Wednesday 24 May 2023
General Update
Madam,
I'm sure that every Member in this Chamber is expecting me, as the President of the Committee for Health & Social Care, to speak about the importance of Phase 2 of the Hospital Modernisation Programme following the recent announcements regarding the capital portfolio and I will come on to this shortly.
Firstly, I'd like to update you on the waiting list initiative now in place to address the waiting times in gastroenterology, which have increased month on month since the start of the pandemic when aerosol generating procedures were stopped due to the COVID-19 risks. Following a long and thorough tender process, HSC is partnering with UK company Medinet to run weekend clinics to reduce the waiting list for endoscopy procedures.
Health & Social Care is in the process of contacting eligible patients who will be being offered a pre-assessment appointment. Weekend clinics will start on 1st of June and will run from Thursday to Sunday with 12 sessions scheduled over those days, and plans are in place for nine weekend sessions to be held over a 12-week period. Depending on the procedures required, these additional clinics will result in around 50 patients per weekend being seen.
I need to register my thanks to the team for getting this initiative off the ground and for the support of the States in allocating the additional funding needed through the Government Work Plan as a recovery initiative. As a Committee we are also aware of the impact for those waiting for procedures and I would like to thank everyone for their patience.
As we have previously committed, as soon as progress is made to the waiting list for gastroenterology procedures, the bowel cancer screening programme will re-start.
There is also an ongoing initiative to tackle the waiting times in orthopaedics through the new dedicated nine-bedded De Havilland Ward at the PEH and this is working well. However, those Islanders who are receiving their procedures and coming off the waiting list are, more often than not, being matched by a slightly higher number being added to the waiting list, and the complexity of cases is also increasing.
Our plans to invest in the ongoing modernisation of the hospital is crucial to the long-term management of waiting times. While bed capacity issues were historically linked to winter pressures, we are now seeing increasing capacity issues within the Princess Elizabeth Hospital all year round - although I would like to emphasise that anyone in need of care in hospital will be admitted if this is clinically necessary.
Before saying more about the Phase 2 investment, it's important that I echo the sentiments of Deputy Dudley-Owen's recent update statement to the Assembly: that I'm also keen to avoid a position where the debate about the future of the capital portfolio is offered as a choice between these two important and "once in a generation" investments in our essential infrastructure. These key areas of work are hugely important to our respective Committee areas and I know we feel equally passionate about being able to proceed.
However, if forced to choose, I and my Committee will put all of our weight behind Hospital Modernisation.
I would like to take the opportunity to reflect on one particular misunderstanding that has evolved recently, which relates to the interdependency between the two programmes in the relocation of the Institute of Health & Social Care Studies to the new education facilities at Les Ozouets.
It has been stated that it isn't feasible for Phase 2 of the Our Hospital Modernisation Programme to proceed before the Transforming Education Programme due to the relocation of the Institute of Health and Social Care Studies to the Les Ozouets Campus, and the way this has been reported in the media is not an accurate reflection of the position.
There are three elements. There is accommodation in the PEH utilised by the Institute, which comprises 16 team members requiring office accommodation and teaching spaces, and there is a library. In addition, HSC has a team of staff delivering mandatory training specifically for our own staff. The important distinction is that although the Institute and the HSC training team currently share some facilities, our mandatory training staff working specifically within health are not part of the Institute and they will remain on the PEH campus, both during and after the completion of Phase 2.
We recognise that there is a particular need to relocate the library facilities from the Princess Elizabeth Hospital, approximately 12 months into the Phase 2 build, to allow this space to be developed into a new Private Ward. Office accommodation would also need to be found for staff working for the Institute, but there is some flexibility about where this is provided, and we could accommodate these staff elsewhere on the PEH campus if necessary.
We have already started to look at contingency arrangements for the library, and this is certainly not going to prevent the Committee from pushing on with the plans for Phase 2 and the delivery of a full range of facilities that we know are crucial to the future of our health and care services.
The Committee is grateful to all States Members who attended a recent presentation and I hope this has helped to paint a clearer picture of the day to day operational challenges of running a hospital, but also the difficulties and risks that will be mitigated by well-designed facilities to be delivered in Phase 2.
As a reminder, Phase 2 of the modernisation programme delivers a mix of new build and refurbishment of existing spaces.
The new build will include:
· a new maternity ward and neonatal intensive care unit
· a new paediatric ward
· private ward facilities
· an admissions and discharge unit
· an outpatient's unit, and
· four additional theatres
The refurbishment plans follow on from the main development works and include new facilities including:
· the refurbishment of the four existing theatres
· Sterile services
· A new orthopaedic ward
· New facilities for the breast unit
· A newly configured Emergency Department
· Fracture clinic, and
· Overnight accommodation
These new spaces have been carefully designed to enhance patient experience; better manage patient flow to allow for greater efficiencies in working practices; reduce clinical risks; reduce unnecessary admissions; to learn from the pandemic experience and ensure our resilience.
