Wednesday 20 November 2024
General Update
Thank you, Sir,
I would like to update the Assembly on the positive progress in transforming our health and social care provision, into appropriately equipped and resilient services, capable of meeting both the increasing and changing needs of our community.
I am pleased to advise that Phase 1 has largely been built. This includes the new build Critical Care Unit (CCU) and Post Anaesthetic Care Unit (PACU) facilities, as well as the new electrical infrastructure upgrades. There have been several opportunities for our clinical teams, senior leaders and our colleagues in the Policy & Resources Committee to tour the new facilities, with the feedback received being overwhelmingly positive.
Looking ahead, what follows next is a programme of bringing the facility into use for both staff and service users as soon as reasonably practical in 2025. This will involve an intensive process of fitting-out of the new area, relocating the Critical Care service and the provision of appropriate training of all the clinic staff with the new area and medical equipment.
My thanks and appreciation must go to all of those Teams who have and continue to work tirelessly to get us in this position. These new facilities will provide another step to the best possible working environment for our professionals in our delivery of healthcare of the future.
Turning now to Phase 2 of the Programme. As I advised the Assembly in May this year, the Committee commissioned an independent firm to review its plans for this important next Phase of development of modernising our hospital facilities. The information provided by this value-engineering exercise is going to be hugely beneficial in understanding how we can best move forward in a fully informed way. We are currently clarifying a number of points so that we can find a pathway through that will deliver the facilities and benefits afforded by Phase 2, aligned as closely as possible with needs, expectations and budget. The outputs of this exercise to date have been positive. However, as with all major capital projects, we need to do further due diligence and we're meeting with the Policy & Resources Committee again shortly to continue our discussions and determine next steps.
With the budget debate fresh in our minds, we must remember that this is not just about cost; the dialogue must be about the service resilience that these new facilities will bring to our community over at least the next 30 years. We need to continue to find more sustainable ways to deliver the range of health and social care services that will be needed for our ageing population. Phase 2 remains fundamental to that process. Without it, Islanders will wait longer for essential procedures; we'll have to increasingly look to off-Island providers for services not without cost; without it staff will need to meet increasing demands in facilities that are lacking, health outcomes will be affected, and no doubt we'd be storing up problems for future generations.
The Committee is unwavering in its commitment to deliver the benefits of Phase 2 in a fiscally prudent way and will continue to keep States Members updated.
Another critical element of the HSC Transformation Programme is our continued work on the Electronic Patient Record replacement, or EPR.
In my September statement, I advised that due to challenges with resources and complexity, the completion of the first stage of the implementation of the new EPR is forecast for the end of June 2025, with further stages to complete by the end of June 2026.
I noted that this is a large and complex programme, and that the Committee does not wish to compromise on scope or testing, but to ensure that a safe and effective programme of digital transformation is delivered for the benefit of all islanders. I also noted that the cost forecast for the Programme is now around £22.2 million, and that we will be working closely with the Policy & Resources Committee regarding funding.
Work continues at pace to deliver to this timeline, with the current focus on migrating data from the existing systems and on the thorough testing of the new EPR by a team of clinicians in Health & Social Care and the Medical Specialist Group. Feedback from the testing teams so far has been very positive, as the staff are now getting the new tools in their own hands and are able to see how they will work in practice for their teams.
As noted, this is complex work, and inevitably there will be more bumps in the road to overcome as we progress. While there are some challenges with the timely delivery by our key infrastructure supplier, the current projection does still remain for the replacement of TRAKCare at the end of June 2025. The Programme team continues to monitor progress and risks, and regularly report to the Governance Board and to the Committee.
I can confirm that the Committee has made a request to the Policy & Resources Committee for the additional funding to support the revised cost forecast of £22.2 million, and based on the discussions between officers at HSC and Strategic Finance, for the provision of a 10% optimism bias, should further unknown challenges materialise.
We will of course keep the Assembly advised on the continued progress of this important and beneficial programme. Indeed, yesterday HSC held a productive session to provide Members who expressed an interest following the States Meeting on 4 th September to discuss EPR and a further opportunity to ask questions. The additional information made available at this session will be circulated to States Members shortly.
