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Hospital capacity and waiting times

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Thursday 23 September 2021

Bed capacity issues along with waiting times for elective surgery are not unique to Guernsey.

They reflect the situation being experienced nationally in the NHS and elsewhere. That being said, Guernsey is constantly monitoring the situation and planning ahead to manage the current situation and what could potentially be a challenging winter.

Dr Peter Rabey, Medical Director said:

'Predictably, waiting times for certain procedures have increased as a result of the COVID-19 pandemic. Whilst Guernsey has managed the pandemic incredibly well, certain areas of business as usual have taken longer to recover.

The largest growth in waiting times as a result of COVID-19 has been in endoscopies and orthopaedics. Endoscopies are an aerosol generating procedure and we have had to take special precautions during the Covid period to protect staff.  The number of gastroenterologists was increased from 1 to 2 in response to the Review of Medicine in 2017.  We are working with them both to seek to reduce the waiting lists which have grown during the pandemic. Endoscopy for suspected cancer patients has been, and continues to be, prioritised.'

An ongoing challenge is the number of patients who are currently in hospital who do not need to be there. Our care home sector is reporting challenges in that very few beds are becoming available and there are increasing waiting lists for residential and nursing care.

Dermot Mullin, Director of Operations said:

'A lack of capacity in the care home sector has a knock-on impact on both hospital and community care services capacity. We have a number of individuals across the PEH whose normal discharge and transfer of care to community services, nursing or residential sector has been delayed.

This in turn creates a capacity issue to meet the demand for acute care and increases the number of elective surgery postponements which contributes to increased waiting times. 27 procedures have been postponed so far this month.

Despite these challenges, we continue to prioritise surgical procedures in consultation with our colleagues at MSG for example for cancer care.'

Dr Gary Yarwood, consultant anaesthesia and intensive care medicine and Chair of the Medical Specialist Group, said:

'We really feel for any patients who have had their care delayed because of the current challenges with capacity. It is a difficult situation, and everyone is working very hard to resolve it. The simple fact is that when community care patients occupy medical beds, acute medical patients have to move to surgical beds, and we then lack the inpatient beds for surgical patients.

We are maximising our use of Day Patients and continue to put our priority one patients first, particularly cancer care, but inevitably other inpatient surgical workload is impacted, especially orthopaedic patients needing joint replacements which can't be done as day cases. We can make inroads into waiting times if we can operate at full capacity but have to maintain a high percentage of activity just to keep demand with new referrals.'

Elaine Burgess, Associate Director, Acute Services said:

'We know that some people are anxious about being discharged from hospital where they have 24 hour a day care and support. For those who do not need to be discharged to a care or residential home we would ask that they, and their family members, make every effort to get home as soon as they are considered safe for discharge.

Every day in hospital is a precious day away from home. We want to embed a 'home first' ethos. Prolonged stays in hospital can be unnecessarily detrimental to your health due to sleep deprivation, increased risk of falls or infection among many other things. So, it's not just about protecting bed space, it really is about ensuring you are in the best place. We would never discharge someone if it wasn't safe to do so.'

A lack of critical care beds has an impact on hospital efficiency as many elective procedures can only take place if there is a critical care bed on standby. Building a new Critical Care Unit has been prioritised in the first phase of the Hospital Modernisation Programme and construction is due to start in Q2 2022. The new unit will have increased capacity from 7 to 12 beds. An adjacent Theatre Recovery Unit will have 10 beds that can swiftly be converted to additional critical care beds to support any future pandemic demands or other emergency situations.

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