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Key performance measures for the Secondary Healthcare Contract published today

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Thursday 23 February 2023

The annual key performance indicators (KPIs) report, published today by Health and Social Care (HSC) and the Medical Specialist Group (MSG), shows improvements in many areas but waiting times for non-urgent care continue to be an issue.

The report highlights improvements in emergency and urgent care, with 100% of emergency inpatients seen within 24 hours compared with 89% in 2021 and almost every urgent inpatient referral (97%) seen within seven days compared with 80% in 2021. 

But with the third COVID-19 wave in early 2022 resulting in staff shortages and further postponement of surgeries, there has been no improvement against the target for seeing all routine referrals within eight weeks.  

Just over two in three (67%) patients were seen within eight weeks, 83% were seen within three months and almost all (94%) within six months of referral. The specialities with the longest waiting times continue to be orthopaedics and gastroenterology. 

The report says that the newly-opened de Havilland Ward with dedicated orthopaedic beds is already making a positive impact and a dedicated waiting list initiative will tackle the gastroenterology backlog with several additional weekend clinics starting by April. 

There has been a reduction from 82% to 52% in the percentage of patients seen within two weeks after a referral for suspected cancer.  This is entirely due to patients referred for potential skin cancers.  There are several types of skin cancers, and by far the most common are the less dangerous ones, which make up the majority of those waiting more than two weeks.   The UK's National Institute for Health and Care Excellence (NICE) recommend that all potential malignant melanomas are seen within two weeks, and they are the priority locally (80% of urgent skin cancer cases in 2022 were seen within two weeks and 94% in 28 days).  The number of dermatology sessions has been increased and safe pathways agreed with primary care for all skin cancers. 

Dr Peter Rabey, HSC Medical Director, comments: 

'The KPIs have been set to reflect high standards of practice and patient care. They are all about encouraging a culture of continual development, learning and improvement. 

'Many of the quality indicators are positive but we are mindful of the impact of delays in waiting times for patients and their families who need surgery or are anxious for a diagnosis or treatment plan. Reducing the waiting list is our priority with waiting list initiatives in place for orthopaedics and gastroenterology which represent over half of the inpatient wating list.   

'There is no doubt that our health services continue to be impacted by COVID-19. The support of the public continues to be exceptional, and the staff of both HSC and MSG continue to work hard to reduce the backlogs caused by the first and second COVID-19 lockdowns. 

'The introduction of the Electronic Patient Records solution at the end of 2023/beginning of 2024 will further improve the KPIs in some areas by streamlining administrative processes.' 

One area which has not improved is the 'delayed transfer of care days' which measures the number of days that patients stay in hospital after they are considered fit for discharge. This is either because a nursing or care home bed is not available or because they need extra care at home. The 2022 result is 629 days per month, up from 387 days in 2021 and against a target of fewer than 100 days a month.  This equates to some 20 beds in PEH constantly filled with patients who could have been discharged which results in postponement of surgery and worsens waiting times. 

Dr Rabey says:  

'Delayed transfers of care have been an issue for several years, but they are on the increase. Following discussions with community colleagues and private care providers, it is clear that there is pressure for long-term care across all care sectors and it's not unique to Guernsey - it is reflected at a national level too.' 

Dr Steve Evans, MSG Chair, adds: 

'We welcome the publication of the KPIs report. It's important that the MSG is held accountable for how we work in partnership with the HSC to deliver high quality secondary healthcare to islanders. 

'We are determined to do all we can with HSC to reduce waiting lists and to get back to the position we were in before the pandemic. None of us want to see patients waiting longer.  

'There are positives on the horizon, including the waiting list initiative which will significantly reduce waiting times for endoscopy patients from April onwards. 

'And phase 1 of the hospital modernisation programme - the new Critical Care unit and the post anaesthetic recovery unit - will make a tangible difference. 

'I'd like to pay tribute to all our consultants and support team members for their hard work, commitment to clinical excellence and to putting the patient first, always. 

'It's very encouraging to see that while we continue to increase the number of patients we care for, there has been no adverse impact on the standards of care. The average length of stay for a patient is just three days (against a target of less than six days) yet our emergency readmission rate is as low as 6% (against a target of less than 10%) which means that we are not discharging patients before they are ready to go home. 

'Recruiting specialists with the right experience and approach to patient care continues to be a top priority for the MSG and we're developing new ways to reach out to consultants in the UK and internationally to promote the unique benefits of being a consultant in Guernsey.' 

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