The plans have been carefully considered, clinically evaluated and independently challenged, and have the benefit of full planning permission being in place.
The risks of any further delay cannot be understated:
· Waiting times will continue to rise - particularly for gastroenterology and orthopaedics - in line with the forecast demographic demands
· We will continue to run with risks that are mitigated by Phase 2
· Incidents of last minute surgical cancellations will continue to increase
· We will need to refer more patients off-island at significant cost and with no guarantee of off-island capacity in a post-covid environment
· Recruitment and retention issues due to poor working environment and sub-optimal patient pathways/flow. We feel that modernisation is our "recruitment USP"
· We have recruited staff with the modernisation plans acting as a push factor for working here and we run the risk of staff leaving, and
· Increased agency spend due to an inability to recruit staff into an aging hospital with the associated risks and issues
While we have emerged from the winter months, the operational pressures that were previously associated with the colder, darker days have yet to ease. Many States' Assemblies before us have talked about the demographic challenges on the horizon, but be under no illusion, they are already here. The Committee is unanimous in its view that if we are to prepare for a more sustainable future for health and care, we must not delay the investment in Phase 2.
It would be remiss of me not to mention another important investment, as we welcome the inclusion of the 'Children and Families Hub' into the capital portfolio and I would emphasise the many benefits for children and their families, and for staff, which are afforded by this investment and by bringing these important services together.
While the review of the capital portfolio and Government Work Plan has been consuming much of our time, we have other key priorities to mention -
The Committee has successfully implemented a two year drug funding programme, making drugs and treatments with a Technology Appraisal from the National Institute for Health and Care Excellence - known as NICE - with an ICER value up to £40,000 available to islanders. As required by Resolution, the Committee recently agreed the terms of reference to review this programme, securing the services of an external provider to undertake the review. I am pleased to say that this is now underway and will consider both the implementation of the programme so far and examine options for future drug funding policy. Communication events setting out the findings of the review will take place before the Committee brings a policy letter to the States in the autumn to enable a decision on future drug funding policy to be made.
Smoking is still an important cause of ill health and death amongst islanders. For example, data from Public Health Services - to be published shortly - has shown that between 2019 and 2021, 10% of deaths in people aged 35 years and above were estimated to be smoking attributable. This equates to 175 deaths over the three-year period, or approximately 58 per year. Simply instructing people to 'stop smoking' is not effective - we need to continue to work towards creating an environment for health through an integrated a programme of Health in All Polices.
The Committee has recently consulted on the draft Code of Practice for the Capacity Law and I wish to thank those who provided their valuable feedback. The Code is vital in underpinning the Law and sets out the practical details and duties of those affected by it, whether they are a worker in the health and care sector, a family carer, or most importantly a person who lacks capacity themselves. This is a key part of the work currently being undertaken to implement the Law in its entirety, having already brought into force the provisions relating to Lasting Powers of Attorney. Work is now focused on implementing the Protective Authorisation Scheme, which is a complex piece of work requiring coordination across various services areas within HSC, and with the Third Sector, but is nevertheless essential in ensuring that care arrangements are in the best interests of anyone lacking capacity.
Furthermore, as approved by the States Assembly through the Government Work Plan, the Committee is progressing with the work required to implement a fair and proportionate system of health and care regulation for the Bailiwick. While the practice of many health professions in the islands is overseen by a UK regulator with the support of local legislation, regulation generally has developed iteratively over many years resulting in a fragmented approach. The Committee is aware of regulatory gaps that exist and the draft enabling legislation that will give the States powers by ordinance to regulate both health and care professions and the provision of care has been prioritised and is being progressed.
Given the current known difficulties being experienced in the care home sector and the knock on effects on bed capacity in the Princess Elizabeth Hospital, the regulation of care home provision, and of those providing care in these settings and in the community, has been identified as a priority area for subordinate legislation once the primary law is in place. As part the Supported Living and Ageing Well Strategy, resource has been allocated to scope the requirements for this work to ensure that ordinances can be made in a timely way following the enactment of the enabling law. I am using my update statement as an opportunity to inform States Members on this work, but wider communications and engagement activity is planned for later this year.
The first phase of the Review of the Children Law was approved by the States in November 2022, and work has been ongoing to implement the various recommended legislative and operational changes to reduce delay and duplication in determining outcomes for children and young people. This work is being supported by a cross-Committee and cross-agency implementation group to ensure that actions are supported and delivered as directed by the States.
Madam, times are challenging in health and social care as mirrored in other jurisdictions. All of the work that we are doing now will help to ensure that our hospital services remain fit for the future and that the policy approach supports a sustainable and affordable model for the future and is aligned with the strategic direction of the Partnership of Purpose.
