Meeting - Gibraltar Health Authority

Transcription

GHA Board report – October to December 2015
GHA BOARD MEETING AGENDA
Venue: Charles Hunt Room, John Mackintosh Hall at 2.30pm
Wednesday 20th April 2016
1. Apologies for absence
2. Minutes of the meeting held on Wednesday 10th February 2016
3. Matters arising
4. Statement by Minister
5. Matters for discussion
5.1 Chairman’s Ruling on amended acupuncture policy
5.2 Mobile Devices policy
5.3 Long service and good conduct medal policy
6. Matters for report
6.1
6.2
6.3
6.4
6.5
6.6
6.7
6.8
6.9
6.10
6.11
Report: Chief Executive
Report: Director of Public Health
Report: Director of Finance and Procurement
Report: Director Estates and Clinical Engineering
Report: Director of Nursing
Report: Director of Human Resources
Report: UGM – Hospital Services
Report: UGM – Primary Care Services
Report: UGM – Mental Services
Report: Director of Information Management and Technology
Report: School of Health Studies
7. Date and time of next meeting
8. In Camera session
Page 1
2 Minutes of the meeting held on Wednesday 10 February 2016
GIBRALTAR HEALTH AUTHORITY
Minutes of Meeting held on Wednesday 10 February 2016 at 2.30 pm in the Charles Hunt
Room, John Mackintosh Hall.
Present:
The Hon. J Cortes (MH)
Mr F Pitto (FP)
Mr E Gomez (EG)
Mr C Lavarello (CL)
Dr K Rawal (KR)
-
Chairman
Chief Executive
Chief Secretary
Non-Executive Member
Medical Member
Apologies:
Dr D Cassaglia (DC)
Mr E Lima (EL)
Mrs P Galliano (PG)
Mr M Netto (MN)
Mr A Mena (AM)
-
Medical Member
GTC Member
Financial Secretary
-
Director of Finance & Procurement
Mr D Figueredo (DF)
-
General Manager St. Bernard’s
Hospital
Mr A Wink (AW)
-
General Manager Primary Care
Centre
Mr H Watson (HW)
-
Director IM&T
Mr P Linares (PL)
-
Director of Human Resources
Mr C Chipolina (CC)
-
General Manager Mental Health
Mr D Alman (DA)
-
Director of Estates and Clinical
Engineering
In Attendance: Mr G Teuma (GT)
Secretary:
Ms E Fa (EF)
1. Apologies for absence:
Dr D Cassaglia (DC)
Mr E Lima (EL)
Mrs P Galliano (PG)
Mr M Netto (MN)
Mr A Mena (AM)
-
Medical Member
GTC Member
Financial Secretary
Welcome from Chairman: The GHA Chairman opened meeting.
2. Minutes:
Minutes of meeting held Wednesday 30 September 2015 approved as a true record.
3. Matters arising:
No matters arising.
Page 2
4. Statement by the Minister:
Pleased to be back as Chairman of the GHA Board. Thanks the Board members for their
attendance. Apologises for the delay in GHA Board meetings due to elections and Christmas
period. Next meeting will be for the period October to December 2015 in April to catch up.
5. Matters for Discussion:
5.1 Acupuncture Policy (Chairman’s Ruling)
MH – This is a new GHA practice and there was no established and approved policy.
Physiotherapists wrote a policy and submitted to the Executive Team. This was approved and
MH ruled in advance of the Board meeting due to the clinical need. Asks Board to formally
approve the policy.
AW – Acupuncture is recognised as a legitimate modality for the treatment of lower back pain
within NICE guidelines. This is an extension of the policy for the treatment of lower back pain.
MH – Acupuncture policy approved by the Board.
5.2 Wi-Fi Policy
HW – The GHA for the last 18 months have engaged in a major project in the hospital with the
installation of the Wi-Fi infrastructure. This was accepted two years ago and spread over a
period. This is now at the stage where it can be switched on. There will be a patient Wi-Fi
network and a GHA clinical use Wi-Fi network.
CL – Refers to paragraph 4 and 5 of the Wi-Fi policy. Paragraph 4 on patient access self-serving
points. What effect does this have putting it into a policy document if what we are trying to do
is put the responsibility onto the users to ensure they are using the service appropriately.
Refers to appendix A and asks if this will be appearing in the patient’s devices when they log in.
Is there any advantage in taking some of the points that appear in paragraph 4 and 5 which
don’t appear in the appendix and putting them in there. Specifically the ones relating to the use
of the internet services.
MH – HW to look into this and send to CL for comments. Policy approved on the proviso of the
amendments to onscreen users.
6. Matters for Report:
Chief Executive’s Report: (As per published in Board Report)
All Directors’ Reports were taken as accepted.
Question Time: None this meeting
Meeting ended with agreement to reconvene on Wednesday 20 April 2016.
With no further business the meeting closed.
Page 3
5.1 Chairman’s Ruling on amended Acupuncture Policy
POLICY NAME:
Acupuncture as an adjunct to the
management
of
musculoskeletal
conditions.
Issued by:
Angelique Fortuna
Date approved by Clinical Governance Group:
Date approved by Senior Management Group:
8/3/2016
Date approved by GHA Board:
Policy Authority:
GHA Board
Effective Date:
Review Date:
POLICY STATEMENT:
This acupuncture policy sets out to ensure that acupuncture is performed by appropriately
trained professionals who are employed by the GHA (Gibraltar Health Authority) in a safe
and effective manner, and that patients have the appropriate information in an appropriate
form to enable them to make an informed decision before opting for acupuncture treatment.
The practice of acupuncture by physiotherapist should be governed by
Professional Conduct of Chartered Society of Physiotherapy (CSP):
Rule 1 of
‘Chartered Physiotherapists shall only practice to the extent they have established and
maintained their ability to work safely and competently and shall ensure that they have
appropriate professional liability cover for that practice’
The giving of appropriate information to aid an informed decision on opting for acupuncture
is central to this policy.
APPLICABILITY:
Following a detailed clinical assessment, acupuncture may be offered as part of a package
of care when 1) the best available treatment has failed to be effective, or 2) where
acupuncture is equally as effective as conventional physiotherapy treatments. Acupuncture
is not available as a stand-alone treatment except in cases where evidence indicates
acupuncture is more effective than any other physiotherapy modality e.g. when a patient has
radicular pain and is awaiting a spinal clinic appointment.
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3.
DEFINITIONS:
Acupuncture is a therapeutic modality involving the insertion of fine needles using current
knowledge of anatomy, physiology and pathology, and the principles of evidence based
medicine.
RELATED POLICIES:
 GHA spinal policy for non –specific low back pain. February 2014
 The disposal of sharps
 GHA needle stick injury
FURTHER INFORMATION:
Guidance on commissioning for AACP members
A summary of evidence for the use of acupuncture in physiotherapy for the benefit of the
patient
The following persons are responsible for clarification and compliance with this policy:
Ms Angelique Fortuna - Senior Physiotherapist MSK services;
1. SUMMARY OF THE POLICY
The acupuncture policy has been developed to ensure safe and effective practice of
acupuncture by trained clinicians and physiotherapists employed by the GHA and to ensure
that patients are given enough information to make an informed decision about opting for
acupuncture treatment.
It is evidence based and the AACP published the evidence in February 2012 which provides
a summary of evidence which should be used to support acupuncture continued use in NHS
physiotherapy practice which is reflected in the GHA. This document is attached.
Acupuncture treatment will be offered by a Physiotherapist with current Health & Care
Professions Council (HCPC) registration who has undertaken an Acupuncture Association
of Chartered Physiotherapists (AACP) recognised training course in acupuncture.
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2.
OBJECTIVES OF THE POLICY
The objective of the Gibraltar Health Authority in Establishing this Policy is as follows:
2.1: To outline the scope of acupuncture in the GHA
2.2: To outline the provision of acupuncture in the GHA
2.3: To ensure the safety and regulation of acupuncture in the GHA
3.
SCOPE
To be used by appropriately trained clinicians and physiotherapists working within Gibraltar
Health Authority.
4. GENERAL POLICY
Location of Practice
Acupuncture may be practiced in any of the environments below as long as an appropriate
clinical area is provided:
 St Bernard’s Hospital
 Primary Care Centre
 Patients place of residence
4.1. Referrals
Patients are referred to Physiotherapy by the usual way
4.2 Regions which should NOT be needled
 Any points with area of swelling
 Cancer patients that have had lymph nodes removed from any limb
 Nipple and breast tissue
 Umbilicus
 Infants fontanels
 External genitalia
4.3. Contraindications and Precautions
4.4. Contraindications
The following are considered contraindications to acupuncture needling










Unstable heart conditions e.g. CCF, arrhythmias
Acute haemorrhagic strokes
Patients that are undergoing chemo therapy
Inability to cooperate/unable to provide consent
Poorly controlled diabetes
Infected/fragile skin
Pacemaker (electro-acupuncture);
Phobia of needles;
Local infected areas.
Pregnancy (first trimester)
4.5. Precautions
 Diabetes- impaired skin condition, unstable blood sugar
 Pregnancy – if appropriately trained
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





Patients without a clear diagnosis (may mask serious pathology)
Haemophilia, Anticoagulant therapy
Known metal allergy
Hepatitis B or other blood borne virus such as HIV
Hyper/hypotension
Immunosuppressive diseases e.g. AIDS (extra attention to hygiene)
4.6. Consent
The following process is required:
 Patients are given information regarding the treatment benefits, side effects,
complications and procedure to allow for informed consent (Appendix 1). If they are
unable to read the information in Appendix 1 it will be given verbally, using
interpreters where necessary.
 The patient’s consent to treatment must be unequivocally obtained (from the parent
in the case of a minor).
 Consent is documented in the Physiotherapy records along with the clinical risk
assessment ( Appendix 2)
 If electronic records are used for that patient’s episode of care the consent form
should be scanned into this.
4.7 Complications of needling
The following complications may occur:
 Needle stick injury – follow GHA policy.
 Fainting or fatigue – remove needles immediately and manage as a first aid
emergency. Complete an incident report form.
 Bleeding or bruising – certain points are more prone to bleeding. Apply immediate
pressure to the area and advise the patient of possible bruising.
 Temporary flare of pain – remove the needles immediately.
 Infection – always use a sterile needling technique. If skin becomes red, itchy and
raised, remove the needles and review at a later date
 Stuck needle – usually due to muscle spasm around the needle. Gently massage
around the needle to relax the muscle and gently reattempt removal. If unsuccessful
remove all other needles and insert another needle near to the site, wait a few
seconds then re-attempt removal.
 Broken needle – Mark the point of entry and go straight to A&E. Complete an
incident report form.
 Bent needle – if you suspect a needle may have bent due to a patient suddenly
moving, allow the patient time to relax and then gently manoeuvre the needle out. If
unsuccessful send to A&E.
 Pneumothorax – seek immediate medical assistance and complete an incident
report form.
 Drowsiness – if it persists longer than 10 minutes, keep the patients in the
department for longer and if necessary contact a friend or relative to assist the
patient home.
 Allergic reaction.
4.8. Needling Procedure




A risk assessment completed (see appendix 2)
Only presterilised, single use, disposable needles maybe used.
Wash hands before inserting and withdrawing needles;
Needles are counted in and out
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








Patients skin is checked before and after treatment paying particular attention to the
needle sites;
Patients are positioned to allow for maximum comfort and safety;
Patients are safely monitored during the treatment session;
Patients must be able to summon someone if required
Needles are disposed into sharps box immediately after withdrawing them;
The GHA Sharps Policy is adhered to.
Anything other than needles, e.g., the needle wrapping, cotton wool must be
disposed of in the appropriate bins.
Needles/ the sharps box must never be left alone in the cubicle with a patient
unattended (case of a child putting his hand inside a sharps box)
The AACP does not recommend that disposable gloves are used regularly only in
some clinical situations (Appendix 3 recommendation of disposable gloves)
4.9 Safety
For safety reasons, the following process should be followed:
1 The Environment:
 Be clean and private
 Have a facility of disposing sharps close by
 Ensure the patient is adequately supported.
2 The Practitioner
 Wash their hands before and after each treatment.
 Have the knowledge to treat the patient
 Discuss with the patient the benefits of the treatment and provide alternative options
 Have screened the patient for contraindications and precautions (Appendix 2)
 Know the anatomical structures relevant to the selected points
3 The Patient
 Be adequately informed of the benefits and the risks of receiving acupuncture with
evidence where appropriate.
 Alternative treatments for their condition.
 The procedure of insertion and stimulation
 A warning of any transient symptoms they may experience during or after treatment
such as light headedness. Reassure the patient that these are common reactions
 Patients are allowed sufficient time to rest and recover safely after treatment
 The current (AACP) safety standards should be adhered to.
4.10 Training
The following training must be carried out:
 Any staff member practicing acupuncture within the GHA must be AACP trained and
fall within the guidance of the AACP and the HCPC regulatory requirements.
 Evidence of adequate training must be seen by the line manager and a copy of the
certificate is advised.
 10 hours continuous professional development (CPD) every 2 years is
recommended by the (AACP) and this level of update should be followed by
physiotherapists to maintain their competency.
 That the GHA provides protected time to maintain their competency.
 Mandatory CPR and anaphylaxis training is current and maintained.
 See attached Appendix 5
4.11 Documentation
The following documentation is required:
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






