MSG Consultants have had 67,084 patient interactions across outpatients, inpatients and theatre operations in 2020.

OUTPATIENTS

• 48,143 outpatient episodes were undertaken
• 33.8% were new appointments
• 66.2% were follow ups
• 80.6% of appointments were contract patients and
• 19.4% were private

Orthopaedics saw the highest number of outpatients at 8,682; of which 3,373 were in fracture clinic and 5,309 at MSG.

Outpatient clinics are held mainly at the MSG’s premises at Alexandra House and Mill House. Some clinics are undertaken on the PEH premises (oncology, cardiology, day assessment unit and at the breast unit) with a few paediatric clinics being undertaken in the community or on other States premises. Some clinics are also undertaken in Alderney.

INPATIENTS

• 12,694 inpatient episodes were cared for by MSG Consultants at the Princess Elizabeth Hospital.
• 76.7% (9,741) were elective episodes and 23.3% (2,953) were emergencies.
• This total figure is lower than last year due to elective admissions being reduced during Covid-19.
• This also means that a higher percentage of the admissions were emergencies.
• 79.9% of the episodes were contract and 20.1% were private.

THEATRE OPERATIONS

The highest number of inpatients were in the general medicine department (3,381 including geriatrics, rehabilitation, diabetes, respiratory, stroke, cardiology, gastroenterology and nephrology) followed by oncology (2,247). Orthopaedics had 1,237 inpatients.

6,247 theatre operations were performed during the year. 91.1% (5,692) were elective and 8.9% (555) were emergencies.

72.4% of episodes were contract, 26.7% were private and 0.9% non-contract.

Theatre operations by highest number:

• General surgery 1,138
• Orthopaedics, 1,090
• Gastroenterology 1008

All inpatient, outpatient and theatre procedure totals have been impacted by the coronavirus as you can see from the comparison table below:

	2019	2020
Inpatient	Total 14,852	12,694 (14.5% Lower)
Outpatient	Total 53,455	48,143 (10% Lower)
Theatre	Total 8,262	6,247 (24.4% Lower)

CAPACITY

As the Bailiwick attempted to contain the spread of the virus on the island in March 2020, safety measures were implemented to ensure the Princess Elizabeth Hospital (PEH) operated safely and effectively during the Covid-19 pandemic.

Yet, with 252 positive cases on island during the first wave the hospital remained relatively stable with a low number of admissions with the infection. This was unlike much larger jurisdictions such as the UK and Italy which saw doctors and nurses overrun as hospital admissions rose drastically, causing a significant impact on their hospital infrastructure and forcing them to operate at much less capacity as a result.

In order to ensure the PEH operated safely, adjustments were made to the standard approach of delivering health care on island. Whilst all critical and emergency interventions continued, like other hospitals around the world less urgent surgery and non-critical medical services at the PEH and MSG were curtailed to minimise the risk to patients and staff as well as the hospital infrastructure.

Restrictions on travel and the requirement to self-isolate has also meant that patients have not been able to travel to the mainland for elective procedures and understandably some patients have declined to access treatment outside of the Bailiwick due to the risk travel poses to their safety.

Whilst we were lucky enough to ease out of lockdown in June and our services had returned to near normal, the NHS are still experiencing a significant amount of coronavirus cases daily which in turn has had a major impact on their elective surgery waiting times.

Approximately 13 weeks of elective operations in the Bailiwick were impacted which caused delays to almost all specialist areas. HSC and MSG have worked hard to restore capacity back up to pre-pandemic levels as quickly as possible, having achieved this at the end of September.

ORTHOPAEDICS

The Orthopaedic department was amongst those specialties affected by the restrictions on elective surgery. As broadcasted in the media locally and nationally, Orthopaedics has already proved to be a high demand speciality due to an ageing demographic and has been under much scrutiny for a number of years.

In 2019, The Orthopaedic Waiting List Initiative was implemented which commissioned patients to receive elective surgery off island to selected tertiary centres in the UK and Jersey, with the aim to improve the number of patients waiting for surgery on island. We are pleased to say that this initiative was successful and saw 104 patients undergo Orthopaedic surgery off island in 2019. In 2020, only 22 patients underwent this initiative as almost all of those on the waiting list that were suitable had already received treatment.

The MSG and HSC put a significant amount of work into the Orthopaedic Waiting List Initiative in order to bring the waiting list down and it is disappointing to see numbers creeping back up. The restrictions on elective surgery has seen the numbers of patients awaiting orthopaedic surgery (as well as other surgery) increase, with 390 patients on the orthopaedic inpatient waiting list at the end of 2019, compared to 596 at the end of 2020. It is important to note that whilst elective surgery was on hold during the first wave of the pandemic, the majority of outpatient clinics were held via telephone at the MSG and thus more patients were being added to the Orthopaedic inpatient waiting list at a time with no inpatient activity.

It is impossible to predict when the numbers will revert back to pre-Covid-19 levels but there was a modest fall in total numbers waiting, from 648, in the last 3 months of 2020. We understand the distress and frustration waiting for an operation can undoubtedly cause patients and we would like to reassure them that we will continue to do all we can to find alternative solutions to improve the Orthopaedic waiting list. We would like to thank patients for their understanding and patience during these unprecedented and challenging times.

CHRONIC PAIN

The pain service also continues to be a high in demand speciality and is provided jointly by the MSG and HSC. Following the arrival of a new pain psychologist in 2020, the pain team now consists of two Consultants, two pain nurses, a psychologist and an extended scope practitioner physiotherapist.

Despite a delay in providing the services due to Covid-19, our Pain Consultants have worked tirelessly seeing over 1200 patients in the pain clinic during 2020. They provided more than 450 interventions to over 360 patients in the hospital Radiology department. These consultations also became virtual during the first lockdown period and this change of pattern of work was well accepted by both patients and Consultants.

During this period, the pain team were able to treat many patients and significantly reduce the waiting times for the service. However, there has since been a surge in demand due to the large reduction of elective spinal surgery being performed in the UK and the team are continuing to work hard to keep new referrals within the targeted eight week waiting time.

We are constantly introducing and trialling new treatments and services. Thanks to a generous donation to the MSG pain service, two new techniques were trialled for pain management this year. These were radiofrequency denervation of the knee joint for patients with inoperable knee pain, and electromyography testing for better needle placement precision to patients with muscle pain. This equipment helped target the affected muscles more precisely. Dr Stefak also trialled Lidocaine infusions for chronic widespread pain.

The pain service has grown with the addition of the experienced Physiotherapist who took up a permanent position of an Extended Scope Practitioner in Chronic Pain services. This has enabled patients to receive triage far sooner after referral to the MSG. The triage is the most important part of initial assessment of pain patients and this will hopefully be expanded even further in the future.

NEUROLOGY

Due to restrictions on travel and self-isolation requirements during the pandemic, visiting off island specialists such as Neurologists were unable to travel to the island to review patients in an outpatient setting, and likewise patients were unable to travel to the UK to access their services. Whilst discussions had previously been held in relation to recruiting a permanent Neurologist on island, the pandemic confirmed the need for this. We are pleased to confirm that at the end of 2020, a Consultant Neurologist position was approved. A locum Neurologist was appointed to cover the service in November and we anticipate that the permanent post will begin mid 2021.