HSC Transformation

The Partnership of Purpose represents a major overhaul of how islanders will look after their health and wellbeing and access the care they need going forward. It was instigated by a 2017 Policy Letter to the States of Deliberation which recognised that our current health and social care model will not cope with future demand, largely due to our ageing population.

In many cases, services need to be brought up to acceptable modern standards, with the essential upgrades to the Princess Elizabeth Hospital perhaps being the most obvious. But our health and social care services extend so far beyond the hospital, and the overall objective of the whole system is to keep people as healthy as possible and out of hospital. This means that ensuring all the non-acute community-based health and social care services are equally fit-for-purpose and easy to find is just as important. 

So simply put, The Partnership of Purpose is about making our health and social care provision as efficient as possible. It's about empowering people to lead healthier and happier lives while knowing how to access to the right care when they need it.

It's a collective effort, calling on the public, private and third sectors, to work collaboratively to future-proof health and social care services. The States of Guernsey is taking the lead in facilitating this change.

A community-wide effort

Why does health and social care provision need to change?

Life expectancy is going up, which means if people keep accessing healthcare in the same way they'll need more of it throughout their lives and the system won't be able to cope with demand.

So the whole way we access health and social care needs to change. On the one hand, the services that the public, private and third sectors offer need to adapt. But equally importantly, individuals need to be encouraged and supported to be more proactive in leading healthier lives.

What do we mean by this? Think of it in the sense that some elements of our health are within our control - perhaps our general fitness or nutrition - whereas unfortunately some elements of our health are outside our control - like the risk of unexpected illnesses or aspects of our menial health. We should all be responsible for keeping as healthy as possible, in terms of what is in our control, as this will help free up health and social services for where they are needed the most.

What can I do differently?

An efficient healthcare system means people should always have access to the right care they need. If you need acute care there will be a hospital bed for you. If you need a GP appointment you should be able to book one promptly at a time that suits you. But it is in all our best interests to ensure we only call on these services when we genuinely need them. Adopting the right personal behaviours around health and wellbeing is key.

A preventative mindset is a bit of a buzz phrase, but what does that mean?

In one sense this might mean acting on any ailments swiftly. Prompt diagnosis will often lead to quicker and simpler treatment or cure. Better for the individual and less impact on the system.

A preventative mindset also means avoiding the risk of health complications in the first place, perhaps though better diet, exercise and general wellbeing. Some people will need a little helping hand to make those lifestyle choices. That might come from knowing the right charity to call on or self help route to go down, rather than a GP always being the first port of call. Every little behavioural change like this will help make health and social care provision more efficient. It's all about ensuring resources are targeted in the right way.

We are modernising the Princess Elizabeth Hospital into a future-proofed, fit-for-purpose facility for patients and staff.

The need to deliver a series of hospital upgrades was unanimously supported by the States of Deliberation in March 2019 and subsequently prioritised within the Government Work Plan in 2021. It is an essential part of the ongoing strategy to transform the provision of health and social care services so that it can respond to the Bailiwick's ageing population and manage ongoing fiscal pressures.

Upgrading the hospital is a priority because demand has already outstripped capacity and facilities across the hospital need to keep pace with modern standards of design and operation.

We now have an overall plan to complete the proposed upgrades across two phases, with careful sequencing of work to ensure minimal disruption to hospital services throughout - we must maintain a fully-functional hospital while we upgrade it. Phase 1 has been fully approved. Phase 2 will be subject to separate business case approvals. 

Rihoy & Son is constructing Phase 1 of the planned works following a robust tendering process conducted with the local construction industry.

 

Hospital phases at a glance

 

Phase 1

Works on site started in March 2022, involving the refurbishment and extension of the old Ozanne Ward, extending the building’s footprint to the south.

Scheduled to be completed over two years, the works will deliver a new purpose-built Critical Care Unit (CCU) with increased capacity from 7 to 12 beds to manage demand and support additional surgery, and a new Post Anaesthesia Recovery Unit with 10 beds that can be swiftly converted to provide additional critical care beds (to support for example any future pandemic demands or other emergency situations). It will involve the refurbishment and extension of the old Ozanne Ward, extending the footprint to the south.

