Thursday 14 December 2023
General Update
Thank you, Sir,
In my last update to the Assembly, I spoke at length about the actions being taken by Health & Social Care to tackle the waiting lists and backlogs in two important areas: orthopaedics and gastroenterology.
Twelve months on from the opening of de Havilland Ward; a dedicated nine-bedded unit for orthopaedic care; it is a fantastic achievement that the ward has enabled 463 procedures, including hip, knee and shoulder replacements to go ahead, in addition to a further 144 operations supported by de Sausmarez Ward. Without the dedicated elective beds on this unit, a number of these procedures would have had to be postponed due to significant pressure for beds in the hospital.
Despite the fantastic and sustained efforts by all involved, our demographics are such that the waiting lists in orthopaedics - as in other areas - continues to grow. Those Islanders who are receiving their procedures and coming off the waiting lists are, more often than not, being matched by a slightly higher number being added to the waiting list, and the complexity of cases is also increasing.
As was the commitment made earlier in the year, using monies allocated through the Government Work Plan and with the support of the Policy & Resources Committee, Health and Social Care was able to commission additional services from a visiting provider to offer a 'catch up' gastroenterology waiting list initiative. I'm pleased to report that more than 500 people were seen over nine weekend visits. I know that it will also be of interest to States members that FIT testing has now resumed to support the bowel cancer screening programme and since June of this year, over 3,500 Islanders have received FIT kits.
As is the case with orthopaedics, while this has been an extremely important waiting list initiative, the number of people waiting to be seen remains higher than we would like. Other measures are being evaluated and were discussed only very recently by the Committee in an effort to establish a better baseline position for service provision in this area. Again, as with many of the services offered in health and social care, we need to be responsive to needs as they present themselves, within the resources available and against the ongoing challenges of recovery following the COVID-19 pandemic. The demands being experienced continue to increase and this is impacting right across our mandate and the full range of services that underpin the care we deliver.
Our experience is that the Bailiwick is not isolated from pressures elsewhere and the challenges locally mirror other Western jurisdictions. However, the recent and very important decision of the States' Assembly to support the 'Our Hospital Modernisation Programme - Phase 2' means that we can put in place a long-term plan for meeting the needs of our community. There can be no doubt as to the rising pressures being placed on our health and care services, but with these additional facilities and resources we will be in a much better position to meet the challenges that lie ahead. It will now be full steam ahead in terms of the plans for Phase 2 and we are grateful to States Members for recognising the importance of this development to the longer-term sustainability of health and social care.
We have also been getting on quietly in the background with a range of policy development work as set out in the Government Work Plan, including in some important areas where progress was impacted by the pandemic and there are a few key things that it would be remiss of me not to mention.
The Committee has engaged Solutions for Public Health to carry out a review of the implementation of drugs approved by the National Institute for Health and Care Excellence, or NICE TAs, following the States decision to move towards an incremental position of funding drugs and treatments with an 'Incremental Cost-Effectiveness Ratio' of up to £40,000. The review is considering both the implementation of the programme so far and examining options for future drug funding policy, and this has been supported by some work carried out by CareWatch to describe the impact on patient experience. Work continues to develop the policy letter that will present the outcomes of this review to the States. This is a complex and highly technical area, and we need to consider fully the implications of the next stage of our recommendations to the Assembly so that we can understand and quantify as far as possible the full range of operational and financial considerations as we move forward in this important area. Communication events setting out the findings of the review will take place before the Committee brings a policy letter to the States in 2024 to enable a decision on future drug funding policy to be made.
The Committee's mandate to improve the health outcomes of Islanders through prevention and health improvement initiatives is one that it takes seriously, and it has considered a suite of measures to move towards greater regulation of electronic cigarettes through legislation. This work forms part of the Combined Substance Use Strategy, set out in the Committee's workplan for 2023-2025 in the Government Work Plan. The Committee will soon be launching a political consultation on a wide range of measures but given the resource constraints and other pressures facing health and social care, and wider government, the Committee will carefully prioritise the most urgent concerns that can be achieved through existing legislative powers. Guernsey has in place substantial tobacco control laws and is able to regulate nicotine products through Ordinances made under the Tobacco Products (Enabling Provisions) (Guernsey) Law, 2010. At this time the Committee considers that the most important issue to resolve is the sale and targeted marketing of vapes to children and young people but Officers are also investigating a ban on disposable vapes because cheaper products increase product accessibility to children and others.
The Committee is grateful for the political interest and support it has so far received in relation to this matter and hopes that its proposals will be equally well supported when presented to the Assembly. If and when resources allow, it is possible that the Committee will bring a further proposal to the States to introduce specific vaping legislation to address, among other things, non-nicotine vape products, but we consider these initial changes to be an important and pragmatic first step in bringing greater regulation in this area.
Work is ongoing to implement the remaining parts of the Capacity Law, in particular focusing on the Protective Authorisation Scheme. As mentioned previously, this is a complex but extremely important piece of work that will have an impact across Health and Social Care and the care home sector. In particular, we have been looking at the formation of the adult advocacy service and engaging with the Third Sector to support this development. The service will provide independent support for people lacking capacity who have no one else to act as their voice when it comes to their treatment and care. We have also been working closely with colleagues in Alderney and Sark with regard to the preparations for this next part of the Law to come into force and are planning further stakeholder engagement in the New Year.
Members will be aware from the two briefings held to date that my Committee, the Committee forEmployment & Social Security and the Policy & Resources Committee are working collaboratively on the development of a new community long-term care model and its funding, as part of delivering the Supported Living and Ageing Well Strategy agreed in 2016 and the subsequent, related directions of this Assembly. The purpose being to seek to grow and stabilise long-term care provision so that we can meet the care needs of the community as it ages and demand for more complex care increases.
The work to explore the options and assess their impact is well advanced and we are now able to seek the views of those involved or impacted by the potential changes. We are currently consulting with key stakeholders including care homes, third sector groups and CareWatch to name a few, on those options that clearly demonstrate they are the best options available to us to meet the aims of designing a fair, affordable, and sustainable model, where person-centred care and a person's independence is enabled and where there could be greater certainty over how that care is funded for many years to come. Independently run focus groups are also being held with members of the community to seek their views on the core aspects of the new model and the changes it presents.
Following which a further briefing will be held with States Members in January on the refined options alongside public events, details of which will be published in due course.
Work also continues on the implementation of a suite of legislative amendments to the Children Law, as agreed by the Assembly, and to progress those key cross-Committee workstreams captured in the 2023 to 2026 Children & Young People's Plan.
On one important final note, I have seen during my time as President of HSC a real coming together of our teams and this was also true of the preparations for Storm Ciaran. On behalf of the Committee, I would like to acknowledge the commitment of our staff and our partners in maintaining essential services in difficult circumstances. Your dedication to the community again shone through and we are fortunate to have such resilient support at crucial times.
I have only been able to touch on a few aspects of the significant mandate of Health & Social Care in this statement given the number of activities and priorities being handled every day, but I am pleased of the opportunity to update colleagues on our key priorities at this time.