Risk assessment form completed
Complete the treatment table – inclusive of all points needled the stimulation
technique and the needling time. (Appendix 4)
Any adverse effects
Information contained in the information sheet given to patient (Appendix 1);
Consent is documented;
Precautions/contraindications are checked and recorded in the notes;
This policy will be reviewed every 2 years or sooner if new evidence becomes
available, and any amendments circulated to all Physiotherapists on the register.
4.12 Monitoring/Audit/Review
On-going CPD must be kept up to date in line with CSP and AACP guidance on
acupuncture training and the HCPC regulatory requirements ( Appendix 5)
Each department (outpatient/community and wards) to be responsible for collecting
data for future audit
This Policy will be reviewed in one year.
4.13 References
i.
Hoffman (2001). Skin disinfection and acupuncture. Acupuncture in Medicine
2001;19(2) pp112-116.
ii.
White et al (2001). Informed consent for acupuncture – an information leaflet
developed by consensus. Acupuncture in Medicine 2001;19(2): pp123-129.
iii.
Acupuncture Association of Chartered Physiotherapists (AACP) Guidelines for Safe
Practice (2012) www.aacp.org.uk
iv.
Acupuncture in Physiotherapy : The evidence (AACP)
v.
Core standards of Physiotherapy Practice (2005) Chartered Society of
Physiotherapy. www.csp.org.uk
vi.
Guidance on commissioning for AACP members
vii.
A summary of evidence for the use of acupuncture in physiotherapy for the benefit of
the patient.
.
Page 9
APPENDIX 1
Acupuncture Patient Information
Please read this information carefully, and if there is anything you do not understand ask
your Physiotherapist.
1. What is acupuncture?
Acupuncture is a form of therapy where fine needles are inserted into the body at specific
points.
2. Why are we using acupuncture?
Acupuncture is mainly used for pain relief; if your physiotherapist is using it for other
reasons this will be explained to you.
3. How does acupuncture work?
There are two main models that explain how acupuncture works – the Western Medical
Model, and the Traditional Chinese Model. In essence acupuncture works by stimulating
pain relief and muscle relaxation responses in the nervous system depending on where the
needle is inserted. The insertion of the needle causes the body to release endorphins for
pain relief and anti-inflammatory cells and chemicals for healing
4. Is acupuncture safe?
Acupuncture is very safe. Serious side effects are rare, less than one per 10,000
treatments. This clinic only uses single use disposable needles.
5. Does acupuncture have side effects?
You need to be aware that the following may occur:
 Drowsiness may occur in a small number of patients after treatment. If you are
affected you are advised not to drive;
 Minor bleeding or bruising occurs after acupuncture in about 3% of treatments;
 Pain occurs during treatment in about 1% of treatments;
 Existing symptoms may get worse after the treatment (less than 3% of patients).
This is usually a good sign and a precursor to a reduction in symptoms, but you
must tell your acupuncturist;
 Fainting can occur in certain patients, particularly during or after the first treatment.
 If you are a blood donor you are not allowed to give blood for the next 6 months
unless treated in the GHA.
In addition if there are any specific risks in your case the practitioner will discuss these with
you.
6. Is there anything your practitioner needs to know?
Please tell the practitioner if any of the following applies to you:
 You have epilepsy, or have ever had a fit, faint or funny turn;
 You take medication to thin your blood (anti-coagulants), e.g. warfarin;
 You have problems with your heart, or have a pacemaker;
 You are allergic to metal;
 You have diabetes;
 You have any history of cancer or problems with your immune system;
 You have a phobia of needles;
 You have haemophilia;
 You feel fatigued or hungry;
 Is there any chance that you could be pregnant?
You may refuse treatment at any time, please inform your practitioner.
Page 10
APPENDIX 2
Clinical Risk Assessment and Informed Consent Checklist for Acupuncture
Patient Name:
DOB:
CONTRAINDICATIONS
Allergy to metal in needles
Broken/fragile/infected skin at needle point
Needle phobia
Hemophilia
Uncontrolled movements or uncontrolled epilepsy
Areas of post-surgical lymphodema
Cardiac Pacemaker (for electroacupuncture)
Pregnancy in 1st Trimester, CI poins for 2nd & 3rd
Trimester: LI4, CV6, CV5, CV4, CV3, BL31, BL32, SP6
YES
NO
PRECAUTIONS
Oedema at needle site
Diabetes
Unstable hemorrhagic stroke
Anti-coagulants
Controlled epilepsy
Immuno deficiency (HIV/AIDS/Hepatitis)
Immuno suppression (Chemotherapy/Steroids)
Skin Condition
Impaired Sensation
YES
NO
EXPLANATION
Treatment procedure of needle insertion
Stimulation of needle (Manual or E.A.)
Transient symptoms (Fatigue, nausea, faint, bruising,
exacerbation of symptoms)
Warned of possible complications (Pneumothorax, infection)
Warned not to drive, if feeling drowsy after treatment
Patient has eaten prior to treatment
YES
NO
I have checked the above contraindications and precautions. I have given the
acupuncture
leaflet to the above patient and have explained about the use of acupuncture for pain
relief.
Physiotherapist's
Name_________________________________
I have been asked the above contraindications and precautions to
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acupuncture.
Patient's Name_________________________________________
Patient's
Signature___________________________________
Date_______________
APPENDIX 3
Recommendation of disposables gloves
The AACP recommend that disposable gloves need ONLY be worn if one of the following
applies:
 If the patient is bleeding profusely
 If vomit/urine is present
 If the patient has a known contagious disease (question whether acupuncture is the
most appropriate treatment)
 If the therapist has lesions on the hand which can’t be covered with a waterproof
dressing
 If the therapist is handling blood soiled items, body fluids, excretions or secretions.
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APPENDIX 4
Treatment Table
Patients Name:
Date of birth:
Acupuncture treatment
Physiotherapists name
Rx - date
Position of
patient
Selected
points
Needling
technique
‘Dose’
Rx response
/adverse
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APPENDIX 5
Peer review and Maintenance of clinical competence
To become members of the AACP Physiotherapists must have successfully completed
the minimum standard of training required to conform with international standards of
acupuncture training in Physiotherapy, and the HPC quality assurance standards. The
minimum training required is in the form of an 80 hour Foundation course, which offers
i) A set of learning objectives and outcomes
ii) Offers reliable, validated assessment procedures in order to measure performance
against known marking criteria
iii) Conducts an assessment of each delegate against assessment criteria
Accredited Membership to AACP set at 80 hours of training
Advanced membership of AACP set at 200 hours of training
Continued Professional Development (CPD) is defined as “A range of learning
activities through which health professionals maintain and develop throughout
their career to ensure that they retain their capacity to practice safely, effectively
and legally within their evolving scope of practice”.
The HPC has defined that the recording of CPD is
The sole responsibility of the HPC member
To be recorded in a professional portfolio
HPC has introduced an audit system and has decided that
A number of portfolios will be selected and audited each year
HPC CPD assessors will undertake random portfolio assessment and audit.
CPD may be acquired by a variety of methods including
In-service training
Critical appraisal of research
Training courses
CPD courses
Conference attendance
Peer review
Case report submission to the required AACP protocol
Reflective practice
Study days
In each the learning objectives and outcomes from the CPD session must be recorded in the
physiotherapist’s portfolio of training & CPD.
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EQUALITY IMPACT ASSESSMENT TOOL
To be completed and attached at the end of any procedural document when submitted to the
appropriate group for consideration and approval.
Yes/No
Comments
1. Does the policy affect one group less or
more favourably than another on the
basis of:

Race
No

Ethnic Origin
No

Nationality
No

Gender
No

Religion or Belief
No

Sex
No

Marital Status
No

Disability
No

Sexual Orientation
No

Age
No
2. Is there any evidence that some groups No
are affected differently?
3. If you have identified potential N/A
discrimination, are any exceptions valid,
legal and/or justifiable?
4. Is the impact of the policy/guideline
No
likely to be negative?
N/A
5. If so can the impact be avoided?
6. What alternatives are there to achieving
the policy/guideline without the impact?
7. Can we reduce the impact by taking
different action?
N/A
N/A
Name of Policy/Guidance Notes/Guidelines assessed:
Name of Assessor:
Grade:
Signature:
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5.2 Mobile Devices Policy
POLICY NAME:
Policy No:
IMT002
Policy Version:
1.0
Mobile Devices Policy
Issued by:
Director of IM & T
Date approved by Corporate Governance Group:
Date approved by Senior Management Group:
Date approved by GHA Board:
Policy Authority:
GHA Board
Effective Date:
Review Date:
POLICY STATEMENT:
The GHA is committed to achieving maximum benefit from mobile technology whilst
maintaining the necessary environment to ensure patient confidentiality and safety. This policy
sets out the GHA’s criteria for the issue of mobile devices, the rules around their use, use of
personal devices by staff, and acceptable use of Mobile devices on GHA premises by
patients/visitors.
APPLICABILITY:
The policy applies to all full-time and part-time employees of the GHA, non-executive directors,
contracted third parties (including agency staff), students/trainees, other staff on placement
with the GHA, patients and visitors present on GHA premises.
3.
DEFINITIONS:
GHA–
GoG
IM & T –
Mobile Device –
Designated Responsible Officer –
Gibraltar Health Authority
Government of Gibraltar
Information, Management and Technology
Mobile phone, smart phone or device, pager, any portable
computer (eg laptop, tablet, iPad, PDA or camera)
Any person assigned to control allocation of GHA Mobile
Devices
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RELATED POLICIES:
IMT Security Policy
W-Fi Policy
Motor Vehicle Policy
GHA Policy on Photography, Video recording and filming on GHA premises
Director of Information, Management and Technology
5. SUMMARY OF THE POLICY
1.1
The GHA recognises mobile phones as an effective form of communication for clinical
and operational emergencies and accept they are now are an integral part of day to day
life. However, in a hospital setting they can be a nuisance to other patients and visitors
and pose a risk to privacy and dignity. They can also in certain circumstances have an
impact on electronic medical equipment.
1.2
The GHA is committed to ensuring that adequate communication facilities are
available to its staff in order for them to carry out their normal daily duties
1.3
Electronic Device Mobility in healthcare environments assists the clinicians in
delivering patient care in a timely manner by making clinical information available
and viewable when and where needed.
1.4
This policy has been developed to ensure that all staff, patients and visitors are
aware of the areas where the use of mobile or smartphones is authorised.
1.5
Calls to mobile phones should be limited and where possible landlines are preferred
to mobiles.
1.6
In this policy, the rules surrounding mobile phones also apply to Smartphones, Data
dongles and any other mobile communication or entertainment device that emits or
receives a data transfer radio or wireless frequency. E.g GSM, GPRS, 3G, 4G or other
wireless technology such as Bluetooth, Wi-Fi, etc.
1.7
The rules in this policy should be read in conjunction with the GHA Internet, Intranet
and Email Policy, Wi-Fi Policy and IMT Security Policy.
6.
OBJECTIVES OF THE POLICY
The objective of the Gibraltar Health Authority in Establishing this Policy is as follows:
2.1
To define the criteria for GHA issued mobile phones and computing devices
2.2
To define acceptable use of both personal & GHA devices for patients, visitors and staff
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2.3
To facilitate the utilisation of mobile computing technology where necessary.
2.4
The GHA aims to ensure peoples’ safety at work by providing clear requirements on
where and when it is safe to use mobile phones. These requirements should enable staff
to undertake their duties safely and at the same time protect the rights and safety of
others.
Information Governance is a key risk when dealing with mobile devices. This document
clarifies responsibilities to ensure confidentiality of GHA information.
2.5
7.
SCOPE
3.1
This policy relates to use of both GHA supplied and privately owned mobile devices and
applies to all staff who have been provided with a mobile phone for work use, or use
their own mobile phone for work.
3.2
This policy applies to patients and visitors whilst on GHA premises
3.3
In all other cases, the use of personal mobile phones at work for private use is restricted
to breaks and emergency situations. In the event that a member of staff needs to be
contacted via their personal mobile during working hours, the phone should be
switched to silent and/or diverted to the messaging service.
8.
GENERAL POLICY
3.4
The GHA will offer a limited range of handsets and mobile devices based on an
assessment of technical requirement, reliability, price and ease of use. Allocation of
handsets/devices is based on the needs of the specific staff role. The GHA will review
this choice on a regular basis to ensure that the most competitive, functional and
reliable equipment is available for staff.
3.5
When first being allocated a device, staff will be required to sign the form in Appendix A
acknowledging the terms of this policy and their responsibilities.
3.6
A central asset register will be held listing all GHA Medical Devices and the GHA
departments or directorates that each device is allocated to.
3.7
The requirements of the law and GHA/GoG policies will be observed at all times.
9.
MOBILE PHONES/SMARTPHONES
5.1
Personal Mobile Phones/Smartphones
Personal mobile phones/Smartphones can be used for work purposes where this has been
agreed between the member of staff and their line manager and where such a phone is
necessary and beneficial for them to do their job.
To meet this requirement staff should meet at least one criteria from (a) to (c) for a mobile
phone and at least two of the criteria (d) to (f) for a Smartphone.
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a) Staff whose work entails predominantly lone working in the community
b) Emergency out of hours staff including any staff on the on-call rota
c) Staff who spend a significant amount of time out of the office and are
required to be contactable during this period
d) Staff whose work regularly requires the use of email whilst: lone working
in the community / working out of the office.
e) Staff whose work regularly requires access to their calendar whilst: lone
working in the community / working out of the office.
f) Staff whose work requires internet access whilst: lone working in the
community / working out of the office.
Applications must be made in writing to the Director of IMT via the Line Manager with
authorisation by the relevant GHA Director or Unit General Manager.
The organisation will not accept responsibility or liability for the loss or damage to personal
mobile phones belonging to staff.
5.2
Use of Mobile Phones/Smartphones for Work Purposes
Staff should not use a mobile phone in any public area where the use is prohibited. This
situation may arise within certain areas of hospital buildings. Staff should therefore be aware of
any local restrictions within healthcare premises and ensure that their mobile phone is
switched off if a risk exists. In line with International Standards or Best Practice it is acceptable
to use mobile phones in healthcare premises, where there is no risk of interference.
When using a mobile phone staff need to consider the following principles of safety, sensitivity,
confidentiality and appropriateness:
 It should be possible to make the call without affecting the safety of yourself and
others around you, or their clinical care.
 Patient confidentiality must always be respected; not all conversations are
appropriate in a public place or another patient’s home.
 Mobile phones should not be used for outgoing calls if a landline is available.
 Try to keep mobile calls brief.
 Personal calls should be made during breaks or in exceptional circumstances.
 If the call is being made in a public place, consider the content and language
used during the conversation.
5.3
Restriction on Use of Mobile Phones
With the exception of certain circumstances which are detailed within section 5.1 and 5.2
mobile phone technology must be switched off in patient care areas where treatment,
examinations etc are carried out or where patients may be resting. Patients and visitors are
asked not to turn this equipment on again until they are in an authorised area as indicated by
signage around the GHA. Staff in restricted areas have an additional duty of care and are asked
to advise patients, colleagues and visitors to switch off mobile phones when in patient areas or
where signage indicates they are within a prohibited area.
To avoid the possibility of medical devices being disconnected and to reduce the potential risk
of fire or electric shock patient and staff personal mobile phones are not to be charged using
the patient bed head trunking electrical supply.
Page 19
5.4
Use of Mobiles Whilst Driving
Using a mobile phone whilst driving can be dangerous and is contrary to the Traffic Act 2005
and the Highway Code. It is an offence to use a hand held mobile phone whilst driving a vehicle.
Refer to GHA Motor Vehicle Policy.
No line manager will require any member of staff to receive or make a call on a mobile phone
while they are driving. Staff are expected to switch their phone to silent and activate the
messaging service. If staff decide to use their mobile phone while in a vehicle, the organisation
expects them to stop the vehicle in a safe place and switch the engine off before checking their
messages or making any calls.
Staff must remember they are responsible for driving safely and within the rules of the Traffic
Act. Staff and not the organisation will be liable if they are found to be using a mobile phone
while driving for work purposes. The only occasion where a hand held mobile can be used is for
dialling and Emergency Services number in a genuine emergency and the driver judges it
unsafe or impractical to stop the vehicle.
The use of hands free sets is not prohibited under the legislation. However the use of these sets
still increases the likelihood of the driver being distracted and thereby involved in an accident.
If this occurs, the driver risks prosecution for failing to have proper control of the vehicle
because of careless or dangerous driving.
10.
MOBILE DEVICES
6.1
Qualifying Criteria for GHA Supplied Mobile Devices
Mobile devices will be provided to those staff whose duties require them to be
contactable or working on-line when away from their normal place of work.
Sometimes a duty will be covered by issuing a shared mobile device.
In all cases approval to issue a device must be given by the relevant Director or Unit
General Manager.
Examples of need are (note: this list is not exhaustive):
• Duties that require working across multiple GHA sites
• There is a genuine need to be easily and immediately contactable during and
outside of normal working hours
• Staff who work in several locations within a single GHA site
• Staff contractually required to be on call
Page 20
6.2
Device Security
Smartphones, laptops and any other device that has the ability to store data must be
encrypted to the Advanced Encryption Standard with a 256bit key.
All devices must have a PIN lock or be password protected
6.3
Private/Personal Data
Mobile devices provided by the GHA, are to be used primarily for business purposes.
Any faults or IT support interventions may involve loss of any personal data.
6.4
Damaged Mobile Devices
Mobile devices in need of repair should be returned to the designated responsible
officer who will return them to the supplier (or GHA IT dept.) for repair or replacement
under warranty. It should be noted that manufacturers’ warranties do not normally
cover damage caused by misuse or neglect and that the cost of such repairs will be
borne by the user responsible.
The GHA will make best endeavours to ensure a suitable replacement is issued as
quickly as possible.
6.5
Device Request/Allocation Process
All requests for devices need to be made via departmental heads.
Devices such as laptops, tablets, iPads (or any other mobile computing device) that are
part of a shared resource for a specific role will need to be signed for prior to allocation.
On return of the device the designated responsible officer will sign that the device has
been returned in working condition.
6.6
Loss of an allocated mobile device
The loss of any device needs to be reported immediately. Where a device is irretrievably
lost a replacement will be procured, the cost of which will be borne by the user
responsible for the loss.
11.
RESPONSIBILITIES
7.1
Chief Executive
The Chief Executive is responsible for overall staff safety within the organisation and for
the implementation of this policy.
Page 21
7.2
Executive Directors & Heads of Departments
All senior staff are responsible for ensuring the day to day health, safety and welfare of
their teams. They should be familiar with this policy and the requirements to use
mobile phones safely.
7.3
Line Managers


