In March 2019, HSC presented a policy letter to the States of Deliberation setting out its proposals for the modernisation of the PEH. It was unanimously supported by the States and we now embark on an exciting new chapter in its history.
Sir, It was in 1949 that our future Queen officially opened the building that was to bear her name, the Princess Elizabeth Hospital. In those intervening 70 years the hospital has played an increasingly important role in the protection, promotion and enhancement of the health and wellbeing of islanders. The work undertaken 24/7 behind its walls has contributed in no small way to residents having amongst the highest life expectancies in the world.
The hospital, or as we all know it, the PEH, has had such an important part to play in our community since it was opened. It is where life begins and ends. It is where lives are saved or improved, it is where we learn what it is to be a mortal human being and who and what are most important to us.
We should be proud of having such a facility on such a small island. There must be very few places in the world that could boast a hospital providing such a range of services for such a small population. There is a tendency to take it for granted but we should not. We are very lucky indeed.
And that is because over the years previous Boards and Committees in various guises have seen the need to adapt it in an ever changing landscape. New innovations in medical practice, advances in scientific understanding, medical research and technology, have all helped to improve outcomes but they have also put increased demands on the physical infrastructure.
There has probably not been a time when the need to expand and adapt the infrastructure of the PEH has not been either discussed or implemented. Now a few months back I read a piece about post war period of health care in Guernsey written by the much respected Dr Brian Seth-Smith who spent a lot of his working life working at the hospital and who sadly died in January. In this article he talks about Plans for Phase 1A and B to create a new Children’s Ward, operating theatres, central sterilisation department, pharmacy, post-mortem room and supporting service area which were first drawn up in 1966. Apparently, these were thrown out by the then States as being too grandiose, with one speaker stating that he didn’t want a mortuary, as he didn’t see why we should spend money on the dead.
But, plans were eventually accepted in 1971 and that first phase of development was completed 15 years later. Dr Seth-Smith made the comment though that, whilst an excellent design, it was unfortunate that x-ray and receiving room were at the Vauquiedor end, far from the theatres and wards.
The most recent developments covered off the new clinical block completed 9 years ago now, and the Oberlands Centre that was opened in 2016.
Just as it has been a focus for our community over the last 70 years, the PEH Campus has a big role to play in the development of our new model of care – the Partnership of Purpose. We see it as the backbone of the system, with the long term intention that it should be the focus for the delivery of secondary health care, including the acute hospital, mental health services and diagnostics.
However, we are struggling with what we have now. The design is inflexible and makes it difficult to implement new technology and new ways of working. Some of the areas are very dated and costly to maintain. Just recently we had to close a theatre because of a water leak into the air filtration system which followed a more serious leak last year. Added to that there are the problems with asbestos in various areas which mean that when repairs are needed, say in the plant room under theatres, staff have to wear full protection gear and the whole process takes much longer than if it was a benign environment.
We are unable to meet various building regulations and standards because of the layout and parts of the site do not support those with a disability, nor provide the best working environment.
The 10 year modernisation programme that we are presenting to members today is an essential catalyst for change enabling greater integrated patient centred care in a modernised hospital that is safe, flexible to meet future needs and which ultimately will improve patient experiences and outcomes.
The programme is divided into 3 phases to minimise the impact on the delivery of services. At the same time it spreads the capital cost over a number of years and should benefit the local construction industry. Details are provided in the policy letter and I won’t repeat all that is said in there.
However, I think it is important to focus on a few points relating to Phase 1 for which we are seeking funding approval today.
Various reviews, including that by the NMC in 2014 into maternity services, have highlighted the issue of the distance of Loveridge, the maternity ward, from theatres. At the moment staff have to undertake drills to ensure they can get women who need an emergency caesarean section from to the ward within 20 minutes. The main risk area being the fact Loveridge Ward is on a different level to the theatre block and therefore a lift is needed. The plans seek to address this issue.
However, this won’t be just a simple lift and shift of Loveridge and Frossard, the children’s ward, but address other limitations of our current offering. This includes a dedicated area for children and young people presenting with mental health issues, space that is more suitable for adolescents and a means for treatment away from the wards.
Now, the backlog with regard to orthopaedics is well known and thanks to support from ESS and P&R and an incredible amount of hard work by HSC staff, we are now actively tackling it. However, a key limitation to us and what needs to be tackled if we are to minimise the risk of this happening in the future, is the infrastructure. A real pinch point that is impacting on the number of operations that can be undertaken and causes a higher numbers of postponements than we would like is the number of critical care beds. This is an increasing problem as the age of those we operate on rises. Whilst in the past we may not have operated on 70 and 80 year olds, this is becoming more and more common. Those patients are more likely to have other underlying health conditions which means they need more care post-op in the critical care unit beds. We currently only have 7 such beds, which means we are very vulnerable to any emergency or trauma cases that arise. The plan is to create enough space that will enable us to start with 10 beds and later to 12.
The plan is for a new theatre block, to include critical care unit to be built that will enable the latest technology including robotics to be introduced, whilst reducing the problems we are currently experiencing in terms of maintenance.
As part of phase 1, work will be undertaken to identify the most suitable location for MSG staff and consultants. This will then enable any building works to be undertaken in phase 2 and within the 7 year deadline when their current leases expire. Having consultants on site will be conducive to greater integrated and patient-centred care.
Throughout the programme we will be building in better support for those with a disability. This will include signage that will support those with conditions such as dyslexia and dementia, as well as new facilities such as changing places toilets.
The overall anticipated costs for the programme are between £72.3m to £93.4m. The first phase, due for completion by 2021, will cost between £34.3m to £44.3m. It’s probably worth noting that Jersey has spent a similar sum just trying to identify where to put their new hospital. We are fortunate with the site we have.
It is for phase 1 that we seek funding support for now. We will be coming back to the States In respect of Phases 2 that will cover orthopaedics, day patient unit, relocation of MSG, equipment library and private wing, and Phase 3 which will include pathology, pharmacy and emergency department as the programme progresses.
Finally, I can’t finish without mentioning transport and parking. The Committee understands the frustrations for those visiting the PEH who find it difficult to park. It impacts us as we don’t have dedicated spaces and our friends and families. Seventy years ago the PEH had 20 parking spaces. 50 years ago it had 120 spaces. Today there are 750 parking places across the Campus. Those are the official ones, not including people parking across grass verges and down side roads. And still it’s apparently not enough. Whilst at peak times we are around 50 spaces short, outside of those times there are plenty of spaces going spare.
We will shortly be adding 80 additional temporary parking spaces that will help as works get underway. However, we can’t just look at pouring more tarmac over the site. History has shown it just doesn’t work and is not value for money. Thanks to the support of E&I a travel strategy has been developed for the Campus and the Committee will receive the report very soon. We hope that this, combined with the development of new staff changing facilities which is currently underway, will help in the creation of a more sustainable long term solution.
Sir, in summary, the overriding aim of the hospital modernisation programme is to improve the experience of anyone needing our services. From the moment that they arrive on the PEH Campus, get the care they need when they need it and leave. We want that experience to be as stress free as possible and with the best outcomes as possible. But more importantly we want it to be a joined up part of an overall seamless experience of community care for all.