brink informed me on 14 January this year of the first death in Wuhan. It is because of that we closed our borders early, we locked down early. It is because of that we brought in on-island testing so we could test, test, test. It is because of that we can now start to evolve our exit strategy and begin to ease restrictions.

Every islander has had a part to play in supporting the approach we have taken to intervene early and prevent the spread of this highly destructive virus and I thank everyone for their part in putting us in the position we are today. It is going to be a long and hard road ahead, we won't get everything right, but what I can say with absolute assurance is that we will continue to work in the best interests of the people of the Bailiwick.

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