7.4
Staff Responsibilities




12.
Managers have a responsibility for the safety of their staff. They should
ensure their staff are aware of this policy and of any local rules around
use of mobile devices within healthcare premises
Managers need to ensure that mobile devices are recovered from staff
leaving the organisation.
All staff should be aware of this policy and be familiar with any legal
restrictions on using mobile devices. They must take reasonable care of
themselves and others when operating mobile devices.
Staff are responsible for the safe keeping of GHA property. This
includes keeping any mobile device secure and fully charged. The loss
or damage of a GHA mobile device should be reported immediately to
their line manager.
Staff need to sign for receipt of the mobile device, and to acknowledge
that they have read, understood and will comply with the requirements
of this policy.
Staff leaving the GHA must return their GHA mobile device to their
line manager who will in turn sign for receipt of the device.
PATIENT CONFIDENTIALITY, PRIVACY & DIGNITY
It is nearly impossible to detect whether mobile phones, most of which now incorporate
cameras and video recording devices, are being used to take pictures. Additionally, with built in
email and other online services capability such pictures can be transmitted anywhere within
moments of taking them.
Healthcare organisations should ensure that systems are in place to protect patients’ privacy
and dignity.
In keeping with the GHA Policy on Photography, Video Recording And Filming on GHA Premises
it is not acceptable for GHA employees to use their own camera phones.
However some staff need to take photographs of/within buildings on site as part of their
normal work. Mobile phones should not normally be used for such photographs, except in an
emergency. Care should be taken not to capture patients or visitors in a photograph of a
building or equipment, unless necessary.
13.
COMPLIANCE WITH THE POLICY
The privacy and dignity of patients and compliance with health & safety is the duty of all staff,
patients and visitors whilst on the hospital premises. For the reasons stated the GHA feels it is
necessary from a clinical perspective that everyone complies with this policy.
Page 22
Patients or visitors who fail to adhere to the policy will be asked to leave the prohibited use
area and security may be called if they become abusive or aggressive towards staff enforcing
this policy, in line with the GHA Zero Tolerance Policy.
All staff who fail to comply with the policy will be reported to their line manager and persistent
breaches of the policy will be dealt with under the GHA’s disciplinary procedure.
Page 23
Appendix A
MOBILE DEVICE ACCEPTANCE FORM
Device Model:
Department:
Reason for Allocation
Issued To:
• I acknowledge receipt of a GHA mobile device.
• I agree to abide by the requirements of the Mobile Device policy document.
Before using the device in the event that I do not agree with the policy document, having read it, I
agree to return the mobile device.
• I acknowledge my liability for the cost of any damage or loss not covered by the warranty terms of
the device
• I acknowledge that in the event of loss of personal information it is not the responsibility of the GHA
to recover.
Signed:
Printed:
Date:
Page 24
Appendix B
EQUALITY IMPACT ASSESSMENT TOOL
To be completed and attached at the end of any procedural document when submitted to the appropriate
group for consideration and approval.
Yes/No
Comments
8. Does the policy affect one group less or
more favourably than another on the
basis of:

Race
No

Ethnic Origin
No

Nationality
No

Gender
No

Religion or Belief
No

Sex
No

Marital Status
No

Disability
No

Sexual Orientation
No

Age
No
9. Is there any evidence that some groups
are affected differently?
No
10. If you have identified potential N/A
discrimination, are any exceptions valid,
legal and/or justifiable?
No
11. Is the impact of the policy/guideline
likely to be negative?
N/A
12. If so can the impact be avoided?
13. What alternatives are there to achieving
the policy/guideline without the impact?
N/A
14. Can we reduce the impact by taking
different action?
N/A
Name of Policy/Guidance Notes/Guidelines assessed:
Name of Assessor:
Grade:
Signature:
Date:
Page 25
5.3 Long service and good conduct medal policy
GIBRALTAR HEALTH AUTHORITY
Issued by:
Date Issued:
Date Effective:
Date of Review:
Date Revised:
Policy Authority
Policy Category
Chief Executive
LONG SERVICE & GOOD
CONDUCT MEDAL POLICY
TBA
TBA
TBA
GHA Board
Human Resources
POLICY STATEMENT:
This policy details the criteria and procedures surrounding the award of the Gibraltar Health
Authority Long Service & Good Conduct Medal.
All GHA employees should be recognised for their long service and good conduct after twenty
years’ service.
APPLICABILITY:
This policy applies to all employees of the Gibraltar Health Authority. This policy does not
directly apply to individuals not directly employed by the GHA but carrying out work on our
premises, such as agency workers and external contractors.
DEFINITIONS:
Stated within the main policy.
RELATED POLICIES:
Page 26
1.
KEY PRINCIPLES
1.1
Employees who have completed 20 years’ service will be eligible for the GHA Long
Service & Good Conduct Medal in recognition of their contribution to Healthcare in
Gibraltar.
1.2
The award of the GHA Long Service & Good Conduct Medal carries no rights to the use
of post-nominal letters.
1.3
There is no absolute right to receive the GHA Long Service & Good Conduct Medal.
1.4
As a consequence, employees subject to penalties and/or sanctions following a
disciplinary hearing will be reviewed to consider eligibility or deferred presentation.
Employees have an obligation to acquaint themselves with the GHA Long Service &
Good Conduct Medal Policy.
Copies of the GHA Long Service & Good Conduct Medal Policy are to be made
available via the intranet and from the Human Resources Department, 5 th Floor, St
Bernard’s Hospital.
2.
SCOPE OF THE POLICY
2.1
This policy applies to all staff employed by the Gibraltar Health Authority, including
Government of Gibraltar employees seconded to the GHA. Seconded employees
previous service in another Government Department/Agency/Authority does not count
towards qualifying service for a GHA Long Service & Good Conduct Medal.
2.2
This policy does not apply to individuals not directly employed by the GHA but carrying
out work on our premises.
3.
PROCEDURE
3.1
Persons entitled to a GHA Long Service & Good Conduct Medal must make a written
application to the Chief Executive by completing the pertinent application form,
available to download from the intranet or from the Human Resources Department, 5 th
Floor, St Bernard’s Hospital.
3.2
Completed application forms must be submitted to The Secretary, GHA Staff Awards
Committee, c/o Human Resources Department, 5th Floor, St Bernard’s Hospital.
3.3
The process is administered by the GHA Staff Awards Committee who will evaluate each
application and verify the information against that held by the GHA Human Resources
Department. Award decisions are based on time served (20 years by the date of
application), influenced only by conduct and disciplinary record.
3.4
The GHA Staff Awards Committee will evaluate each potential recipient and submit
their recommendations to the Chief Executive for approval, or otherwise.
3.5
The Chief Executive must authorise issue and confirm the suitability of each recipient.
Page 27
3.6
The Secretary, GHA Staff Awards Committee will communicate to the recipient in
writing whether his/her application has been approved, or otherwise.
4.
ELIGIBILITY
4.1
Employees must have completed 20 years’ continuous or aggregated service in the
Gibraltar Health Authority, during which time they have had a record of continuous
good conduct.
4.2
Part-time working: providing the officer works the required number of 20 years’ then
s/he is eligible for the award.
4.3
Maternity leave: Maternity leave should count as qualifying service for the GHA Long
Service and Good Conduct medal.
4.4
Career break: Career breaks are discounted in the calculation of length of service.
4.5
Overseas service: Overseas service does not count as qualifying service unless the
officer has been seconded by the Gibraltar Health Authority.
4.6
Unpaid Leave: Periods of Unpaid Leave will not count towards reckonable service.
5.
NON-ELIGIBILITY AND FORFEITURE OF MEDAL
5.1
Employees eligible for the GHA Long Service & Good Conduct Medal must be above
reproach in respect of their conduct and performance throughout their service.
Employees whose conduct at any time during their service has proven to fall below the
standards of professional conduct or whose behaviour brings the service into disrepute,
or which results in a conviction for serious criminal or civil offence(s), may be deemed
ineligible to receive the medal, or for a period of service being regarded to be nonqualifying.
5.2
Employees that are awaiting the outcome of a disciplinary investigation or hearing
when they complete 20 years’ service, presentation of the GHA Long Service & Good
Conduct Medal will be deferred until the outcome of the proceedings are known as this
may result in the employee being deemed ineligible to receive the medal.
6.
MEDAL
6.1
The following diagram depicts the style of the medal.
Page 28
The medal, suspended from a light blue ribbon will be round and silver-plated with a
diameter of 36.6mm. The medal may be worn ‘military style’ by pinning to the chest.
The medals will be presented in a presentation case.
7.
REVIEW
7.1
This policy will be reviewed periodically by the Staff Awards Committee every two
years or whenever changes are deemed necessary.
Page 29
Appendix ‘A’
APPLICATION for the grant of the
GHA Long Service & Good Conduct Medal
1.
Persons entitled to a GHA Long Service & Good Conduct Medal must make a written
application to the Chief Executive by completing PART 1 of this application form.
2.
A person receiving the medal will have served in a facet of the health service for at least
a minimum of 20 years during which time they have had a record of continuous good
conduct. Service time need not be continuous.
3.
The medal is presented by the Gibraltar Health Authority.
4.
The medal will be presented on occasions or at times as designated by the Gibraltar
Health Authority.
5.
The NAME OF THE RECIPIENT will be engraved on the reverse of the medal.
Please ensure the spelling in PART 1 is correct.
6.
Completed forms must be submitted to The Secretary, Staff Awards Committee, c/o
Human Resources Department, 5th Floor, St Bernard’s Hospital for evaluation and
approval, or otherwise.
PART 1
To be completed by the Applicant
I hereby submit this application for the GHA Long Service & Good Conduct Medal as I
have completed twenty years’ service in the authority.
Name*
medal
*as it will appear on the
Grade
Department
Date of Entry
Total Years of Service
Signature
Date of Application
PART 2
To be completed by the Staff Awards Committee
Page 30
This application has been evaluated by the GHA Staff Awards Committee, and on behalf
of the Committee, I recommend/do not recommend* this applicant for the GHA Long
Service & Good Conduct Medal. (If applicable) The reason for not recommending this
application is as follows:
Name:
PART 3
Signature:
Date:
To be completed by the Chief Executive
I approve/do not approve* this application for the GHA Long Service & Good Conduct
Medal. (If applicable) The reason for not approving this application is as follows:
Name:
Signature:
Date:
*delete as necessary
Page 31
6.1 Chief Executive
Mr Chairman, Board members, this report refers to the final quarter of 2015 (October to
December) and the 3rd quarter for financial year 2015/2016.
The following is a summary of the Directors’ reports highlighting some of the main points
which are enclosed in the main body of this document.
1. New Catering Facility
The new Catering facilities commenced operations on Saturday 10 th October 2015 with the
official opening taking place on Thursday 22nd October 2015. A ceremony presided by the Hon
Chief Minister and Minister for Health.
The new facility and service has been welcomed positively by staff and patients. The initial
feedback on the quality of the food has been excellent.
Together with the new Catering Unit has been the introduction of a ‘Bulk food’ service.
The next stage in this transformation is the development and implementation of the new menu.
It is planned to have this completed during the first half of 2016.
2. New Chemotherapy Suite
Works on this new unit commenced in November 2015, with the project expected to be
completed by April 2016.
3. A&E Re-development Plan
The project to extend the A&E department went out to tender during this period. The works
will provide the following additional improvements to the department;
 Expanded Minors area
 New Ambulance entrance
 New Plaster room
 Extra clinics
 New changing facilities
 New place of safety
 Expansion of the reception area (clinical)
The design has been developed with the cooperation and input from clinical staff.
4. Health & Lifestyle Survey
The analysis of the data collected by the Health & Lifestyle survey has now been completed and
is in the process of being interpreted and edited prior to being published. Publication is
expected by May/June 2016.
5. Health Promotion
This period has seen numerous Health Improvement campaigns organised by the GHA’s Health
Promotion Department through public events, Health Education and the publication of articles.
The campaigns included topics such as;
 Health and Safety in the workplace
 Mental Health
 World Diabetes Day
 World Aids Day
Page 32




