It is with pride that I stand before the Assembly today, as President of the Committee for Health & Social Care, which employs over 2,000 staff and provides a very wide range of health & care services to our community.
I am not standing in front of you as a lone voice, but as that of a Committee which is fully committed to collegiate working. In anticipation of our considerable workload, delegated roles have been established, or are being developed, for Committee Members.Members’ interests will continue to be nurtured, including the use of new technology in the health sphere, where both helpful, and potentially harmful, as in the influence of social media on young people’s mental health.
There is much to celebrate about our Health & Care system. Most islanders can access same day GP appointments, we do not have long waiting times in the Emergency Department, we have a consultant-led secondary health care service that offers very high-quality care and we have a dedicated workforce of health and social care professionals who work tirelessly to support, treat and care for islanders, often at their time of greatest need.
Demographic change inevitably influences the demand for and funding of Health & Care services. One of the Committee’s key priorities for this political term will be to develop a sustainable health and care system.
Our work will include a fundamental review of the whole system of the delivery and funding of health and care, including a review of those services that might be most effectively delivered by primary care, a review of medicines and the role of community pharmacies, a review of the secondary healthcare contract and consideration of which services can be delivered most effectively by commissioning from the third sector. The Committee is committed to submit for consideration, a bespoke programme suitable in scale and size for our island, by the end of our term of office.
To the States, and particularly to our Treasury colleagues, the burgeoning cost of Health and Care dominates discussion. The Committee acknowledges the need to make savings, and indeed some savings were factored into our budget submission.
In association with our colleagues at the Medical Specialist Group, we continue to work to repatriate work previously done off island, to reduce expenditure. It is to the benefit of our service users that, where possible, major operations are carried out closer to home and family. The revision joint replacement scheme, a complex area of surgery which used to be handled in Exeter, is now managed locally.
Nevertheless, the Committee recognises the significant challenges facing us.
We have forecast the net rise in the health and social care budget, year on year, if we do not change the way that we deliver services. The figure that needs to be mitigated varies between £6 and £8m of extra resources required per annum. Inevitably, the discussion will be around who pays for what, how much should the user contribute, and the means for doing this.
Approximately 60% of the net healthcare budget is spent on staffing costs. Attention has been focused on the use of expensive agency staff. I am pleased to say that the use of agency staff has substantially declined in recent years, from approximately £16m in 2023 to £12m in 2024, with a further reduction of nearly £3 million forecast for this year, albeit some service areas remain hard to recruit to and continue to be major users of agency staff.
The Committee is committed to prioritising prevention and early intervention. This essentially refers to the long-term aim to reduce the burden of acute and expensive interventions further down the line. Such examples of effective upstream prevention can be seen in the newly funded roll out of a pilot study of weight loss drugs, to those with health conditions related to defined levels of obesity, provided alongside dietary and lifestyle advice.
No healthcare reform can be achieved without reform of social care, and our Committee is fully supportive of the work being progressed to deliver the Supported Living and Ageing Well Strategy (SLAWs). We will work with Policy & Resources and the Committee for Employment & Social Security to ensure a financially sustainable model of long-term care is created that is both still in existence when the present generation of funders have access to the scheme in their years of need, and to provide increased community support for those requiring domiciliary care.
At the same time, we must not forget the ‘Ageing Well’ part of the SLAWS strategy. Supporting this part of our community to have active, healthy and happy lives, free from loneliness will prolong active and independent living and reduce the burden for support placed upon the States.
We will also work, with other Committees, to focus on children and families with family friendly policies, to support Early Years programmes and young people’s mental health services.
Demand continues to rise for young peoples’ services. Referrals to the Multi Agency Support Hub (MASH) have grown significantly in recent years and are running at 150-250 every month. Furthermore, a failure to address the mental health needs of an increasing proportion of our young population will have significant consequences for the States in forthcoming years, with an inevitable rise in the numbers of young people Not in Education, Employment or Training.
The Committee is planning to co-locate a range of community health and care services for children and their families on the Raymond Falla House site. These services are currently dispersed across eight separate sites. This has led to inefficiencies, poor user experience, and operational challenges; as well as difficulties in recruitment and retention due to substandard working environments. The project will release a number of sites owned by the States that could be better used for housing or other purposes. The Committee will bring an outline business case and policy letter to the Assembly for consideration during 2026.
A year ago, almost to the day, my predecessor, Deputy Al Brouard, stood up to present his penultimate Presidential address. Specific mention was made of the Hospital Modernisation and Electronic Patient Record programmes. A commitment was made to keep the States informed on the timelines, which with respect to the opening of Phase 1, was anticipated as bringing this project into clinical use ‘as soon as reasonably practical in 2025’.
Members of the States, and the public, will know that this target has not been achieved. This delay, while deeply regrettable, is unavoidable and stems from remedial issues that must be addressed by the contractor before the new units can safely operate. While we hope we will be able to open the units in 2026, this is dependent on the contractor rectifying the identified defects. I am pleased to announce that we have recently agreed that the contractor will take back responsibility for the site, which should speed up this process.
The news is positive for Phase 2 of the Hospital Modernisation Project. Phase 2 was originally envisaged to provide additional theatre capacity, alongside a new build rehousing multiple clinical areas. In October 2023 the States agreed to fund Phase 2 at a total cost of £120 million.
Following an increase in the estimated costs, a value Engineering report was completed bringing the project’s expected costings closer to the £120m approved, but with the split of the project into Phases 2A (predominantly new build, including maternity and theatres) and 2B (predominantly refurbishment, notably the Emergency Department), subject to clinical reappraisal.
I am pleased to say that with the input of a Healthcare Planner, a Healthcare construction project management company, our local teams and the Committee, such reappraisal is approaching completion. Further appreciable design changes to reflect our falling birth rate and the modern provision of maternity care have been realised. An outline business case and policy letter will be brought to the States during 2026.
I can also provide an update on the Electronic Patient Record Programme. After some historic challenges as previously reported, and referred to by Deputy St Pier in his statement today, I am pleased to say that we have some good news – the initial release of the EPR for Child Health, Children’s Services and Community Services successfully went live in August.
The next and main release of the programme, to replace TRAKcare with the new EPR, is expected to go live in the first quarter of 2026. While this is later than originally planned, it is a very important step forward in building a strong digital foundation for continued improvements in service delivery and care. We thank Deputy Marc Laine for his advice on, and support of the EPR Programme to date, a role which is being developed further.
I am very conscious of the old adage ‘Promise little and deliver much’, very relevant when I consider the considerable tasks awaiting us at HSC. I have every confidence in the new Committee in achieving much of what we set out to do, recognising that progression of this work may continue into the next term.
Finally, a public health plug, both to members of the Assembly and the wider public. We are potentially facing a very difficult flu season. Please protect yourselves, and others, by getting a flu jab. And don't forget to renew or take out a St Johns Ambulance subscription. As I myself have found out recently, you never know when you may need it.
I thank you Sir, and members, for your time and patience in listening to this Statement. I await your questions with interest.