Putting the case for phase 2 of hospital modernisation

Six consultants from the MSG are sharing their views on why phase 2 of the hospital modernisation programme should go ahead to safeguard patient care for the Bailiwick.

Here’s a summary of the points they made in a recent presentation to States of Guernsey deputies.

Dr Steve Evans, MSG Chair and Consultant General Physician

‘Over the past 20 years, I have seen more and more services crammed into a small building, making it very difficult to provide excellent healthcare to patients.

‘Phase 2 is vital to recruitment. If we are to attract high calibre medical specialists in an incredibly competitive market, they have to know they are coming to an island which values and invests in healthcare.

‘So much time, effort and energy has been invested in this project. We have worked out the details of room sizes, transfer times, walked it all through, and we have a great contractor on site with invaluable experience of working in a healthcare environment.

‘Just a few reasons from my point of view as to why Phase 2 cannot be delayed. Here’s what some of our more recently appointed specialists have to say.’

Dr Michelle Le Cheminant, Consultant Anaesthetist

‘As someone who was born and educated in Guernsey, I’ve got a high personal investment in our healthcare service. All my extended family live here, making use of these facilities, and I’ve devoted nearly half my life training for this role.

‘When I took up my post in 2019 the need to deliver a series of upgrades to the hospital was already unanimously supported by the States. I felt reassured there was a clear vision and credible strategy to deliver high quality, sustainable healthcare to meet the needs of our population.

‘Local waiting lists in endoscopy and orthopaedics remain high and Phase 2 provides much needed additional theatre capacity for both areas. A recent study in the British Journal of Surgery predicted that by 2030, one in five of people over 75 will need surgery each year. A huge number of additional procedures for an elderly, frail population with multiple health problems will place strain on already stretched services.

‘Additional theatre capacity also provides a much-needed all-day emergency theatre so urgent surgical work, often for elderly patients, can be done in daytime hours.

‘One of the major lessons learnt during Covid-19 is that we must be better prepared for future pandemics. Phase 2 helps us do this with isolation rooms in maternity and paediatrics and the flexibility to repurpose facilities.

‘For recruitment in a highly competitive market our setting has specific challenges – an isolated location, demanding a broad scope of practice and in many specialities, a high frequency of on-call. Healthcare workers need to feel valued and achieve job satisfaction, which means delivering high quality care for patients and to do that we need the right facilities. The alternative is burnout, worsening recruitment challenges and ever-rising agency staff costs.

‘I hope I’ve highlighted the reasons why I feel Phase 2 must proceed as planned and on schedule.’

Mr George Cooper, Consultant Orthopaedic Surgeon

‘We’ve all seen the projection of increased demand for healthcare over the next 10 to 15 years. I’m going to focus on hip and knee replacements.

‘Having arthritis in your hips or knees is extremely painful, dramatically impairs quality of life and managing it is very costly to society.

‘Hip replacement has been coined the “operation of the century” because it so reliably addresses this suffering. And studies all over the world have repeatedly demonstrated that it is more cost effective to treat patients with hip or knee replacement than to leave them unable to function.

‘Our theatre efficiency and length of stay in the PEH is excellent by UK standards and has increased remarkably over the last two years. It is at capacity and the waiting list is increasing.

‘And private care for joint replacements provides a large income to the hospital.

‘At the moment we only have one theatre with laminar flow, a special type of air conduction system that Is essential for hip and knee replacements. It’s in constant use. Phase 2 would give us a second theatre with laminar flow.

‘So, if it will cost society more if we don’t increase hip and knee replacement capacity, if people will suffer for longer without more theatres and if they lose income – how can phase 2 be reasonably rejected or delayed?’

Miss Lauren Green, Consultant Obstetrician and Gynaecologist.

‘When I came home to Guernsey in 2021 to take up the post of obstetric lead, part of the attraction was the planned modernisation of women and children’s facilities. The current maternity set up with no immediate access to an obstetric theatre presents a significant risk to local families and staff.

‘The target for performing a ‘crash’ caesarean section is within 30 minutes from decision. This involves a swift transfer to an operating theatre, a place of safety to allow necessary intervention to keep the mother and her baby safe. In every other unit I have worked, the woman in labour is transferred along a short corridor to theatre. Here, the transfer necessitates leaving Loveridge ward, travelling along public corridors past three other wards, calling a lift, turning around sharp bends and past ITU to reach theatres. This is time consuming and undignified for the women we care for.

‘Even as a local, I would have reconsidered my application had modernisation of facilities not already been underway. We want to deliver the best care possible, and need to be supported with the facilities to do so otherwise we risk significant issues with recruitment and retention. 

‘Our current ward environment is no longer fit for purpose. Privacy, dignity and respect are pillars of the care we aim to provide. At present we do not have en-suite facilities for labouring women. It is difficult to provide the care we aspire to when having to ask women to share a toilet.

‘Our day patient unit is located at the far end of the maternity ward, meaning that attenders need to walk past the entrance to labour ward and the inpatient beds. This is difficult in maintaining privacy and infection control, especially during the pandemic.

‘Our current facilities are not adequate to provide the standard of modern maternity care that our island needs, and I urge the States to support progressing with Phase 2 as planned.’

Dr Kate Allen, Consultant Physician and Diabetologist

‘I’m really interested in phase 2 because it includes a complete revamp of outpatient services which would bring together our diabetes team of specialist physicians, nurses and dietitians.

‘To give an idea of the scale of the problem there are currently more than 3000 people living with diabetes in Guernsey. In the hospital today, one in six patients have diabetes.

‘When I first qualified, the traditional model of diabetes was for me to see one patient at a time in a consulting room. It’s just not possible to do this now.

‘The rest of the team and most of my emergency work are at the PEH and yet my clinics, due to lack of space at the PEH, are at the MSG. I need to work alongside the team so that I can make a strategic difference to how diabetes care is delivered.

‘HSC and the MSG have made a considerable investment in smart technology that allows people to better manage their diabetes and reduce the risk of complications. If the team sat together, it would be much easier to remotely monitor a person with diabetes’ condition, with their permission, and call them in if they are struggling.

‘It’s frustrating, because I know how much better the quality of life could be for people living with diabetes if we could work in this multi-disciplinary way.’

Dr Matthew Clark, Consultant Medical Oncologist

‘I’ve worked in quite a few countries so can bring an international perspective. When I worked in Singapore, they were investing hundreds of millions of dollars to prepare their healthcare facilities for the demographic change that they called the silver tsunami, which I think is the crux of the issue.

‘In Guernsey the Government’s own figures show that the proportion of people over 65 is going to increase by 20 to 25% over the next 20 to 30 years. What does that mean for healthcare? There’s a great piece or research from Norway where they looked at the entire population and demonstrated very clearly that more than 50% of hospital services are used by the over 60s. So, this huge demographic shift means a huge increase in the requirement for healthcare.

‘When I was considering the move to Guernsey last year, I heard about the plans to modernise the hospital and I was hugely impressed by the foresight and the understanding of what’s needed. It was a big factor in me coming here, thinking about how over the next 20 to 30 years we can really deliver fantastic care for islanders.

‘And finally, when I popped over to Jersey recently there was a palpable sense of anger and dismay from everyone I spoke to about the delays in building their new hospital. And a sense of disbelief that Guernsey might pull the plug on a much-needed hospital modernisation that is all ready to go ahead.’