Brighten your Christmas with Advice
Flu Facts
Common Winter illnesses
Stroke Awareness
Given the work being undertaken, it is very encouraging that a second Health Promotion Officer
vacancy has now been filled and the new Health Promotion Officer will be joining the
department early in 2016.
6. Antibiotic Awareness
A high profile campaign was organised by the Public Health Department with the assistance of
Consultant Microbiologist, Dr Nicholas Cortes. This was part of the European Antibiotic
Awareness week to promote awareness of antibiotics as a lifesaving resource, but one open to
risk of misuse.
Part of this campaign included the launch of the GHA’s comprehensive evidenced-based
guidelines on antibiotic prescription for use by doctors and nurses.
7. Vaccination against Meningitis B
November saw the introduction of a new vaccine against Meningococcus B disease as part of
the routine childhood vaccination programme. The vaccine will be offered to all babies to
protect them against this serious disease.
Meningococcus B is the leading killer of babies and young children, causing infections that come
on very quickly and can leave permanent damage.
This is a very safe vaccine which has been widely tested and has been administered in the UK
for several months.
8. Colorimetry Service
After being approved by the Board and with additional GHA funding, the Colorimetry Service
has now been fully implemented/functional with children already benefiting from this unique
service. Patients no longer need to fly to UK to obtain the treatment which is another example
of the GHA’s aim to repatriate services. It has cut waiting times by 50% and led to savings; but
most importantly are the benefits to patients which in many cases has changed their lives.
9. Colorectal Cancer Screening Programme
The programme continues as planned with the support of the St Georges NHS Foundation Trust
Screening Colonoscopists. The current programme is being reviewed in order to explore areas
for improvements. Even though some cancers are being diagnosed in patients who would
otherwise be asymptomatic, the response rate of the programme continues to be disappointing
with an uptake of 38.1% when compared to that of the UK, which is around 60%.
The Public Health Department is reviewing ways of improving this.
10. School of Health Studies
In November the first cohort of pre-registration degree students graduated. Four Registered
Nurses successfully completed and were awarded a Diploma in Healthcare Practice and twelve
Registered Nurses graduated with a BSc in Healthcare Practice.
Page 33
11. GHA Expenditure
The financial performance report presented covers the period 1st April to 31st December 2015.
As stated in previous reports, we expect a forecast overspend. This overspend is mainly being
influenced by the increased pressure on many of the patient demand led budgets.
12. Estimates 2016/2017
The estimates process for 2016/2017 has been completed and submitted on time.
13. Staff Awards
The Staff Awards programme for 2015/2016 is now well underway. Board members are
reminded that the ceremony is scheduled to take place on Monday 16 th May 2016 at the John
Mackintosh Hall commencing at 6pm.
I would like to thank Dr Antonio Marin for all the work done during his time as Medical
Director. Dr Marin has decided to step down after two years in post. The recruitment process
for the post is in progress.
To conclude, I would like to thank all the Directors, contributors and their staff who have
assisted in providing these reports, without whom the achievements outlined would not have
been possible.
Respectfully submitted,
Mr Fred Pitto
CEO
Page 34
6.2 Director of Public Health
Health and Lifestyle Survey
The analysis of the data collected by the Health & Lifestyle Survey has now been completed and
is undergoing interpretation and editing prior to publication. This part of the project is time
consuming as each section has to be reviewed for accuracy as well as perspective.
At the time of writing, it seems that the report will be written by the target date of 1st April
2016, but the publication of the print editions is likely to take a few more weeks.
Information Analyst
The Information Analyst has continued to service the Monthly Reporting of Government
statistics.
In line with her contractual commitment to undergo training, the Information Analyst has
commenced her distance learning Diploma Courses in Statistics and Epidemiology at the
London School of Tropical Medicine and Hygiene.
Colorectal Cancer Screening Programme
During the period spanning the months of October to December 2015, a total of 811 invitations
were mailed to eligible participants inviting them to take part in the Colorectal Cancer
Screening Programme. During this same period 804 test-kits were prepared and mailed to the
participants and 306 samples were returned to the hospital laboratory for analysis. The
following is the breakdown of the results:

