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Statement by the President of the Committee for Health & Social Care

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Wednesday 23 November 2022

General Update

Thank you Madam,

I will start, as I often have done over the past couple of years, with an update on the COVID-19 pandemic. Whilst it has generally been quite stable these past few months in terms of case numbers, Public Health Services continue to monitor the situation and are prepared to act if things do change. We have shown that we will move quickly if needed in a proportionate and effective manner, as has been seen recently with the short-term reintroduction of mask wearing and lateral flow testing at the hospital when it was necessary to do so.

The autumn booster programme continues to progress well, with some 15,000 doses being delivered in this programme, for front line health and social care workers, carers and those in clinical risk groups. Those eligible are also able to access flu vaccines free of charge, which should help to ease some of the anticipated winter pressures.

HSC has also been preparing for what is anticipated to be a potentially challenging winter. Public Health Services are keeping close surveillance on respiratory viruses, not just COVID-19, so that measures can be taken early to address infections and are working closely with colleagues to monitor service provision in the hospital and other healthcare providers so that any knock-on effects can be identified early and minimised. We are working to ensure that we have contingency plans in place in the event that there is a new variant or outbreak that needs rapid response. We do know, however, that our winter pressures are likely to be compounded by the cost of living crisis and rising fuel costs, and that such difficult times can have knock-on effects on people's health.

Whilst HSC will do what it can, everyone has a part to play in stopping the spread of viruses. Please continue to practice good hand hygiene, continue where possible to test yourself before going to crowded or large-scale events, and please, please stay at home if you are unwell. Nobody wants to hear any coughing and spluttering through their Carol service.

We are also aware of the impact that the COVID-19 pandemic has had on how we deliver our services, particularly on our waiting lists for surgery, and we recognise the impact that delays and postponements have for those affected and their families. Demand on services generally mirrors the experiences and challenges witnessed in the UK, which is also experiencing high demand and large waiting lists. According to the BMA 7.1 million people are on the waiting list for treatment in the UK with similar challenges in respect of gastroenterology and in orthopaedics.

However, we are hopeful that, with the support of the Medical Specialist Group and with the recent opening of the new de Havilland unit at the hospital, which consists of nine beds ring-fenced solely for use for orthopaedic surgeries, we are now in a position to be able to begin to tackle that particular waiting list head on.

The MSG have also been working very hard to recruit a full-time gastroenterologist. They have employed several locums to cover the services over the past six months and have two full-time locums during December that it is hoped will be able to see more patients and reduce waiting times.

More broadly, Phase 1 of the Hospital Modernisation Programme continues to progress as planned and construction is well underway for completion towards the end of 2023 before it is commissioned for use in early 2024. As a reminder, Phase 1 will deliver a new purpose-built Critical Care Unit to support additional surgery, and a new Post Anaesthesia Recovery Unit. Your support so far has been essential and will continue to be so as preparations continue for Phase 2 beginning in 2024. This project will increase hospital capacity and directly help to improve waiting times. Similarly, contracts for the suppliers of the new electronic patient record system were completed in May this year, and the discovery phase went as planned, which has enabled us to 'map out' the specific requirements for the new system, working alongside clinicians to understand their processes. A Full Business Case for the EPR project has been developed and the first elements are scheduled to go live from Q4 next year.

I would just like to take the opportunity to add that whilst work to develop the facilities and systems that HSC has available to it continues to progress well, it must be emphasised that these projects are nothing without the skilled staff who know how to make these things work. I have spoken in this Assembly on several occasions about the need for key workers, and whilst we are taking steps within HSC to develop our staff through the 'Grow Your Own' programme we continue to require staff from outside the island to ensure effective and safe delivery of services. The position is quickly becoming unsustainable, with staff vacancies adding further strain to our existing workforce.

HSC has said consistently that a new facility akin to John Henry Court on the PEH Campus could be filled without delay. The demand continues to be there, and we are not able to fill some roles because staff would not have anywhere suitable or affordable to live. We are looking at ways that we can provide such key worker accommodation, but in order to be able to deliver our services, knowing that the demand will only increase, we need the support of this Assembly to be able to do so. We have recently had to change our delivery model for domiciliary care, in part as a result of issues relating to recruitment and retention and I hope that we can work together to help to ensure this doesn't happen in other areas.

Moving now to mental health, which I know is something that our community, and indeed many in this Assembly, are rightly passionate about, we have recently published in full a review of mental health and wellbeing services. This review took into account the views of a range of stakeholders, and I hope that those Members that wished to do so were able to participate. The review noted that whilst services are well resourced and compare very well to UK equivalents, and that Guernsey is fortunate to have a rich network of voluntary sector organisations and States provided services, there remain gaps that need to be addressed. I wish to thank Mr. David Gedze for his work, and for all of those who participated in the review, and HSC can now focus on working with key partners in Guernsey and Alderney to implement the recommendations.

In terms of other legislative work, it has now been six months since the introduction of Lasting Powers of Attorney under the Capacity Law in the Bailiwick and uptake so far has been good. Since 1st April the Greffe has received a total of 332 LPA applications, and as at the start of November, 255 have been registered. Work is now continuing on the implementation of the rest of the Law.  

We have also completed the first phase of the Review of the Children Law which is due to be debated this week.

The Committee were also proud to have seen the signing of the reciprocal health arrangement between the Bailiwick and the UK in August this year. This will enable islanders to travel to the UK safe in the knowledge that they will be able to receive free healthcare if they suffer serious injury or illness whilst there. Work is ongoing to implement this arrangement, not just in Guernsey, but in Alderney and Sark as well, so that it can enter into force on 1st January 2023.

With regards to Alderney, while the public challenges in respect of health and care provision in Alderney over the course of this year have related to services which fall outside the transferred services, States of Guernsey officers have provided advice and support throughout to the States of Alderney and facilitated additional support from Guernsey-based partners. It has acutely highlighted the challenges of providing healthcare to such a small jurisdiction and the need to consider what is proportionate and sustainable for the future. Deputy Matthews and I were pleased to meet with Alderney politicians, along with Deputy Helyar, - in a new forum, the Alderney Care Board - and additionally with Alderney health and care providers. Politically, we have agreed a programme of work which recognises that the anticipated expenditure for 2023 is unsustainable and a more effective delivery and funding model needs to be found as a priority.

As a final point, looking ahead at 2023, the Committee will continue to focus on and prioritise the work in the Government Work Plan. In addition to that which I have already mentioned this will include our Category 1 actions, such as phase 2 of the Children Law Review and options for long-term care in SLAWS, together with reviewing the implementation of NICE TAs and next steps in this area. We also have 'on the books' to finalise the legislation around the reform of the Adoption Law and the primary legislation for the regulation of health and care.

Madam, it has been a busy few months as it always is in Health & Social Care, and I do not doubt that it will also be a busy winter and beyond. But we have been able to put measures in place to tackle some of the key issues despite the challenging environment we are all working in, and I do not doubt that our ever-dedicated staff will continue to do all they can over the coming months to provide safe and effective health and care services. Thank you.

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