During last years UK General Election the various political parties focused on the NHS and whilst promising different cures, the ills were generally recognised as the same: increasing patient demand outstripping limited resources.
Here in Guernsey we face similar pressures for the same reasons; with our ageing population and medical advances inexorably driving increased demand. Whilst the number of people living in Guernsey will change little; it is forecast that over a 25 year period from 2010 we will see a shift from having four working adults to every one old age pensioner, to three adults aged under 65 for every two aged over.
Combined with this shift in economic demographic is the fact that many significant medical problems such as cancer, heart disease and strokes are more common in the elderly. To illustrate using my own speciality, Intensive Care Medicine, the eldest one sixth of the population make up half of our patients.
To give some context to the rise in local demand, our Orthopaedic surgeons saw 12,551 patients in Outpatients in 2018/19, compared with 10,405 in the previous 2 years; an increase of over 20%.
This upward trend in Orthopaedic demand is unlikely to slow. For example, osteoarthritis is a condition that develops slowly over the years, so naturally the MSG has seen significant recent rises in demand as our local population ages. Not unsurprisingly the increasing number of patients seeking treatment has affected inpatient waiting times, which last year received much local publicity.
Recognising this escalation in demand there have been significant efforts made to reduce patient waiting times. The States of Guernsey took steps last year to fund an additional anaesthetist, which enabled our Orthopaedic surgeons to maximise current local inpatient capacity, which is limited by virtue of the fact that orthopaedic operations require an ultraclean theatre.
The outcome of this investment was that a record number of orthopaedic patients had an operation in Guernsey last year. In addition, the States also funded a significant Orthopaedic Waiting List Initiative, with patients being operated on off island or at weekends, to reduce both the numbers waiting and the length of time a patient waits. We were pleased to play a full role in this work and will continue to support efforts to manage this demand on island.
However, the most significant news of 2019 was the States of Guernsey voting unanimously to support Health and Social Care’s proposal for a ten year programme to modernise the Princess Elizabeth Hospital, in support of The Partnership of Purpose. The MSG is delighted with this decision as there is currently no spare capacity in the hospital, so this investment is needed if the hospital is to be “fit for purpose” for those we serve enabling the MSG to meet the increase in patient demand for surgery on island.
Up to £93.4 million pounds in total has been earmarked for a three phase project, with £44.3 million for Phase 1, which will deal with the most pressing infrastructure needs. Behind the scenes the MSG and HSC are putting in a significant amount of work to ensure that the developments at the PEH lead to a hospital that not only meets the Islands needs today but is also going to meet the demands put upon our healthcare infrastructure in the future. For anyone looking for further information on the modernisation programme, please visit the States of Guernsey website, https://www.gov.gg/pehmodernisation.
However, as a cautionary note, investment in infrastructure alone will not meet the growing patient needs of the island, the extra ward beds and operating theatres will need to be staffed. There has been much publicity about a national shortage of nurses for some time, but the combination of the recent UK General election and fears related to Brexit have brought into a sharp focus the significant shortage of doctors in the UK, both of GP’s and Consultants. Many EU nationals have been backfilling UK posts, so concerns with regards to shortages are well founded if indeed we find that Brexit encourages them to leave. Uncertainty remains and we should watch this developing situation with caution.
On a positive note, the UK has increased training numbers for medical students very significantly in response, but it will take more than 10 years for these extra students to mature into senior doctors. The British Medical Journal recently reported a census conducted on behalf of the Royal College of Physicians (RCP) that showed that 43% of advertised Consultant Physician posts in England and Wales went unfilled, with over half of the recruitment failures receiving no applicants at all.
Senior doctors in the UK, our prime recruitment area, are therefore currently in a buyers’ market. Guernsey, with a Consultant delivered service, remains very dependent upon being able to recruit and retain high calibre candidates; so it’s very important that, as for nursing, efforts are made by allied sectors in Guernsey to support us in welcoming new staff and their families. We have in the last few months lost high quality candidates because of issues with housing or schools, which is regrettable and probably unsustainable. Doctors will vote with their feet; the RCP census showed that North Wales is currently the most unattractive area, with 73% of appointments unsuccessful. Guernsey does have the advantage of its independence, so hopefully can continue to compete successfully in what will be an increasingly tough market; we will need to continue to make ourselves as attractive as we can.
Lastly, I can’t let 2019 pass without a special mention regarding the retirement of Dr George Oswald after 34 years of Consultant service in Guernsey. George is the last of the doctors who founded the MSG to retire. We are indebted to those doctors who had the vision to realise that medicine was becoming increasingly sub-specialised and that the GP model for delivering specialist hospital care was therefore unsustainable. They had the drive and determination to coalesce all of the secondary care doctors into a single team, which gave the States of the day one organisation to negotiate with, leading to Guernsey being in the enviable position of being able to offer all Bailiwick residents access to Secondary Healthcare free of charge at the point of delivery. I believe that all of us in Guernsey today, on both sides of the fence, patient or hospital Consultant, owe them a great deal of gratitude.
So, in summary, 2019 has again demonstrated that medical care delivery never stands still. At the same time as we say farewell to the last founding doctor of the MSG to retire, we embrace the States of Guernsey’s significant new investment in modernisation for the PEH. The challenges will be ongoing and we at the MSG will continue to play our role to the best of our abilities in delivering the best healthcare that we can to those who live in the Bailiwick of Guernsey.