261 Negative for occult blood results

26 Inconclusive for occult blood results

19 Positive for occult blood results
Of those participants invited to participate, two persons refused outright to participate in the
screening programme. In accordance with the protocol, they will be re-invited to participate in
two years.
Of the 53 invitations extended to eligible participants residing in Spain, six individuals
expressed interest in participating in the screening programme.
During this same period, three additional individuals who aged over 74 and therefore not
routinely invited group, approached the screening office requesting to be included electively in
the CRCS programme.
Participants continue to visit the screening office seeking advice on whether they should be
taking the FOB test, in view of the various medications they were taking. Other persons visit to
request replacement test-kits or to get clarification on the method.
It was noted whilst speaking to prospective participants that, while there was some new
interest as the CRCS programme became a point of conversation, in some instances during this
quarter, other family and friends were apathetic to participating in the CRCS programme
Page 35
because they felt that having no symptoms made it unnecessary. Apparently, more education is
necessary because it is exactly such complacency that the screening is designed to counter.
The Response Rate of the programme continues to be disappointing at 38.1%, when compared
to that of the UK, which is around 60%. To address one possible reason that some people could
find the test kits confusing, the Public Health department has produced an instructional video
on a DVD, which has been incorporated as part of the test-kit since December 2015.
Abdominal Aortic Aneurysm Screening Programme
During the same quarter, 47 invitation letters were mailed to eligible participants, of whom 35
accepted their invitations (74% response). All these participants were issued with ultrasound
appointments.
A total of 26 reconsider letters were issued to participants who did not reply.
No expressed refusals were recorded during this period. However, 19 invitees, who did not
respond to either the invitation letter or the reconsider letter were marked as ‘Inactive’ and
notified.
Requests were received from 3 individuals aged 66-74+ years (outside the invitation range) to
take part in this initiative as elective cases. This adds to the 11 such requests in the previous
quarter. It would seem that the broadcast of the GHA infomercial promoting the screening
programme on GBC television may have contributed to the interest.
During this period, 65 men were screened. One man who was diagnosed in the previous
quarter to have a medium sized aneurysm was found that after 3 months during re-screening
the aneurysm had grown to a large aneurysm. In accordance with the medical protocol, the man
was referred urgently for vascular surgery.
Out of those men screened during this quarter, one man was found to have an undiscovered
medium sized aneurysm whilst two other men were found to have previously undiscovered
small sized aneurysms. These three men have been referred to their respective general
practitioners for further management according to the medical protocol.
As a matter of note it has been noticed that a number of individuals who have repeatedly failed
to accept multiple invitations to participate in the AAA programme readily accepted instead to
participate in the CRCS Programme, an observation that deserves further analysis.
Influenza
During October, a case of H1N1v was reported in a middle-aged man, whose condition
deteriorated rapidly, necessitating critical care and supported ventilation, but he recovered
fully. Family (household) contacts were contacted and offered vaccination.
The annual seasonal flu vaccination campaign was started. In the GHA, staff and all long stay
patients in both the GHA, Cochrane and Calpe wards were offered vaccination. To date 392
persons, both patients and staff had been vaccinated by the Infection Control Practitioners.
In December, a second H1N1v case occurred of a 61yr old woman who developed acute
respiratory distress syndrome, a complication of the disease, necessitating ventilation.
Page 36
Household contacts were contacted and offered vaccination, while some staff contacts and
other family contacts also received medical prophylaxis.
Pertussis (whooping cough)
An unusual cluster of six Pertussis cases occurred in 3 adult couples during October. Cases were
unrelated and not known to each other. All were treated with antibiotics.
Health Improvement
While services for Health Improvement continue to be provided by one Health Promotion
Officer, it is very encouraging that a second health promotion officer has now been recruited
and will be joining the department in early 2016.
The following are some of the activities carried out within the department:
Public Events
•
The Health Promotion Officer participated at a conference on Health and Safety in the
Workplace at John Mackintosh Hall. The presentation included dangers of sun
exposure, skin cancer and ‘the patient’s experience’
•
The Health Promotion Officer supported and participated in the setting up of a Mental
Health Information Stall at Bayside Comprehensive School on Friday 9th October
2015. Several leaflets and posters were displayed and the stand was well received by
both teachers and students. Other professionals included staff from Club House,
Gibraltar, Mental health, Practice Development (GHA) and Youth services.
•
World Diabetes Day 2015 campaign on Friday 13th November was held outside the
ICC Building. Members of the GHA Diabetes team and the GHA Dietetics department
also participated.
•
World AIDS Day was commemorated on 1st December 2015 with a display outside the
ICC Building that included posters and leaflets on HIV and AIDS. Red Ribbons were
given out to the public. The event was covered by the Chronicle and GBC TV.
•
The HPO supported the annual CAB event at the Piazza on Thursday 3rd December,
handing out “Brighten your Christmas with Advice” leaflets.
Health Education
•
The Health Promotion Officer gave an interview to James Murphy from GBC on the
subject of Healthy Lifestyles for a new programme to be televised in 2016.
•
Leaflets and posters on the dangers of Smoking were given to the Royal Gibraltar Police,
to address their concerns about smoking in the workforce.
•
The Health Promotion Officer wrote the following articles for the Gibraltar Chronicle:
Diabetes
Antibiotics
Flu facts
Page 37
‘Pregnancy and the Flu’
‘Drink Safe and be safe this Christmas’
‘Common Winter Illnesses’
‘A stress-free Christmas’
An article ‘New Year, New You’ was also written for the Insight Magazine.
•
A number of health topics were covered on Radio Gibraltar Health File, including Diabetes,
Antibiotic awareness and HIV/AIDS.
New Resources
•
The department has procured two new display boards for use in Campaigns
•
A new leaflet for the Meningitis B vaccine was designed and printed. This will primarily
be distributed through the Maternity and Child Health Departments
•
A DVD containing the instructions for the Colorectal Cancer Screening programme for
distribution to clients was completed in December 2015.
•
A new poster was designed for the Colorectal Cancer Screening Programme and
displayed at St Bernard's Hospital (Outpatients and Medical Investigation) and the
Primary Care Centre . It is planned that the poster also be displayed at other locations,
like senior citizens clubs and the Victoria stadium.
•
An infomercial on Dementia has been completed for broadcasting in January.
•
An infomercial on Depression and another on Antibiotic resistance are under
preparation.
Assistance to Support Groups
•
The HPO supported an awareness event on Stroke organised by John Sheppard and held
on Saturday 7th November outside the ICC Building.
•
The Health Promotion Officer met with Mrs Polly Lavarello founder of the ‘mum on the
rock’ (‘MOTR) website to discuss working together to enhance public awareness on
issues faced by prospective parents, new parents and other issues of concern infants
and children.
Antibiotic Awareness
A high profile campaign was led by the Public Health department through the European
Antibiotic Awareness Week (15th-21st November 2015) to promote the awareness of
antibiotics as a vital life-saving resource, but one open to risk of misuse and the long term
threat to humanity.
It included a number of initiatives with participation from across different departments of the
GHA:
 A series of articles by different professionals were published in the Gibraltar Chronicle
throughout the week, covering different aspects of antibiotic use, misuse, antimicrobial
resistance, prevention of disease and control of infection in hospital.
Page 38
 The Gibraltar Chronicle published an interview with Dr Nick Cortes, Consultant
Microbiologist.
 A number of retail pharmacies participated in the event as ‘drop off points’ for the
disposal of unused/unwanted antibiotics and other oral medication antibiotics by the
public. Collection points were located at Morrisons pharmacy, Trafalgar pharmacy,
Wesley pharmacy, the Hospital pharmacy and the Primary Care Centre. Collection bins
were dropped off at the locations and removed by GHA staff.
 On Antibiotic Awareness Day (18th November 2015) a stall was manned outside the
ICC Building foyer, by GHA staff from Microbiology, Health Promotion, Pharmacy and
Infection Control displaying posters and information leaflets to raise public awareness
about antibiotic resistance and the importance of correct antibiotic use. Leaflets were
distributed to the public and advice regarding antibiotic usage given. The event was
covered by GBC TV and radio.
 At the event, the public were encouraged to take part in a small quiz on antibiotics
during the day.
Page 39
 A new infomercial on antibiotic use and misuse was commissioning for production in
2016.
 Material from the successful UK website ‘TARGET’ was used with permission from the
owners, Public Health England and the Royal College of General Practitioners.
 The GHA launched comprehensive evidence-based guidelines on antibiotic prescription
for use by doctors and nurses.
Dr V. Kumar
Director of Public Health
Page 40
6.3 Finance & Procurement Directorate
Developments
Payroll System
The GHA signed the revised new salaries software development and implementation proposal
with M4 in August 2015. The project is now on track for go-live early in the new financial year.
Progress continues to be closely monitored with regular meetings with the developer and in
lines with the conditions of the contract, invoicing against the contract is based on successful
delivery of milestones to guarantee successful delivery and implementation of the software.
A test system is already installed within the GHA salaries department and as we progress with
the user acceptance testing phase of the software we will be inviting other GHA stakeholders,
representatives of the Government Treasury Salaries Department, Central Government IT and
the Audit Office to review the new software.
The Government Treasury will assess the viability of this application as a realistic option for
replacing Central Government’s own antiquated Morph payroll software.
If the software manages to address all GHA payroll complexities, it will potentially only require
some further customisation and adaptation to the specification needs of Central Government
payroll and if viable could undoubtedly provide significant software development cost savings
to the Government.
Estimates 2016/2017
GHA Estimates for 2016/2017 have already been presented to the Financial Secretary for
consideration.
Electronic Inventory Management application for Stores
The development of the in-house application to fully serve the electronic inventory
management needs of the main GHA supplies store continues to progress well. The piloting of
the software with pantry stock items is currently on track ahead of a phased roll out.
The Procurement HEO continues to lead on this initiative with eventual roll out of the
application hopefully improving control of inventory and delivery of all its associated benefits
in efficient and effective stock control, better cash flow management in the procuring of stock
items and overall cost saving as a result of better control and less wastage and obsolescence.
Following the culmination of the staff restructure in Stores, the HEO continues to work on
producing an actionable Gap Analysis report to show our current position relative to the
Parkhill review recommendations of some years back, and also highlighting our aims going
forward. This will serve as the platform to attempt to bridge any gaps and further update on
recommendations accepted, as to those already implemented and those that still need to be
implemented following on from the Parkhill review.
Page 41
Mr G Teuma
Director of Finance & Procurement
Page 42
6.4 Estates & Clinical Engineering Directorate
Report to the GHA Board of Management:
4th Quarter October - December2015.
St. Bernard’s Hospital: Improving Patient Access to Main Entrance.
The civil works were completed during October and the delivery and first fix of the new
escalators was carried out on the 4th November. This was carried out during the night so as to
keep traffic disruptions to a minimum. The final commissioning is expected during December.
Page 43
St. Bernard’s Hospital: New Chemotherapy Suite
Works commenced on site on the of November. This entailed demolition of redundant
partitions and HVAC equipment. Some of this work has been carried out in-house to keep costs
down to a minimum. During December installation of first fix HVAC and plumbing/electrics was
also commenced.
The project is expected to be completed for handover by the contractor during March/April.
The total costs for the project including equipment is currently estimated at £160,000.
St. Bernard’s Hospital: Redevelopment Plan for A&E
Following the detailed planning phase for the extension to A&E, the project has gone out to
competitive tender. It is expected that the contractor will be appointed in January with works
commencing in February 2016. The design is based on Clinical Staff input and the first phase is
estimated at £75k. The project will incorporate the following additional features:
1. Expanded Minors Area.
2. New Ambulance entrance.
3. New Plaster Room.
4. Extra Clinics.
5. New Changing Areas.
6. New Place of Safety.
7. Expansion of Clinical reception.
Completion is currently estimated for May 2016.
Page 44
Page 45
6.5 Director of Nursing
The Nursing Directorate’s Gibraltar Health Authority’s Board Report submission.
October – December 2015
Child Health: This quarter has seen the introduction of two additional vaccines.
Meningitis B has been included in the childhood programme and has required an
additional vaccination session.
Meningitis CY125 replaces the meningitis C and is been administered from age 13. The
team will be carrying out a catch up exercise over two years, vaccinating years 9; 10;
13; the Hebrew school and the College students.
Additionally this quarter the Child Health Team has assisted in another catch up
exercise by administering 67 BCG vaccines to babies who were not able to receive it on
discharge from the Maternity unit.
Influenza vaccination programme:
The overall uptake of vaccines at Primary Care and Community from October to
December has totalled 1035. The figure is reduced from previous years despite the
vaccine been offered almost a month earlier than in 2014.
EHR:
Nursing staff continue working on developing working processes and templates to
incorporate within the electronic health system.
Diabetic Service:
The Nursing team will be carrying out an exercise to update the existing annual review
register to incorporate to the EMIS recall system. Further plans include calling patients
to advise of forthcoming recall before sending the letters in an attempt to reduce DNAs.
Training:
Several updates and training modules specific to Primary Care Nursing services have
been planned with the SHS for 2016.
In addition, several members of staff are currently undergoing independent studies in
their specialist fields
Primary Care Nursing workload Activity July to September 2015
Oct
Nov
Dec
Annual
'15
'15
'15
Total
Child Health Dept
Dr's Clinic
Health Visitors/Nurse
Team
Weighing Clinic
HV Assessments
HV Primary Visits
School children assessed
School Health visits
Eneuresis Clinic
64
54
41
529
236
42
125
0
4
500
229
35
80
0
3
380
237
37
3919
0
7
Page 46
Immunisation Clinic
Total
694
1630
604
1451
226
906
17475
Cardiar Rehab. Nurse
114
215
140
2034
Diabetic specialist
Nurse
558
690
417
Nurse Practitioner
630
541
612
9116
Practice Nurses
Treatment Room
Phlebotomy Clinic
Ear Syringing Clinic
ECG Clinic
Vaccinations
Nurse clinics
Total
999
991
59
114
314
393
2870
970
1116
62
107
395
462
2112
1079
958
53
157
119
379
2745
33671
Cryotherapy
(Dermatology Nurse)
744
870
615
6928
MWO
104
99
118
1354
292
238
55
156
225
132
184
298
151
128
0
19
97
733
177
0
4
76
770
159
1
3
0
1938
District Nursing Team
Diabetic/Insulin
Dressings
Injections
VisitsSupport/Monitoring
Terminal Care
Catheter Care
INR and Blood Samples
Total
Grand Annual Total
7433
10408
88215
Victoria Ward:
The Nurse Management team have been busy during this period with further increasing
service demands from most areas. Despite these inevitable pressures the team is proud
to provide high standards of care to patients and other service users addressing any
concerns at source in order to improve and maintain standards of care.
Training continues to be high on the priority list and staff endeavours to continue look
at ways in which to maximise staff attendance.
Page 47
Training undertaken by staff
Safeguarding adult course for managers in November
Attended by – Jessica De Santos Ward Sister
Basic Awareness of Safeguarding Adults at Risk
X 1 staff Nurse attended the above training.
Dignity Training
Attended by one of the Enrolled Nurses
Phlebotomy - Blood Department:
Phlebotomy staff and managers are exploring a blood appointment system to reduce
waiting times and patient anxiety. This hopefully will soon be put into action.
Staff attended the following Educational Sessions:
Post Mastectomy Reconstruction and Open access follow-up after treatment for Breast
Cancer presented by Mr Graham Offer (plastic and reconstructive surgeon).
Basic Awareness of Safeguarding Adults at Risk attended by one of the Staff Nurses.
John Ward:
Safeguarding adult course for managers in November
Attended by – Acting Sister Helena Kelly – the Nursing Directorate welcome senior
nurses to undertake this training as there has been a clear need for senior nurses to be
trained in this field.
In house trainingA course in Cannulation was attended by X4 RGNs
The Acute Medical Care Module- was attended by x2 RGNs
Meals
Nurse Management continue to receive positive feedback about the quality of food
since the bulk system has been introduced.
Page 48
CCU:
Nurse management is committed to continue to provide staff with opportunities to
access appropriated training and development opportunities within CCU with the
support of the team. This has resulted in the following opportunities for training.
Attendance at the European Society Intensive Care Medicine Congress held in Berlin –
October 2015
Attended by two staff Nurses
Audit Master Class course held in London – 14th November
This was attended by one of the Sister of the unit.
New Bodyguard 545 Epidural pumps training sessions was undertaken by 3 staff
members and a total of 10 staff have attended the training sessions and the trainers
have trained other staff in the unit.
The Immediate Life support Course was attended by 6 members of staff
SN Luis Balmaseda attended as one of the ILS instructors.
Clinical Reasoning in practical assessment (Part 1 & 2) modules was held at the SHS by
Kingston and was attended by two members of staff.
Acute Medicine (part 1) module held at the SHS by Kingston was attended by another
two staff members.
Four staff CCU staff members have been involved in the development of
guidelines/protocols for Non-Invasive Ventilation.
Rainbow Ward:
Academic achievement
The directorate is pleased at the achievements of two staff members namely SR Sarah
Smith and Staff Nurse Cary Anne Taylor. Both staff members have graduated locally
with the St George’s programme.
Training
Neonatal workshops delivered by Kingston University lecturer for all staff
SR Sarah Smith attended the EPLS Generic instructor course
Equipment: A new Diabetes equipment cupboard is now placed outside rainbow clinic
where patients can easily access renewal of medication & equipment. Two new trollies
with drawers arrived for use in the High Dependency Unit (HDU).
Page 49
Donations to the Department:
Rainbow has been inundated by the kind generosity both locally and abroad
throughout 2015.


The Tartan Army Sunshine appeal donated and presented a total of £5000, this
went towards the Christmas party & the purchase of 2 express breastfeeding
pumps (one that went to Maternity).
The Guardian Angel Foundation are currently funding the refurbishment and
purchasing of furniture, Toys etc. for the playroom & multi-sensory room.
Rainbow Ward 2015 admissions to the unit according to the data collected totalled 765,
an increase of 59 patients.
The staff were saddened to hear of the death of Dr Steve Higgs who worked for the GHA
at St Bernard’s hospital. He was a very dedicated professional always available to staff
and parents/children for advice. He will be sadly missed by all who knew and worked
with him. His down to earth approach made him popular both with staff and the
general public.
A&E Department:
various training opportunities have been taken on by the unit staff with x 3 RGNs and
x1 Enrolled Nurse attending BIPAP Non-Invasive ventilation training session held on
the 25th & 26th November.
A rolling programme has been developed by the team for A&E staff to attend the
anaesthetic room on morning placements this will improve their knowledge and skills
enabling them to assist the intensivist with intubation. This will allow for better
management of the critically ill patient.
The staff have also been able to attend training sessions delivered by the Consultant
Paediatrician for A&E staff this is on-going.
Basic Awareness of Safeguarding Adults at Risk was attended by one staff member.
Surgical Directorate:
Dudley Toomey Ward:
DTW continues to have a high turnover when compared to other wards with a mean
monthly admission rate of 90 patients per month and average occupancy of 98%.
During the reporting period (October- December 2015) the patient mix consisted of 8%
medical overflow.
Page 50
In order to cater for the care needs of all patients from diverse specialities, the
following issues have continued to be tackled in collaboration/partnership with Ward
managers and clinical staff:

Sr. Fennelly & Sr. Dean attended a clinical placement in St Georges University
Hospital (London) on 22/10/15 to 25/10/15 where they understudied the role
of the Ward Manager and were able to validate local practises. These visits are
part of a succession planning and leadership development initiative which it is
hoped that in the future it will gradually encompass all clinical areas.

