Thursday 02 July 2020
The response to the Bailiwick COVID-19 pandemic had a profound impact on the delivery of health and social care services, with all aspects of operations impacted to a greater or lesser extent.
The need to prioritise staff and resources to protect patients, manage the spread of the virus and support those who became infected was rightly at the forefront of the successful response strategy. The support of the public has been exceptional and has made a real difference to all that has been achieved during this unprecedented time.
With the fantastic progress of the community overall allowing the Bailiwick to enter Phase 5, all teams and staff across health and social care have been working hard to recover their individual services and address the impact of the pandemic across the work of their teams.
As a result of this effort, staff across Children & Family, Adult Community, Adult Disability and those within Mental Health Services are expected to be able to restore their full service provision in the shortest timeframes now that Phase 5 has been entered. Services across the Acute care sector, provided from the Princess Elizabeth Hospital have experienced the greatest degree of disruption however, and specific plans will need to be delivered to address the waiting list issues that have arisen which will in turn require the continued understanding and support of the community.
Dr Peter Rabey, HSC Medical Director said:
'During the entire lockdown period, all 'Priority 1 & 2' surgical operations were delivered throughout the pandemic. This work involves the most critical and urgent casework, including cancer responses and trauma treatments.
Additionally, MSG worked hard to provide their routine outpatient services during lockdown, often over the telephone, via technology or through the use of PPE if the appointments had to be conducted in person. As such, all current outpatient services continue to be delivered within 8 weeks of GP referral with many experiencing much shorter wait times, depending on the specialism concerned and with the exception of orthopaedics which continues to experience very high levels of demand.'
The outpatient activity that has been delivered during lockdown however has added to the overall lists of patients requiring a day or inpatient procedure, with no ability during lockdown for staff to address this work. This was because, in line with all NHS Trusts across the mainland, scheduled operations had to be postponed during the pandemic, and our day patient unit was converted to serve as 'hot' (COVID-19) Intensive Care Unit, taking it out of service from its normal use. Additionally, now that more islanders have the confidence to visit their GP, outpatient activity is expected to increase significantly, adding further caseload across the specialities for those that require a surgical intervention.
Now that we are in Phase 5, many patients who are on inpatient waiting lists will be anxious to understand when their operation will be delivered, and HSC and MSG are working hard to respond and support patients at this time. A new 'Frequently Asked Questions' has been created and posted on the MSG website (www.msg.gg/faqs-waiting-times/) and the States of Guernsey website (www.gov.gg/peh) to answer the common queries that patients may have in respect of their operation.
Patients are asked to review this FAQ in the first instance to allow staff to focus on the scheduling of operations now that all PEH facilities are becoming available again. Within the PEH, clinical staff are maximising the services that they can deliver across the working week to support the delivery of surgical work.
Dr Gary Yarwood, MSG Chairman said:
'Patients who have read the FAQs and do contact the MSG to enquire about their operation date will not unfortunately receive definitive information at this time. We are anticipating increased referrals from Primary Care now that patient confidence to visit healthcare settings has returned and although continuing to improve, PEH theatres are not yet back to full capacity.
MSG staff will therefore only be able to provide a guide at the present time, based on the wait times experienced by individuals who have recently received surgery, but this may not be indicative of future cases if demand outstrips capacity. There are particularly heavy caseloads to work through in orthopaedics, and specialties such as Ear, Nose & Throat will still have restrictions as to the work they can deliver safely in Phase 5 because of the aerosol-generating nature of the related procedures.
Undoubtedly, and principally because of the theatre disruption experienced throughout the pandemic, almost all surgery will be delivered outside of an 8 week wait, for which we apologise.'
It will not be possible to achieve full capacity immediately within the PEH, and operations are sometimes unavoidably postponed if the condition of a patient worsens, if urgent emergency work has to be prioritised or if specialised nursing/operating department practitioners for whatever reason are unavailable. The impact on the PEH of the need to respond to a further COVID-19 outbreak would of course also materially impact what can be delivered. Despite these challenges, HSC and MSG staff are aiming to achieve their pre COVID-19 'business as usual' average workload of approximately 460 day patient and 100 inpatient surgical cases per month as soon as possible.
Thanks to islanders' excellent compliance with lockdown and the phased exit from lockdown plan, we have come out of lockdown faster than many other jurisdictions which means that waiting list times are not as bad as they could have been. In terms of looking off island for additional capacity to support the Guernsey waiting list management (as has been undertaken in the past 18 months for orthopaedics for example), this is not felt to be viable at the present time owing to the pressures on the NHS and their own waiting lists which have lengthened considerably owing to the ongoing pandemic. The option will however remain under review.
To manage increasing patient demand on island, and to keep pace with the needs and requirements of our changing community, HSC are delivering a major 'Hospital Modernisation Programme' which, subject to States' approvals, will break ground in 2021, providing the facilities, services and capacity required by our community into the future.
Once again, islanders are thanked for their response and support of the process to manage the COVID-19 threat and asked for their patience whilst HSC and MSG recover surgical services and optimise the activity that can be delivered for patients over time.