I will now move on to update the Assembly on the positive progress made in relation to the 'Our Community Services' projects.
Works are progressing well for the much needed, new specialist residential provision at L'Islet, known as 'La Vielle Plage'. Once completed this will provide 14 bespoke flats tailored to meet the needs of the future residents, who have varying degrees of learning and physical disabilities.
Through the Guernsey Housing Association and its construction partners this is now a busy construction site with the bones of an impressive looking building. The site is nearing the stage of being wind and watertight, and is a great milestone, and it is due to be ready for occupation next summer. It is an exciting time for all involved in this long-awaited project.
In relation to the Children & Families Hub, the Project is now progressing, and options are being explored for co-locating services which support children and their families at the Raymond Falla House site.
The Children & Families Hub will deliver significant benefits, including;
o Improved outcomes for children and their families, through enhanced access to and co-ordination of services;
o An improved working environment for staff, supporting recruitment and retention; and
o The ability to exit and return buildings to States Property Unit for sale or repurposing.
A wide range of stakeholders have been engaged, and the requirements to support future service delivery have been scoped. Thank you to all involved in that detailed exercise. On completion of the detailed Options Appraisal for the physical premises design, a Business Case will be submitted for support and funding consideration.
I would now like to move on to focus on some of our key pieces of policy work. I advised in my December statement last year that the Committee had engaged Solutions for Public Health to carry out a review of the implementation of drugs approved by the National Institute for Heath and Care Excellence, or NICE TAs. We have delivered on this promise and this matter is scheduled for debate during this States meeting.
Likewise, I advised that as part of the Committee's mandate to promote preventive measures, to improve health and wellbeing, we would move towards greater regulation of vapes. Again, we have delivered on this commitment, and are seeking approval of The Vaping Products (Enabling Provisions) (Guernsey) Law, 2024 during this States meeting.
It will be the sub-ordinate legislation that will set out the prohibition of selling vapes to children, introduce advertising restrictions, establish a retail licence scheme and ban the sale of disposable vapes. This legislation is being drafted and our Officers are beginning the work to consult with colleagues in other departments, such as Environmental Health and Customs, before those drafts can be finalised and presented to the Committee.
It is our intention to submit that sub-ordinate legislation to the Assembly before the end of the political term.
With regards to the Capacity law, work continues to progress on implementing the parts of the Law relating to the Protective Authorisation Scheme. The Committee has recently approved a phased approach, that it is hoped will see parts of the Law come into force this political term. This includes concepts around capacity and best interests, advanced care planning, and Advance Decisions to Refuse Treatment, with the remaining parts relating to the Protective Authorisation Scheme coming into effect in the second half of 2025.
As I have highlighted before, this is a complex and incredibly important piece of work that will have a far-reaching impact across Health and Social Care and the care home sector, as well as the wider States and the Bailiwick as a whole. As part of this work, we are also currently engaging with various Third Sector organisations to provide an adult advocacy service. This will provide independent support for people who lack capacity and have no one else who can act on their behalf when it comes to treatment and care. It presents a great opportunity to utilise the skills and knowledge present in the Third Sector as a commissioned service.
A new Capacity Law webpage on the States of Guernsey website has recently been launched and includes items such as the Code of Practice and different information leaflets. This site will continue to be updated over the coming months. Given the scope of the work there will also be further engagement taking place in the coming months, including with colleagues in Alderney and Sark to ensure that they are also able to take these steps to implement the Law.
Just drawing to a close, I would like to acknowledge the continued efforts and hard work of all those involved in managing the ongoing waiting list challenges. While waiting lists generally remain higher than any of us would like, there are approximately 400 fewer people waiting for inpatient admissions compared to this time last year and this is a significant achievement.
I was very pleased to recently announce that HSC has partnered with Newmedica to offer Ophthalmology patients treatment off-island to reduce the waiting time for both cataract surgery and outpatient appointments. We must also recognise the additional work in orthopaedics and gastroenterology which have reduced waiting times, and the many other steps taken across Health & Social Care and the Medical Specialist Group to tackle waiting lists in other areas.
As I and my fellow Committee Members will continue to advocate, the ongoing modernisation of the hospital is a critical factor in our long-term management of waiting times.