Issues of interest identified during the visit included:
 Nursing hierarchical structure (Divisions/Head of Nursing roles/strategic and operational
overlap.
 Electronic rostering (integration of HR/Nursing/Salaries/staff with limited access)
 Online mandatory training systems
 Complaints documented via IT Daytex system
 Practise Development themes- pressure damage and end of life care.
 Active leadership development programmes (band 6-8).
 Role of Modern Matron (visible in clinical areas in uniform).
 Stores top-up systems.
 Dedicated elderly patient wards (Senior Health)
Page 51
Captain Murchison:
Turnover continues to be low in view of the complex delayed discharges associated
with the current patient mix. Liaison with relatives, social services and other AHP’s
continues to be vital in order to establish long term plans of care in a more
appropriate environment outside SBH (meeting every Wednesday afternoon). In
order to cater for the care needs of the current client mix, the following issues have
continued to be tackled in collaboration/partnership with ward & other clinical
staff:
 Sr. Ivana Finlayson attended a clinical placement in St Georges University
Hospital (London) on 22/10/15 to 25/10/15 where she understudied the role of
the Ward Manager and was able to validate local practises. These visits are part
of a succession planning and leadership development initiative which will in
future gradually encompass all clinical areas.
 Issues of interest identified during the visit included:
 Dedicated elderly patient wards (Senior Health) & MDT/multiagency working
 Activities programme
 Falls prevention/monitoring
 Nursing hierarchical structure (Divisions/Head of Nursing roles/strategic and
operational overlap.
 Electronic rostering (integration of HR/Nursing/Salaries/staff with limited
access)
 Online mandatory training systems
 Complaints via IT Daytex system
 Practise development themes- pressure damage and end of life care.
 Active leadership development programmes (band 6-8).
 Role of Modern Matron (visible in clinical areas in uniform).
 Stores top-up systems.
 Dedicated elderly patient wards (Senior Health)


An activities programme coordinated between CMW and VMW is on-going. From
previous satisfaction surveys conducted 92% of patients/relatives support the
introduction of an activities programme.
In an effort to continue to monitor accountability among trained staff, a list of
patients continues to be posted at ward level identifying the named nurse for
Page 52
care planning purposes. Compliance will be monitored by the Ward Manager &
CNM’s responsible.
Ophthalmics:
The Ophthalmic team continue to undergo in - house training to ensure high quality
standards of patient assessments, treatment and better flow of patients through the
department, this with the one stop clinics has assisted in eliminating waiting times for
patients requiring Cataract Extractions under L.A.
Nurse led clinics have continued to impact on the number of patients that the
department is now able to attend to. This includes a continuous improvement in the
number of ophthalmic conditions diagnosed and treated in house and an extension in
the services provided to the General Public.
The Nursing staff complement has been under revision as a result of the workload and
number of patients seen and treated within the department and as a consequence there
will be an additional Registered Nurse joining the Ophthalmic team as from March and
one of the Nursing assistants presently undergoing Enrolled Nurse Training.
Additionally two other members of the Nursing Team are also undergoing additional
training to enhance the Nursing skill mix and Ophthalmic expertise offered to patients
currently.
Operating Theatres:
The Gibraltar Health Authority in collaboration with Edge Hill University are currently
delivering an acclaimed academic module to four Registered Nurses / experienced
Theatre Practitioners based on the Surgical First Assistant role as outlined by the U.K
perioperative Care collaborative. The course will cover a number of topics including the
legalities of the role, risk assessment, principles of the role from draping, positioning,
tissue retraction, assisting with haemostasis and electro surgery. The aim being for the
Nursing staff to be recognised for the role / lead they currently undertake.
Following the successful collaboration between the Gibraltar Health Authority and
Edge Hill university, both the School Of Health studies and the Clinical Nurse Manager
for Theatres are working closely together with Edge Hill to explore the possibility of
introducing the Operating Department Practitioner training locally.
Historically all Operating Department practitioners have been trained and recruited
from the United Kingdom as it has not been possible to do so locally.
The training programme would consist of a three course at BSc (Hons) level covering
all aspects of Theatre practice.
The Theatre Nursing Team continue to work together with the Medical Director,
Surgeons and the Anaesthetic team to maximise Theatre capacity and productivity, by
utilising free sessions and Theatre 3 to undertake additional Theatre lists such as
Visiting Consultants, Special needs Dentistry plus regular Ophthalmic G.A lists to reduce
surgical waiting lists.
Page 53
Day Surgery:
The Day Surgery unit continues to expand its services and the number of procedures
undertaken within the unit with the introduction of 2 full day G.A operating sessions on
Tuesdays, to reduce the waiting list for patients requiring Dental / Max-Fax surgical
procedures and a G.A General Surgery list every Wednesday.
At present a total of 12 – 15 L.A Dental Max/ Fax procedures are undertaken within the
Monday and Tuesday sessions, with the additional provision of a further 4-6 Max-Fax
G.A cases now being carried out on alternate Tuesdays.
The Day Surgery Unit continues to undertake on average 85 – 95% of all elective
patients requiring surgical procedures of all sub specialities.
Pain clinic / infiltration sessions also continue to be undertaken as well Cardio
Versions and Plastic Surgery procedures (during visiting consultant’s visits)
During the period from January 2015– December 2015 a total of 2,487 surgical
procedures have been undertaken within the Day Surgery Unit and a total of 2,871
patients admitted and processed through the unit (as reflected in the DSU Monthly
Statistics)
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
Total
Day Surgery
189
276
304
220
238
224
290
210
213
242
251
214
165
251
268
183
200
193
246
168
187
216
221
189
%
87.30%
90.94%
88.16%
83.18%
84.03%
86.16%
84.83%
80.00%
87.79%
89.26%
88.05%
88.32%
Percentage as Day Surgery
Patients
87.30%
90.94%
88.16%
83.18%
84.03%
86.16%
84.83%
80.00%
87.79%
Page 54
Page 55
TSSU Department:
With the increase of elective Day Surgery Procedures and provision / utilisation of
Theatre 3, TSSU / CSSD has had to undergo modification and development of its
services at many levels.
Educationally three members of the team have undergone SSD Manager / Supervisors
(DTM HTM) training at Eastwood park hospital in the UK as part of the natural
progression in CFPP practices and E.U requirements.
The Department has recently undergone refurbishment and updating of its Steris
automated washers and decontaminations units to enable to continue to provide a
streamlined service to its users which include:














Operating Theatres
Day Surgery Unit
Maternity
Accident & Emergency Department
Ambulance Services
Radiology Department
Dialysis
All Wards & Clinics in SBH
PCC
ECA
Ocean Views
HMS Prison
RGP & City Fire Brigade
St Johns Ambulance
MIU/Outpatients Department:
The Colorectal Screening Programme continues with nursing actively undertaking the
lead in the re-design of policies and care pathways for patients who are recalled to
undergo further screening.
The visiting Gastroenterologist’s from St Georges Healthcare Trust continue to provide
support and teaching / training session updates on Endoscopic Practice and
procedures for the Endoscopy Nursing Team to maintain service delivery to patients in
accordance to NICE Guidelines and quality assured standards.
MIU continue to undertake many other procedures / interventions within the
department itself on a weekly / monthly basis which include all the interventions listed
below;
Page 56
GHA Board Report – October to December 2015
Medical Investigations Unit
Procedures
Endoscopies
Stress tests
Cardiac Holter
Sleep Studies
Spirometry
Stress Echoes
Echoes
Echoes in patient
Bronchoscopies
Pacemaker checks
EEG
B/P Holters
Bone Marrows
CPAP
Bronchoscopies
Pacemaker checks
EEG
B/P Holters
Bone Marrows
CPAP
2015
JAN
FEB MAR APR MAY JUNE JULY AUG SEP OCT NOV DEC
37
44
34
58
62
54
50
36 59
73
56
77
15
10
10
15
12
15
13
6 27
27
12
0
60
60
60
60
60
60
60
27 26
60
60
60
30
30
30
30
30
30
30
30 30
36
33
30
16
16
16
16
16
16
16
5
3
5
4
2
2
3
0
0
0
8
10
8 14
15
8
1
49
44
55
53
60
66
55
97 59
76
73
75
38
22
38
18
23
19
17
12
2
2
2
2
1
1
2
2
1
1
2
1
10
2
7
4
4
4
4
1
4
6
7
6
3
8
1
2
4
5
1
1
3
3
2
1
1
0
20
22
8
2
2
2
2
1
1
2
2
1
1
2
1
10
2
7
4
4
4
4
1
4
6
7
6
3
8
1
2
4
5
1
1
3
3
2
1
1
0
20
22
8
Infection Control:
The following highlights the work carried out by GHA infection control team
during this quarter:
 Incidence of Pertussis in community –Bordetella Pertussis, symptoms
were that of persistent spasmodic cough and all cases proved to be
unrelated.
 The team manned the ‘Antibiotic Awareness’ Campaign stand on the 18 th
November along with the Microbiology department, GHA pharmacist and
Health Promotion team to promote awareness of the misuse of
antibiotics, leaflets and information give to public as well as a week -long
series of articles published in the Gibraltar Chronicle. New GHA antibiotic
guidelines were also released to clinicians.
 Commencement of Hepatitis B vaccination programme to all dialysis
patients (on-going)
 Flu vaccination programme commenced for GHA staff and all long stay
patients in GHA and Calpe and John Cochrane, also Prison staff and
inmates.
Page 57









The team also manned the GHA stall in support of World Aids Day on the
1st December – delivering information and ribbons to the general public
on HIV.
PPE training delivered to Environmental Agency staff.
Mandatory training and teaching delivered to first year students at the
School of Health studies.
The team also visited St Bernard’s middle school to deliver information to
school children on infection, microbes and hand washing.
The infection control team continue to routinely screen all patients
returning from other hospitals for MRSA and have commenced CRE
screening too.
Daily monitoring and surveillance of all hospital acquired infections.
The department staff also manned a stand on hand hygiene at the
Gibraltar University’s open day.
The ICT continue to attend various meetings within their remit including
meetings for Sexual Health Strategy.
The department have also been involved in commencing a clinic for HIV
patients to be seen in the GHA.
Breast Care:
The following is the Breast Care report for this period.
October – December 2015
Clinical / Patient Care
New patients / primary secondary breast
Ca
Lymphoedema Appointments
Lymphoedema review clinics
Breast Care Clinic
IV infusions (Zometa)
Porta Cath Care
SC Injections
Telephone calls
Patient drop ins
Wound Care appointments
Patient undergoing plastic surgery gha
Stoma Care
Home Visits
6
11
23
9
17
31 + Ivabs 7
16
56
23
16
4 patients seen
1
0
The breast care nurse as part of her personal development has attended the
Annual Breast Care Conference in London and the Metastatic Breast Cancer Day
held in London. She also attended the Breast Care Education event in October
2015 held at the Elliot Hotel local. The guest speakers at this event were from the
RMH and Leicester Royal Infirmary.
Page 58
Bed Management Board Report October- December 2015
1.1 The month of December 2015 as a ‘snapshot’ of the quarter has
demonstrated a continuation in high bed occupancy for adult patients at
SBH.
1.2 Extra beds have been used intermittently throughout the period with an
average adult occupancy was 111%.
This percentage remains substantially higher than the average occupancy
recommended by the DOH 2001 - 85% sealing.
A sustained high overall bed occupancy level in CMW and VMW remains as a
consequence of:

A constant high number of long stay/complex cases populating acute
hospital beds (‘snapshot’ 88 beds held in December 2015)
Despite these issues the following efforts continue:






MDT working both on acute & long stay wards (rehab).
Improving patient flow on JMW (acute medical).
Proactive approach to the discharge process.
DC hour’s availability to support discharge (delays on occasions).
Closer integration with The Care Agency (availability of long term beds in
order to expedite patient flow).
Utilisation of John Mackintosh Wing (Old SBH).
There are, however, historical ‘bottle necks’ which continue to delay the
discharge process which together with an anticipated increase in seasonal
demand, will in the balance of probability, cause pressure on bed availability &
patient flow in the coming months. These are:




