In regards to the Committees plans for the coming months.
Sir, my statement today is intended to update members and the community generally on what has been happening in Health and Social Care since my last statement and our plans for the coming months. I apologise in advance that, because we have managed to get our policy letter on the future model of health and care submitted in accordance with the timescale set by Policy & Resources, you have both this statement and our policy letter at this meeting. This means that this statement will, in accordance with the Rules of Procedure, focus on matters falling outside the transformation programme. However, it won't be a surprise that it hasn't been difficult to fill 10 minutes I have available despite that.
The new contract with the Medical Specialist Group is due to commence on 1st January 2018. At a cumulative cost of £100m, this is the largest for the States of Guernsey, and, as such, requires proper management on an ongoing basis. Contract monitoring has been a weakness generally of the States of Guernsey and we need to up our game to ensure best value for money and that users get the service that we have paid for. Accordingly proposals were submitted and approved earlier this year to create a new Client Team that will ensure effective control and best value from the contract with joint funding provided from HSC and ESS. I thank that Committee for its support.
Now, the vast majority of secondary health care is delivered within the timeframes specified within the contract. However, there are key pressure areas in certain disciplines - chronic pain, gastroenterology and orthopaedics.
The Committee understands that waiting times are really important to islanders and that sometimes it can be distressing having to wait for a referral or operation. Islanders want to know when they can expect to receive treatment and for this timeframe to be adhered to. HSC will be requesting that CareWatch consider this matter and the expectations of patients. This will then inform ongoing dialogue with the MSG through the regular Contract Monitoring Meetings and the development of joint remedial action plans under the new contract.
Positive steps have already been taken in respect of Orthopaedics. A fourth surgeon was appointed this year and a physiotherapy pilot in primary care has reduced unnecessary referrals. These have contributed to the increase in the number of operations taking place in the contract time since the beginning of this year. The Medical Director is also looking at how matters can be improved further.
In respect of Gastroenterology, work has been undertaken with primary care to reduce referrals by reviewing care pathways and a review of general medicine that took place recently by representatives from the Royal College of Physicians of Edinburgh, due to their expertise in remote and rural settings, and the full report, is likely to make further recommendations that may help the situation, although at additional cost.
A core part of HSC's work is the delivery of community care services and every day there are multiple contacts with individuals in their own homes. In the last quarter Community Services have been able to increase their staff resource and, by thinking and working differently have reduced the time people are waiting for a care package. Plans are also well developed to introduce a re-ablement service later next year.
The team has also worked with colleagues from ESS and the Guernsey Housing Association to obtain planning approval for the autism build at Le Vieux Jardin. We know that an enabling physical environment promotes independence, with a resultant decrease in the need for care and support and the team are therefore considering other areas where this partnership approach will make a difference.
Those members who were in the States in the last term will be aware of the long running saga of the hyperbaric chamber. To date we have been renting a chamber to ensure that there was a facility on-island for professional divers and whilst we had been expected to purchase a chamber from the bond proceeds, this was not possible due to the lack of a reliable income stream. Therefore a request was made to purchase a chamber from capital recently and I am pleased that the Policy & Resources Committee have approved that request and I thank them for their support. This also means that we will be able to review the fees and charges associated with its usage as our ongoing costs will be significantly reduced.
The Committee has developed a close relationship with the Arts Commission. Indeed, any trip around the PEH site today will demonstrate their influence in making it a brighter and more welcoming place. The latest project saw a makeover of the restaurant with new locally themed artwork and dementia friendly signage, creating a space that provides a positive and relaxing environment for staff and service users. This will be complete next year when we replace the furniture which dates back 30 years from when the Gloucester Room was created.
I've already mentioned the support from the CESS and HSC really appreciates the close working with our colleagues on that Committee which is helping our transformation. It is probably the clearest demonstration of what joined up government is meant to be about. This was shown just last week through the joint initiative to make a full range of contraceptive services available for women under the age of 21 years, provided free at the point of access. We believe this programme will result in an improvement in the health and wellbeing of young people with a decrease in the reliance on social benefits.
We're also delighted that the Committee forEnvironment & Infrastructure have agreed to support HSC by developing a travel plan for the PEH Campus. I know parking there can be a source of irritation, but as a Committee, our primary focus has to be on the health and wellbeing of Islanders and resources need to be prioritised on ensuring this is not compromised. I therefore thank the CEI for providing their help and support, which is most welcome. Again, an example of joined up government, thank you.
Moving on to health promotion, In November, the UK Supreme Court unanimously rejected a legal challenge over Scotland's proposed introduction of minimum unit pricing on alcohol.I am pleased this matter has finally concluded and can confirm that HSC is investigating how this can be implemented locally in accordance with the Policy & Resource Plan. Recently Dr Nikki Brink, our Acting Director of Public Health gave a presentation to members of the States of Alderney about the role of public health and work they were doing to support Alderney, which I understand was very well received.
Following the transition of the Drug and Alcohol Strategy from Home Affairs to HSC, I was pleased to represent Guernsey at the BIC Ministerial Meeting on the Misuse of Substances. It was memorable not just for having 6 female Ministers to one male but also for the clear recognition that sentencing policy for first time and young offenders should focus on rehabilitation as opposed to criminalisation. This is in line with Home Affairs' Justice Policy and its commitment to delivering the correct interventions at the right time. HSC looks forward to working with Home Affairs in the delivery of programmes to support rehabilitation and ensuring "early misdemeanours" do not disproportionately affect a young person's life.
Brehon Ward recently received the Bailiwick's first Blue SCAPE Award which represents the highest standards of care. Standing for Safe, clean and personal care every time, SCAPE is a rigorous assessment of the quality of nursing care that teams deliver which needs to be consistently delivered over the course of two years. The Emergency Department followed soon after and I'm sure others will want to emulate their success.
Last week, we celebrated the Health & Social Care Annual Awards. Categories include outstanding contribution, Manager of the Year, Team of the Year and Special Recognition. Those nominated illustrate the exceptional practice across health and care services, and the professional, dedication and enthusiasm shown by HSC's staff, both frontline and back office.
The Care Values framework, which was launched in November 2016, went live at the beginning of this year. Through six key principles, it is designed to promote quality, service user centred care by skilled, educated staff dedicated to innovative ways of working for our community. Significant progress continues to be made, including;
- Sage and Thyme training to develop structured conversations with people in distress or with concerns.
- Schwartz rounds where all staff, clinical and non-clinical, come together regularly to discuss the emotional and social aspects of working in healthcare; and
- the development of a lessons learnt bulletin following serious incidents - ensuring that learning is shared and the quality of services can be strengthened.
I had to cut out a lot there due to the time available. There is much more.
Next year our Chief Nurse will launch the initiative Safer Every day. Through highlighting the positive steps taken daily by healthcare professionals to ensure that service users are safe, it will raise awareness of good practice, prevention of harm and protection of patients and staff.
Last but not least, I turn to Finances. I spoke recently on finances during the budget so won't repeat that detail now, other than to advise that we will have generated a surplus this year thanks to the hard work of people throughout the organisation making service improvements on a daily basis. However, with a £3.6m reduction in our budget, we are going to face real challenges next year and, whilst this is something that is more for the policy letter I should make it clear that we have reached the limit of budget cuts and what we need to focus on now is future cost avoidance. When the balance is skewed to the now is when things unravel and I do not want to see the good work done to date lost due to the short term expediency, when what we really need is strong, strategic and evidence-based decision making and that will be the subject of my next speech.