The new CCU will feature modern single rooms with natural light and a new courtyard facility which is recognised to enhance patient experience and recovery. New staff and relative’s facilities will be put in place as part of the Phase 1 works

Watch the video below for a virtual walk-though of the new CCU:

Phase 2

(Still pending full States approval)

Phase 2 is due to start in 2024 and will take up to four years to complete. It will involve an extension being built out from the current main entrance. Alongside this new build will be significant refurbishment work of existing internal spaces to update facilities and rearrange the overall layout to create the best adjacencies between departments.To that end, a focal part of Phase 2 will be a new main entrance with an interior atrium spanning all three levels, making it a lot easier for people to visualise the different parts of the hospital and find their way around. 

 

The new CCU's single rooms is depicted in the architects’ image below, noting that the final plans may be subject to some amendments in terms of finish.

 

 

New Facilities

Please use the drop downs below to find out more about what is proposed in Phase 2. 

Maternity/Neonatal Intensive Care Unit

Purpose built from scratch

Adjacent to the new theatre block 

All single rooms with facilities for partners to stay

Outpatient facility for minor procedures

 

Paediatrics

All single rooms, with computerised tech appropriate to age of occupant

Front of new ward will have outpatient facility to reduce stress for minor procedures

Theatres

Increased capacity

Facilitates future expansion to eight theatres

 

Admissions and Discharge Unit

A new facility to help alleviate pressure on beds

 

Private ward

A new purpose built 23-bed unit

An appealing facility with own outside entrance akin to UK private hospitals

 

Ambulatory Care

Adjacent to the new main entrance, this new unit will provide 'hot desk' clinical space, enabling the centralisation of all out-patient clinics

Departments throughout the hospital will operate services from this space

 

Breast screening

A new purpose-built facility will support pre-operative procedures

Emergency Department

Separate entrances and areas for major and minor medical cases

Single rooms

Suitable facilities for vulnerable adults. Direct link to CCU

Fracture clinic

Adjoining the Emergency Department and with close proximity to radiology

Orthopaedics

A modern facility with adequate space, separating elective and trauma

Onsite physio gym to aid rehabilitation

This programme to replace HSC's electronic patient record system was approved by the States of Deliberation in 2020 as a key element of the Partnership of Purpose. It is both a necessity to replace and update key software in use across HSC but also represents a significant step forward in terms of the way digital health records can be managed and utilised. It is working towards creating one electronic view of each patient providing a modern experience of technology that our clinicians and service users expect.

The first elements of the new EPR are due to go live at the end of 2023 and the full system is scheduled to be in place by the end of 2024. 

The new EPR will be provided by two experienced suppliers, who will work together to create one integrated solution. IMS Maxims will be used for Acute & Mental Health services and Access (formerly known as Servelec) will be used for Community, Child Health and Learning Disability services. Contracts for each of these suppliers were completed in May 2022.

There is ongoing significant clinical input, led by MSG consultant Dr Steve Evans who has been seconded to work full time on the project. 

Progress

Confidence in sourcing the right solution

The London Procurement Partnership framework was used to select six suitable bidders, with this shortlist narrowed down over three procurement phases. Each phase assessed what was needed from the system by looking through four key aspects of the health service - Acute, Mental Health, Community and Child Health. In phase 3, bidders had to demonstrate their ability to meet 1,000 individual requirements across each of these four lots

This procurement process saw input from 60 practitioners from across HSC and MSG. Technical input was also received from the States IT partner, Agilisys 

Summary of the new system
  • Replacing all functionality currently provided by TRAKCare,
  • Fill current gaps in the functionality e.g. CCU, Domiciliary Care, electronic prescribing and billing,
  • Specialist systems will be retained,
  • Consistent platform to further transform health & social care processes.

In addition to the new EPR solution, the programme will also explore the opportunity that exists to digitise historical (paper) records.

This programme is focussed on integrating HSC's  wider health and care system (including partner organisations) to improve service awareness and accessibility. It is recognised as a key element of the Partnership of Purpose.

The community services run by HSC and other partner organisations are currently scattered across the Bailiwick and many are housed in unsuitable premises. This needs to change to provide easier access and help de-stigmatise services.

Community services

The long-term ambition is to create a community hub, which would see multiple complementary services within a central location. In the short-term this programme is implementing service improvements and new ways of working to help deliver efficiencies. This is seeing some services being relocated or co-located. 