Housing/rehousing/buildings & works issues.
Absence of a dedicated ‘in house’ Hospital Social Worker.
Limited long term care beds (Care Agency) in relation to demand hence a
backlog in SBH/OV.
A dedicated multidisciplinary team to focus on complex delayed
discharges & inpatient social care needs with a view to further develop a
more robust & seamless service into the future.
Page 59
1.3 Total admissions from October 2015 – December 2015 for SBH are as
follows:
Admissions all areas
866
Admissions via A&E
561
Admissions Adult & CCU
537
Admissions via A&E
389
Paediatrics
170
Admission via A&E
91
Maternity
147
Non elective
80
Data captured on Bed Management Database.
Fig 4. Total Admissions SBH January 2014- Dec 2015 (adult wards)
Total Admissions per ward 2014 -2016
140
120
Number of patients
100
80
60
40
20
0
Fe Ma
Ma
Au Se
No De
Fe Ma
Ma
Au Se
No De
JanAprJun-JulOctJanAprJun-JulOctb- ryg- pv- c'1
b- ryg- pv- c14
14
14 14
14
15
15
15 15
15
14 14
14
14 14
14 4
15 15
15
15 15
15 15
ADMISSIONS DTW
115 103 114 104 112 95 102 104 100 109 93 91 111 118 117 101 113 121 109 122 118 99 90 84
ADMISSIONS Capt.M
1
10
ADMISSIONS JOHN
57 63 62 69 61 36 84 66 108 83 69 66 88 53 69 37 44 35 9* 30 32 45 36 40
3
1
2
0
0
0
6
2
2
1
2
4
1
0
3
1
0
3
3
1
1
4
5
2
14
3
3
8
6
3
0
3
1
2
1
1
0
1
0
5
3
0
ADMISSIONS VICTORIA
2
ADMISSIONS CCU
50 38 40 38 47 34 33 43 50 58 48 55 41 53 62 56 59 63 62 40 38 39 41 54
Page 60
1
1
0
Fig 2: Average (Adult) Bed Occupancy SBH inclusive of CCU January 2011 to Dec
2015.
150%
100%
50%
0%
Jan
Feb
May
June
July
Aug
Sept
Oct
Average Occupancy 2011-Adults
97%
94%
96%
93%
92%
89%
95%
94%
96%
95%
109% 103%
107% 109% 104%
82%
88%
96%
91%
87%
81%
85%
89%
92%
96%
102% 100.70 99%
102%
97%
95%
90%
97%
92%
96% 85.30%95.20% 95%
94%
97% 99.60%97.60% 88.70% 91%
97%
Average Occupancy 2014- Adults 102% 104%
March April
98%
Nov
Dec
Average Occupancy 2015- Adults 96.90%99.46% 103% 100% 96.70% 102% 101% 102% 101% 110% 109% 111%
Fig 3. Distribution of elderly long stay/dementia/complex-snapshot as @ 15th
Dec 2015
20
15
10
5
0
Complex Delayed Discharges
DTW
4
CAPT
10
VICT
10
JOHN
8
CCU
0
Long Stay Elderly pending CA
0
15
16
0
0
Dementia
0
11
9
5
0
Page 61
Fig 4. The collective breakdown of this cohort of patients is as follows.
Complex
Discharges
32
Elderly LongStay
31
Average age 83 years
Dementia
25
Identified from nursing assessment.
88
130 adult beds SBH –88 = 42 acute beds available
Total
Held
Beds
Fig 5. Distribution of Beds SBH Dec 2015
25%
Dementia
24%
Complex Discharge
Distribution of beds
Elderly Long Stay
19%
32%
Acute Beds Availabl
1.3 Following re-configuration of wards, DTW & JMW continue to be the acute
surgical & acute medical wards respectively.
Fig 5. Total Cancellations elective inpatient surgery January 2014 to Dec 2015
due to bed shortage
Total cancellations due to beds 2014-2015
.
Total Number of Patient's
13
8
3
-2
Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- DecCancellation due to unavailability of bed
1
0
0
0
0
0
0
0
2
0
0
0
0
0
10
0
0
3
0
0
Page 62
0
0
4
3
1.6 Patient flow out of VMW & CMW remains dependent on transfers to The
Care Agency & successful rehabilitation candidates.
1.7 There have X 3 cancellations of elective inpatient surgery specifically due to
bed unavailability in December 2015 and X4 in November.
Eddie Holmes
Director of Nursing Services
Page 63
6.6 Human Resources Directorate
1.
RECRUITMENT & SELECTION ACTIVITY
Vacancies for 38 posts have been processed during the operating period covered by this
report.
2.
DISCIPLINARY ACTIVITY
An update of the Disciplinary activity is contained in part of this Report.
3.
STAFF AWARDS
The staff awards programme for 2015/2016 is now well under way and the HR
Department continues to receive nominations by patients, relatives and staff. The
closing date for receipt of nominations is the 29th of February 2016.
Discussions are also taking place with potential sponsors of the awards programme.
Board members are reminded that the Staff Awards Ceremony is scheduled to take place
on Monday 16th May 2016 at the John Mackintosh Hall commencing at 6:00pm.
After lengthy discussions, the Staff Awards Committee has agreed on the introduction of
a Long Service & Good Conduct Medal that will replace the existing long service awards.
The medal will recognise the contribution to healthcare by employees of the GHA who
have completed 20 years’ service who in addition have a record of continuous good
conduct.
The GHA Long Service & Good Conduct Medal policy has been drafted and it is
anticipated that the Staff Awards Committee’s recommendations will be shortly
finalized for approval by the GHA Board very shortly.
4.
HR DEPARTMENT
4.1
Employee investigations law & practice
As reported in my last submission, HR staff attended a course on employee
investigations in the UK with the intention of disseminating the learning outcomes to
others in the department through a structured presentation/workshop.
The idea is also to roll-out the presentation to others in the organisation in order to
provide an understanding of the legal and best practice requirements necessary to
conduct employee investigations and the techniques required of the investigators.
Those attending will then be included in HR’s list of potential investigators in order to
assist the department in future employee/disciplinary investigations.
4.2
Annual Leave - Internal Audit
The HR Department will shortly be embarking in a series of internal audits in order to
inspect and check consistency in the recording and management of Annual Leave
throughout the organisation.
The Guidelines on Managing Annual Leave have been recently reviewed and updated,
copies of which will be distributed to all those officers with the responsibility of
Page 64
Managing and recording Annual Leave, in order to ensure that there is consistency in the
way the GHA manages the process of Annual Leave within the principles enshrined in
both General Orders and Industrial Regulations.
4.3
Policies
There are a number of policies that are currently being drafted and these are envisaged
to be presented to the board for approval during 2016. The policies are as follows:Special Leave Policy
This policy is intended to address and cover a wide range of circumstances when
officers require paid or authorised leave of absence from work which are not covered
presently by General Orders or Industrial Regulations.
Mandatory Training Policy
The underlying objective of this policy is to identify and state the training that the GHA
considers to be mandatory and ensure that all staff are provided with mandatory
training in a timely manner.
On-call Policy
This policy is intended to clearly set out the GHA’s and the employees obligations in
relation to on-call.
Peter Linares
Page 65
6.7 UGM - Hospital Services
Contents
1) Introduction
2) Facilities Management
a) Catering Services
b) Domestics Services
c) Hospital Attendants & Messenger Services
d) Medical Records Library
e) Reception & Call Centre
f) Release of Records
g) Minor Works
3) Ambulance Services
4) Pathology Services
5) Radiology Services
6) Sponsored Patients
End of Report
Page 66
1. Introduction
This 4th Quarter saw the official opening of the new Catering Unit by the Hon Chief
Minister and Minster for Health on Thursday 22nd October 2015. The facility has
been welcomed positively by staff, user groups and the patients themselves.
The siting of the facility within the hospital estate brings logistical and operational
improvements to the services provided and have eradicated the long standing
difficulties of the transportation of meals.
The main concerns of quality, temperature, taste and smell that have been the root
of many complaints regarding hospital meals, have been addressed with the new
bulk food system and catering assistants. Further information is included in the
Catering Services section on page 4
The Estimates Submission for the financial year 16-17 was completed and
submitted.
2. Facilities Management
Fire Prevention
GHA Senior Management continues to review and improved the general
management of Fire & Emergency Evacuation. The Fire Strategy plan is nearly
complete pending final reviews with a target start date of 1 ST Quarter 2016. The
Facilities Management team have introduced new fire prevention checks and will be
improving on this in the next financial year.
Fire Prevention courses for Head of Departments shall be arranged during 2016 with
the assistance of the Gibraltar Fire and Rescue Service.
Health & Safety
The Health & Safety Committee continue to carry out Risk Assessments across GHA
sites and have now developed a database to record all findings and actions taken.
Heads of Departments are being informed of the Risk Assessment findings and
advised of actions required within specific timeframes dependant on Risk Score.
The Committee is being reviewed due to key personal changes within the
departments and new dates shall be set for the 2016 period.
2.
(a) Catering Services
The new Catering Unit commenced operation on Saturday 10th October 2015.
Page 67
This was a tremendous logistical task and delays meant that the new facility had
to be fully stocked for the opening while meals had still to be provided from the
old facility. There was no disruption to the services and all inpatients and
outside agencies continued to receive the meals as normal.
A vast array of professionals from various departments and agencies were
involved and without them this important task would have not been completed
as smoothly as it was.
Whilst the transfer from the old facility to the new one was being undertaken a
separate team from the GHA and the GoG Technical Service Department was at
the same time vacating and decommissioning the old facility to make way for
another Government project.
General
There has been a great uplift in organoleptic attributes. Food is of a better
quality in general and temperature which is the main problem encountered by
most similar operations in UK is a thing of the past.
All food provided to wards at St Bernard`s Hospital are probed for temperature
and this logged into a special catering file located in every single ward which can
be seen by anyone requesting it. Quality has improved without a change in menu
since we moved into this facility however, some new menu items have been
introduced with positive feedback. Bulk food service has the advantage that all
foods are suitable for it. Therefore now while designing the new menu the meal
distribution system does not stop us from being able to supply anything making
such menu compilation much easier and way more varied.
The new menu will be finished in the 1st quarter of 2016 and presented to the
dieticians for approval after which can be implemented.
Meals Provided for the period October to November 2015
Environmental
One vehicle has been taken of the road therefore reducing carbon emissions and
running costs. At present we are gathering figures to see to what extent the new
facility stands in comparison the old one in terms of Gas, Water and Electrical
consumption.
The amount of 12v batteries taken out of service is 48. These had to be changed
twice yearly therefore 96 batteries are no longer disposed off. These batteries
were part of the former meal distribution system.
A very important consideration to the environment and to cost is the substantial
savings made in terms of electrical consumption. This is presented in the
comparator below:
Page 68
Old Facility
Perio
Total
d
Oct- £7,989.
14
60
Nov- £7,989.
14
60
Dec- £7,109.
14
60
Jan- £8,435.
15
10
New Facility
Perio Total
d
Oct- £5,102.
15
88
Nov- £5,850.
15
13
Dec- £3,875.
15
63
Jan- £3711.
16
13
Total
Saving for new
facility
£2,886.72
£2,139.47
£3,233.97
£4,723.97
£12,984.13
Bulk Food Service
This service means that food is transferred in large containers known as
gastronomes from kitchen to point of service.
The positive
Choice at point of consumption
Pleasant Smell
Heat retention meaning better temperature
Customised portions
Food is safer as it`s easier to control the temperature of a larger gasstronorm
container than a plated meal.
Second servings can be provided
Possibility to combine different options available
Less wastage due to higher food intake
Temperature
Items of food which are sent to wards and for other services are probed for
temperature and these findings recorded in order to comply with best practice
not happy only with this but food is also probed and findings recorded at arrival
to wards. Meals are plated on a four at a time basis to ensure that temperature is
not lost between serving and bedside.
Ward Catering Assistants
Eighteen new supply domestics have been recruited and trained to undertake all
catering services duties in the hospital wards. This role may be developed
further in the future.
Training
The department has seen an intensive programme of training that will be
continued as part of the strategy of the new Catering Unit. Training included,
induction, familiarization and the safe operation of catering and cleaning
equipment.
 Hobart Induction
 Bonnet Induction
 ELRO Induction prior to occupation of new premises and retraining on
February 2016
 Thermomix Induction
 SUTTER Cleaning training with certificate
Page 69


Karcher Induction
Vianen Ventilated ceiling operations and troubleshooting
Feedback
Positive feedback has been the case throughout but like in everything we cannot
please every individual taste and at times service users feel that we should. At
the moment we are offering choice at point of consumption which is an
enhancement from the previous meal service. There have been issues brought to
my attention as complaints but when investigated these were more to do with
personal likes and dislikes.
Patients wishing so are enjoying a second serving of food too.
Sandwiches are being made at ward end in order to guarantee freshness.
The department is considering conducting routine surveys at ward levels to find
out how inpatients feel about the meals being served to them.
2.
(b) Domestics Services
General
Improvements and initiatives introduced by the Domestic Service Management in
this last quarter include:
 Dementia Day Facility

