Phase 5 could be as risk-free as Guernsey gets

Monday 08 June 2020

The number of people on the waiting list for operations has increased by hundreds during lockdown, however local medical services are now doubling their theatre capacity as they work through lower risk patients ahead of focussing on higher risk patients in Phase 5.

Speaking at the latest media briefing, Guernsey's Medical Director Dr Peter Rabey said there had been a marked increase in the number of operations now being carried out at the hospital and explained what measures are being taken to keep patients safe from Covid-19.

That includes asking patients to self-isolate before they undergo surgery.

"The reason for that is really to protect them from incubating the virus at the time of their operation," said Dr Rabey. "I know it’s inconvenient and we are really grateful to the people who have made the effort to do that."

Dr Rabey said that even in Phase 5, the hospital team will be advising people "to at least think carefully about self-isolating" before their operation. 

After a general lull in normal, day-to-day activity at the Princess Elizabeth Hospital site during the peak of lockdown, Dr Rabey said there has been an increase in service users across the board. 

"The hospital and the MSG are working much more like normal again now, we are seeing more activity coming through outpatients, a big increase in face-to-face outpatient activity compared with phone consultations, and Emergency Department attendances are up again, which is good because it means people have the confidence to come to the hospital when they need to.

Pictured: There has been an increase in activity at the Emergency Department in recent weeks.

"But as Heidi [Soulsby, HSC President] has told you, the story really at the moment is that people are worried about what has happened to their operations and procedures they have been waiting for during this time.

"The first thing I want to say is thank you for bearing with us, because the pressures have been enormous and just like every other jurisdiction in the world we have not been able to do the amount of planned surgery and planned activity we would normally have done.

"We are delighted that we can make a start on that again and we did as many cases in theatre [last week, up to Friday] as we did in two weeks during the lockdown period. We have doubled the theatre capacity with plans to go higher very quickly.

Understandably, Dr Rabey said waiting lists had grown, with 1,400 people added to the waiting list for operations since 1 March and 1,000 able to be taken off those lists. 

"We have been working hard but have not been able to deal with all the numbers on the list," said Dr Rabey. 

During Phase 4, which started 10 days ago, the emphasis has been on dealing with patients who are at less of a risk if they were to contract Covid-19 post-op. 

"In Phase 4 we have been focussing on the patients where the risk to patient is as low as possible even if they were to develop symptoms after their operation," he said. 

"The reason we have chosen this group is that there is some evidence that people that get Covid disease immediately after an operation seem to be at quite a high risk, and so we are concentrating on people who are having less major surgery, people who are younger and a bit less at risk if they were to get Covid.

Pictured: Dr Rabey said his team are trying to protect the most vulnerable patients on the waiting list by holding off until Phase 5 to carry out their operations. 

"Until we know that your chance of coming to theatre and not getting Covid in the post-op period, not because you pick it up in hospital but because you are incubating it when you come into the hospital, and we are trying to protect those people."

It is likely that there will be a significant shift in focus when the island moves into Phase 5 of its lockdown exit strategy.

"When we move to phase 5, and I hope that won’t be too far away, we are going to change tactics a little bit and start concentrating on the very high risk patients who have been waiting for a long time.

"We will be looking at the elderly and people with co-morbidities and people who need their operation but who we haven’t felt it safe to go during this time.

"When we enter Phase 5 the risks might be as low as they ever get with Covid in Guernsey and so we want to concentrate on those patients."

Pictured top: The Princess Elizabeth Hospital and, inset, Dr Peter Rabey.