Key work in progress is to upgrade HSC residential accommodation to a standard akin to the Autism Hub. This joint public-private sector initiative enabled a high quality facility to be delivered in a very cost-effective way, and has led to substantial social and quality of life improvements for service users - see pics below. It is now regarded as the benchmark standard for future developments. 

Autism hub

 

 

Progress

Over the last four years, HSC has been working with public, private and third sector providers to develop this new model of health and social care, with two key strands of work taking place to date:

1. Laying the foundations for the transformation, which has included: 

  • Progressing the design work to modernise the hospital site
  • Exploring the development of complementary community hubs
  • Procuring the new electronic patient record (My eHealth record) system
  • Reforming how health and care funding is managed within the States of Guernsey
  • Receiving approval for the future model of health and care regulation

2. Developing new and improving existed services aligned to the values of the Partnership of Purpose.

These have been wide ranging but have included the development of social prescribing, the commencement of a programme of joint strategic needs assessments to better inform how and where services are most appropriately provided and numerous projects looking to improve islanders' experiences, for example the introduction of a new diagnostic service in cardiology, advances in pain management and work to provide greater support to some local families.

Social prescribing

HSC is now in a position where it can start formally accrediting those public, private and third sector partners working to realise the Partnership's values. As an initial step, the first five members of the Partnership of Purpose have been announced. Each organisation plays a different role in the overall Partnership; either by providing frontline healthcare services, raising awareness, seeking to shape future policy or providing preventative services to the community. Together they have demonstrated their commitment to working towards a healthier and happier Bailiwick.

Members of the Partnership of Purpose

The Health Improvement Commission

Established in 2018 and bringing together public, private and third sectors, the Health Improvement Commission seeks to empower, enable and encourage healthy living in Guernsey and Alderney. Their work focuses on four main areas; Be Active, Eat Well, Healthier Weight and Substance Use. The importance of their role was clearly demonstrated throughout lock down as they supported islanders in eating well, through, for example, supplementing nearly 1000 Guernsey Welfare Service Food Bank parcels with approximately 8,630 adult portions of fresh vegetables and fruit and encouraging islanders to be active. They maintained access to weight management services through phone and online-based provision and the Substance Use work stream continued to offer information and practical help through the drug and alcohol agencies it supports. During those difficult times of lock down, it was vitally important to continue to provide local, confidential support for alcohol, drugs, domestic abuse and mental health. As our community moves forward, the Commission continues to advocate for environments which make it possible and easy to live healthily across the Bailiwick.

Choices

The local charity works to empower individuals to make positive choices about their reproductive and sexual health, providing an accessible, confidential and affordable service which provides non-judgemental, individualised advice. They work closely with a range of stakeholders to reduce the rates of unplanned pregnancies and abortions and are the main providers in the Bailiwick for free contraception for under 21s, a project jointly delivered with the States of Guernsey and which has seen teenage pregnancies reduce dramatically since it was introduced.

Beau Sejour

As the Island's only community based sports and leisure centre, and with a footfall of approximately 600,000 per annum, Beau Sejour plays an invaluable role in supporting islanders' access to physical activity. It is the only facility on-Island offering Exercise on Referral 'LifeFit' sessions (689 individual referrals made in 2019) and Aqua Health Referral sessions to the local community. In addition, the Active Health team deliver other specialist classes such as CanMove (exercise classes for individuals who live with or are recovering from cancer treatment) and MoveSmart (exercise classes for individuals with Multiple Sclerosis).

Queens Road Medical Practice

Working with HSC and the private sector, QRMP has developed the first genomic screening programme in the Bailiwick to identify and treat people with the genetic condition Familial Hypercholesterolaemia. The disease, which results in high levels of cholesterol that can lead to cardiovascular disease, the leading cause of preventable death in the developed world, is significantly under-diagnosed in the British Isles and the programme is aiming to be one of the most effective in the world.

Public Health Services

While brought to prominence through COVID-19, Public Health provides a vital role ensuring our population is as healthy as possible. By assessing, measuring and describing health and wellbeing, as well as health risks, health needs and health outcomes for our population, Public Health Services provides the evidence for shaping health and care across the Bailiwick.

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