Marc Leadbeater: Improving our health

The new Committee for Health & Social Care (HSC) will face many of the same challenges that the current one has. In fact, they are the same challenges seen in health and social care across western society.

I think it is important for our community to understand that the annual budget for HSC is not solely about the Princess Elizabeth Hospital campus, but has wider reach across multiple health and social care settings in the Bailiwick.

Recruitment and retention of staff has been one of the most challenging areas for HSC this term. The most frustrating part is that many of the levers needed to address the issues are located out of the committee. For example, pay and terms and conditions are the responsibility of the Policy & Resources Committee, as it acts as the employer for all staff, and key worker housing is currently split across three committees: P&R, which holds the purse strings, Environment & Infrastructure, which is responsible for housing policy, and Employment & Social Security, which provides key worker and social housing in conjunction with the Guernsey Housing Association.

Right at the beginning of this term, when the current HSC Committee was formed, we very quickly became aware of the massive issue faced in respect of key worker housing. One of the first actions the committee undertook was to write to P&R to raise a red flag and ask for immediate support. We needed to house hundreds of key workers to fill the hundreds of vacancies we had in the organisation. The local housing market was already bursting at the seams and we didn’t want to have to continue, as has been happening historically, to compete with the local population for accommodation for our staff. We desperately needed housing for our staff that would not negatively affect the wider local market. In fact, if we had enough key worker units for our staff, we could vacate the approximately 140 local market units we currently rent and release them back onto the local market to accommodate the general public. Pitching local people against incoming key workers in competition for housing is a terrible policy and has caused a rift between locals without adequate housing and the key workers HSC needs to keep the wheels turning. We need to reverse that trend.

The transformation of HSC, including the modernisation of our estate and facilities, and the way we fund and deliver health care and social care, is a massive undertaking with many workstreams that will span electoral terms because of the sheer volume of work needed, and also the resources, both financial and people. Lots of the workstreams we undertake also need input or support from other committees.

Operational matters at the PEH or the Oberlands, for example, are live issues that have to be dealt with in real time because our services operate 24 hours a day, seven days a week, 365 days a year, and therefore our team cannot simply switch off, shut down and go on holiday. Consideration needs to be given to the fact that we only have one hospital in Guernsey, meaning we don’t have the luxury of being able to send patients to the nearest hospital with capacity if we experience any catastrophic events, like NHS trusts can in the UK. This means that we must have a modern, fit- for-purpose, resilient hospital with enough capacity and resources to provide the level of health care needed for a growing society with diverse and complex needs. Given the structure of the Bailiwick’s population, it is inevitable that the HSC will need greater resources in the future to meet the increasing demands for both health and care from our local population.

Currently our maternity ward is on a different level in our hospital to that of our operating theatres. This presents a potential risk for mother and child if a birth experiences complications and an emergency surgical procedure is needed. If complications are experienced during birth, the time frame for transferring a mum from maternity to an operating theatre is a maximum of eight minutes. If the lifts at the PEH are out of order, the patient has to be taken out of the hospital and wheeled around the hill to a doorway on the same level as the theatres. This is not an acceptable risk to manage, especially as we have experienced issues with the lifts not too long ago. I cannot emphasise enough the importance of the extra theatre capacity and revised clinical adjacencies of Phase Two of the ‘Our Hospital Modernisation’ project to the continued delivery of first-class services now and in the future.

Moving on from physical healthcare to mental health provision, I am proud to have been involved in designing and rolling out the new Mental Health and Wellbeing Strategy (MHWS) 2023-29. I chair the MHWS technical team made up of professionals from HSC, Education, Sport & Culture and Home Affairs and third sector organisations such as Guernsey Mind and Guernsey Suicide Awareness (formally Talking Benches), which also has valuable input from those with lived experience of the mental health system in the Bailiwick. The strategy was launched in September 2023. There has been excellent progress across the four pillars of the strategy which will be explained when our first full annual report is published in the next couple of weeks.

Social care is probably the most rapidly growing area of the mandate of HSC. The words ageing demographic make you think of people living longer and requiring more interventions, surgery and medication. But the vast majority of the older generation will also need social support as they grow old, such as domiciliary care so they can continue to live in their own home or in an alternative setting. The projected number of new care beds needed over the next 15 years is 350. That’s the equivalent of a home the size of Greenacres coming online every two years for the next 15 years. In my opinion, without States intervention, it’s simply not going to happen. The Assembly did pass some funding changes for payments to residential homes to stimulate the market, but more operators seem ready to leave the sector than enter it.

When we don’t have enough beds in residential homes and there’s not enough domiciliary support to look after people in their own homes, we must care for them at the PEH. When we have a lot of delayed discharges in the PEH, it has a negative knock-on effect on the services we can provide. At times we’ve had to cancel elective surgery because there simply weren’t any beds available. Without enough extra capacity in the care home sector, this issue will be exacerbated in the years ahead, and it’s of paramount importance that the States works with the private sector to deliver workable solutions.

We have a brilliant team of professionals and officers who support HSC. I’ve found the experience of working on HSC this term different to my experiences last term on Home Affairs, ESC and the Development & Planning Authority. I gained valuable experience on each committee, but there’s something different about HSC. The mandate is extremely broad and the work often complex in many ways, and it gets under your skin. You feel far closer to the front line, especially as the decisions the committee makes can have a profound impact on the health and wellbeing of individuals and our entire community.

Many of the challenges that this committee has faced since its formation in October 2020 will continue, and the opportunities for transformation and hospital modernisation need to continue to be progressed in this fast-paced environment.