The Domestic Services team have had on site meetings in order to measure
up for window curtains. Fabric has been selected and purchased and the
GHA seamstress team are currently manufacturing the curtains.
A staffing plan for Dementia Day Facility has been presented on a phased
programme.
Page 70
2.
(c) Hospital Attendants & Messenger Services
Security Door Access System
The access grouping in the new door access system has been finalised and the
Facilities Management team are currently preparing all the new ID/Access cards
for distribution.
Final commissioning is expected by 1st Quarter 2016 and change over to the new
system will be phased.
2.
(d) Medical Records Library
Grooming Health Record File/File Tracking
Filetrail has now been implemented and commissioned for all external users ie
Ward/Clinic clerks and all patient notes are being tracked on the new system.
This tracking and paper management system will also be introduced in Mental
Health.
We are still faced with challenges and difficulties as this is a manual system and
fully dependent on individual users tracking file movement accordingly.
Accident & Emergency Ward Clerks
The ward clerks recruited in April this year have integrated well in the
department and are operating a 24/7 administrative support in the Accident &
Emergency Department. Efficiencies in responding to the public and providing
patient records, registration and accounts function has been improved due to the
quick response having staff on site. All staff are being updated and trained in all
functionalities of the role.
There has also been a substantive saving in overtime costs as staff previously on
on-call duties had to attend when recalled in order to cover this role.
Medical Health Record Library
The Medical Records output performance for outpatient consultations continues
to be maintained in the high 90% success rates. This can be seen on the graphs
from our internal audits. Table 1
Table 1.
The figures and performance outlined above can be contrasted with the output
achieved in terms of the volume of requests and the actual number of Records
delivered within the given period. Table 2
Page 71
Table 2.
2.
(e) Reception and Call Centre
As per my previous report the Call/Centre staff continue to report on daily
cardiac arrests call-out.
Weekly reports on the response rates are submitted to the Clinical Director
Anaesthesia, Intensive Care and to the Deputy Director of Corporate Services.
Staff have been trained on EMIS WEB the new electronic patient record system
introduced in PCC. This system is now being used to schedule outpatient
appointments at the PCC. Call Centre staff assist with appointment booking at
peak hours.
2.
(f) Release of Records
Statistics on the number of Subject Access Request for release of medical notes
received from Oct 2015 to Dec 2015 are as follows. Monthly average for the 4 th
Quarter = 58.
Requests
Oct-15
Nov-15
Dec-15
Lawyers
Shipping Agents
Insurance Companies
DSS
RGP
Patients
3.
8
0
2
1
0
73
9
0
0
3
2
61
8
1
0
4
8
40
Ambulance Services
The Gibraltar Health Authority’s four paramedics have completed their
first year of practice which has resulted in tangible benefits for prehospital care in Gibraltar, particularly in the field of analgesia.
Additionally, Emergency Medical Technicians (EMT’s) have completed
their fourth year of being able to administer a range of safe and effective
medications in emergency situations. These emergency medications
include aspirin, IM adrenaline (Epipen), GTN spray, Glucagon, salbutamol
and atrovent.
Table 5 provides a summary of the annual usage:
Page 72
EMT MEDICATION ADMINISTRATION 2015
2015
January
February
March
April
may
June
July
August
September
October
November
December
TOTAL
salb
13
7
7
3
3
3
5
4
6
5
4
11
71
atrovent
2
1
3
1
0
1
1
0
0
1
0
3
13
GTN
8
6
7
8
3
0
5
6
1
1
3
8
56
aspirin
11
7
9
7
5
1
7
5
4
2
7
7
72
glucagon
0
0
0
1
3
2
0
0
2
1
0
3
12
Epipen
0
0
0
0
0
0
0
0
0
0
0
1
1
PARAMEDIC MEDICATION ADMINISTRATION 2015
226 patients have received paramedic medications throughout 2015, representing
approximately 6.5% of the 190 call volume and this figure is consistent with UK
ambulance statistics. From the data above, as well as from experience, analgesia is
clearly the primary medication benefit provided for by paramedic practice in 2015. The
patients’ results and feedback are clear evidence that pre-hospital pain management is a
key factor in improving the patient experience, with over 60% of those receiving
analgesia reporting at least a 50% reduction in their pain score . Being able to transport
patients with manageable pain levels relieves stress levels for patient, relatives and
ambulance crews, as well as reducing the pressure for nursing staff on arrival at A&E.
An inter-departmental initiative which has proven beneficial is the ability of paramedics
to obtain blood samples from patients prior to arrival at A&E. This has permitted lab
results to be analysed quicker and without the need for additional venupuncture,
Apart from advanced medications, paramedics have started working from a response
car when resources allow. This maximises the availability of the paramedic to back-up
both GHA and GFRS ambulance crews, as well as being available as a solo responder for
non-conveyance and mental health assessments.
Meds
Amiodarone
Adrenaline IM
Adren IV/IO
Atropine
Nalaxone IM
Diazepam
Odansetron
Glucose IV
Paracetamol
Morphine
Chlorphen
Saline
Total Meds
total patients
Analgesia
PS red >50%
Jan
feb
Mar
April May
june
July
Aug
Sept
Oct
Nov
Dec
TOTAL
0
0
0
0
0
1
0
0
1
1
0
2
5
0
0
0
0
0
0
0
1
0
0
0
0
1
1
1
0
1
1
1
0
0
4
1
0
3
13
0
0
0
0
0
0
2
1
0
0
1
0
4
0
0
0
0
0
0
1
0
0
0
1
0
2
1
0
0
0
0
1
1
2
0
2
0
0
7
5
6
3
9
10
10
6
13
2
6
9
15
94
1
0
1
1
0
0
0
0
3
0
0
1
7
6
6
7
13
11
10
7
11
3
12
8
4
98
6
5
6
6
8
7
4
8
3
5
8
13
79
0
0
1
1
0
0
0
0
0
0
0
0
2
8
1
3
4
8
0
7
8
1
4
4
7
55
28
19
27
35
39
30
28
44
17
31
31
49
378
23
11
14
22
22
16
17
25
16
17
17
26
226
10
9
9
14
13
9
9
11
6
12
12
14
128
70% (8/9)87% (6/9)67% 29%
46%
55%
68%
55%
33%
50%
83%
79%
61%
Page 73
New Statistical Data Available
Statistical data now forms part of Crew Leader’s corporate responsibilities and as a
result a new system has been implemented which provides important information
regarding emergency deployments zones. The system will soon be upgraded in order to
provide further data such as time deployment patterns, data analysis, paramedic
interventions and paramedic response vehicle activity.
Main Zone Deployments
Month
*Oct
Nov
Dec
Total
Gib Port
7
5
6
18
North Area
60
63
71
194
Eastside Area
9
5
14
28
Westside Area
197
124
159
480
South District
116
74
95
285
Upper Town
33
24
47
104
Town Area
89
84
82
255
Frontier/Airport
7
6
3
16
Nature Reserve
3
2
3
8
*October Data includes 6 x days from September
Summary of Patient taken for Scans and or Transfers to Spain - October 2015 –
December 2015
Destination
Oct
Nov
Dec
Algeciras
44
38
24
Benalmadena (Xanit)
32
38
30
Cadiz
0
2
2
Gibraltar
8
6
4
La Linea
0
0
0
Malaga
4
1
2
Seville
0
0
0
Jerez
2
6
0
Marbella
0
0
0
Totals
90
91
62
Page 74
Summary of Local Patient Transfers - October 2015 – December 201
Month
Total
Average per day
October
135
6
November
130
6
December
96
4
Emergency Ambulance Deployments - October 2015 – December 2015
Month
Total
October
420
Average per
day
14
November
387
13
December
480
15
Advanced First Aid Training
The GHA Ambulance Service and Royal Gibraltar Police continue strengthening their
links and close collaboration. On this occasion GHA Ambulance Service provided
Advanced First Aid training to 34 members of the RGP Firearms Department. The
training included:
 Basic Life Support & Automated External Defibrillation
 Haemorrhage control using appropriate tourniquets
 Pressure & Blast dressings
 Treating sucking chest wounds
 Summary on internal & external ballistic & in depth terminal ballistics
 4 x stages of blast injury
4.
Pathology Services
Beta 2- macroglobulin
The Department has introduced the in-house analysis of Beta 2- macroglobulin
(B2M) which is used as a tumor marker for some blood cell cancers. It has been
associated with the amount of cancer present and provides additional
information about prognosis for the patient. B2M may be requested to help
determine the severity and spread (stage) of multiple myeloma, to help evaluate
the prognosis of cancers such as multiple myeloma and lymphoma, and to
evaluate disease activity and the effectiveness of treatment.
When someone has been diagnosed with multiple myeloma or lymphoma, that
person is likely to have a poorer prognosis if the B2M level is significantly
elevated. For monitoring treatment, decreasing concentrations over time in
Page 75
someone with multiple myeloma indicate that the person is responding to
treatment. Stable or increasing levels indicate that the person is not responding.
5.
Radiology Services
The Chief Minister and the Minister for Health unveiled a plaque to
commemorate the upgrade of the CT Scanner on 11th November 2016.
All radiographers are now fully proficient with the new the Ingenuity 128 slice
CT scannerwith dual injector pump.
The Department held a core user Train the Trainer course for the new
Computerised Radiology Information System CRIS® (expected to be fully
operational this April 2016).
In November 2015 the Department commenced CRIS® cascade training,
including demonstrations for future Radiology users, system management
training and voice recognition training for system administrators.
There is an ongoing Ultrasound Scan initiative lists with an aim to reduce
waiting times in this modality.
A total of 14 extra lists have been undertaken = 192 patients which has led to a
slight reduction in the waiting time for a ‘routine’ scan to 5 weeks and made a
significant reduction in the waiting time for an ‘urgent’ scan to 1 week or less.
CPD


6.
A Radiologist attended a Breast Cancer Conference locally.
A Radiologist successfully completed their annual appraisal.
Sponsored Patients Services
The Sponsored Patients Department activity continues to grow based on the
demand for tertiary services.
Following an internal review, the Hon Minister for Health published the changes
in sponsored patient allowances in his Budget Speech of 23rd June 2015.
As from the 1st of July, the weekly maximum allowance was increased from
£427 to £504, with a corresponding 18% increase in the allowances for those
Page 76
staying at Calpe House. Other improvements included greater flexibility in
arranging return dates and escort conditions for the children and the elderly.
These much overdue changes have been discussed with and welcomed by
patient groups.
A new patient escort internal policy and payment process was introduced and
has seen benefits in the way that escorts are appointed and remunerated.
International transfer protocols for emergency transfers of patients to specialist
hospitals in Spain and the UK have also been arranged including retrieval teams
for paediatrics and high dependency critical patients.
October to December 2015 Statistics
Spain Referrals
1180
Spain Patients
UK Referrals
UK Patients
Flights
Air Ambulance (Atlas
Jets)
Holiday Dialysis
GHA Ambulance
Request
UK Taxi Requests
Tourists Insurance
Spain
Visa Applications
Retrospective
Sponsorships
Translations (Link
Europe)
Assessments per day
465
466
348
1541
3
2
151
636
6
7
0
137
Average 3 - 4
End of report.
Darion Figueredo
UGM – Hospital Services
Page 77
6.8 UGM – Primary Care Services
GP CLINIC ACTIVITY
Monthly Attendances to Primary Care Centre
(October, November, December 2015)
Within the past three months a total of 33,184 patients have been seen at the Primary
Care Centre by General Practitioners, an increase of 4,238 patients.
It should be noted that EMIS was introduced in June 2015 and following arrangements
were made to achieve a smooth transition re allocation of appointment slots.
These were as follow:
 As from the 25th September to the 11th December, 12 appointments were made
available per session per General Practitioner, with 2 overflow appointments
released for emergency cases again per session per GP. This allowed the GPs 4
administrative slots per session per day.
 During the Christmas period from the 14th December till the 31st December, 14
appointments were made available per session per General Practitioner. Including 4
overflows released for emergency cases, again per session per GP. This allowed the
GPs 5 administrative slots per session.
 As from the 1st January 2016, amendments have been made to the appointment
system once again, therefore at present we are able to provide 12 routine
appointments, 3 emergency overflow slots and 1 critically ill slot to be used in the
case of an emergency requested by the nurse in charge to the GP.
Below is a view of monthly patient’s attendances at the PCC per areas and Locum GP
during the months of October, November, December 2015.
(Figure 1)
(Figure 2)
DNA appointments at the Primary Care Centre
Three methods for cancellation of appointments are in use for patients should they
not be able to attend.
Page 78
- Voicemail service: 200 43331
- E-mail: www.gha.gi/cancel.php
OR
- Appointment line: 200 52441
Not with standing, a total of 1,460 appointments have been missed between October,
November and December 2015 as can be seen in Figure 3+4. In comparison to July,
August and September 2015 the PCC has seen an increase of 99 missed appointments by
patients at the Primary Care Centre by areas and Locum General Practitioners.
(Figure 3)
(Figure 4)
Weekend Attendances to Primary Care GP Emergency Clinics
A buddy system is put in place to be able to manage the increase in demand, this is a
non-contractual but remunerated arrangement by GP’s. The GP’s cover each other
within the same group. Should a GP from their group not wish to provide cover then a
GP from another area is approached. Should there be a strong likelihood on the day that
clinic attendances will exceed 35 the buddy system will be activated by the GP/sister in
Charge.
Below you are able to view the amount of patients seen at the Primary Care Centre on
the weekend emergency clinics during the months of October, November and December
2015.
Page 79
(Figure 5)
(Figure 6)
Nurse Practitioners attendant appointments
Figures 7&8 show nurse practitioners attended appointments between October and
December 2015.
(Figure 7)
(Figure 8)
Nurse Practitioners DNA appointments
As can be seen below 278 appointments have been lost during the months of October
through to December 2015. In comparison to the months of July, August and September
2015, 304 patients have missed their appointments.
Page 80
(Figure 9)
(Figure 10)
House Calls
Figures 11+12 below shows the amount of house-calls recorded during PCC working
hours, a total of 752 patients have been booked in for house calls during the months of
October, November and December 2015. No record is kept of house-calls requested after
PCC working hours. In comparison to the months of July, August and September 2015,
651 house calls have been booked. This shows that there has been an increase of 101
house calls during the past three months.
(Figure 11)
(Figure 12)
GP Well Woman Clinic
The well women service is provided by one GP on a part-time basis and by nurse
practitioners. A total of 604 patients have been seen by the women’s health clinics (Fig
13&14) between the months of October to December 2015.
Page 81
(Figure 13)
(Figure 14)
GP Well Woman Clinic DNA’s
As can be seen from figures 15&16, 198 appointments were missed.
(Figure 15)
(Figure 16)
Page 82
Audiology attended appointments
Below you are able to view the statistics regarding the amount of patients in which have
been seen at the Audiology department at the Primary Care Centre. As we can see from
the charts below, a total of 480 patients have been seen during the months of October,
November and December 2015.
(Figure 17)
(Figure 18)
Audiology DNA appointments
As can be seen underneath during the months of October, November and December
2015, the Audiology Department at the Primary Care Centre has had 21 patients miss
their appointments.
(Figure 19)
(Figure 20)
Occupational Therapist Seen Patients
As can be seen from figures 21+22 below, during the months of October, November and
December 2015. The occupation therapist department at the PCC have seen a total of
2193 patients.
(Figure 21)
Page 83
(Figure 22)
Occupational Therapist DNA appointments
As from the statistics available we have been able to find out that during the months of
October, November and December 2015 there has been a number of 7 appointments
missed during the months mentioned.
(Figure 23 )
(Figure 24)
Paediatric occupational therapists seen patients
As from the statistics available we have been able to find out that during the months
October, November and December 2015 there has been a number of 2046 patients seen
at the Paediatric occupational therapist department at the PCC. As from our findings
during the months of July, August and September 2015 the paediatric occupational
therapists had seen 1254 patients. This shows that there has been an increase of 792
patients seen within the months of months October, November and December 2015.
Page 84
(Figure 25)
(Figure 26)
Paediatric occupational therapists DNA appointments
As can be seen below, we have been able to find out during the months of October,
November and December 2015 the Paediatric occupational therapists have had an
amount of 19 missed appointments.
(Figure 27)
(Figure 28)
Physiotherapy Appointments Attended
Page 85
As from our findings the physiotherapy department at the PCC have been able to see
2343 patients during the months of October, November and December 2015.
(Figure 29)
(Figure 30)
Physiotherapy DNA Appointments
Below in figures 31 &32, you are able to view the results we have obtained regarding the
amount of lost appointments within the physiotherapy department at the Primary Care
Centre. As a result, a total of 66 appointments have been missed during the months of
October, November and December 2015.
(Figure 31)
(Figure 32)
Paediatric physiotherapy Appointments Attended
As can be seen from Figures 32 & 33, these are the results we have obtained in which
show the amount of patients seen within the paediatric physiotherapy department at
the Primary Care Centre. As a result a total of 812 patients have been seen during the
months of October, November and December 2015.
Page 86
(Figure 32)
(Figure 33)
DNA Paediatric Physiotherapy Appointments
We have obtained the following results for the months of October, November and
December 2015; unfortunately, 85 patients have missed their appointments within the
Paediatric Physiotherapy Clinic.
(Figure 34)
(Figure 35)
Speech and Language Attended Appointments
As from our statistics Speech and Language department at the Primary Care Centre have
seen a total amount of 2143 patients during the months of July, August and September
2015. Below you are able to view the amount of patients seen during the months of
October, November and December 2015 (2869 patients). As you can view, there has
been an increase of 726 seen patients within the three months.
Page 87
(Figure 36)
(Figure 37)
DNA Speech and Language Appointments
As can be seen from the charts below we are able to identify that the Speech and
Language Department within the Primary Care Centre have had an amount of 357
missed appointments during the 3 months. This is a substantial amount of lost
appointment in which could be used by other patients in need.
(Figure 38)
(Figure 39)
Page 88
Dental Department
The department continues to operate at near full capacity both at PCC and SBH, with
visits to St Martin’s School, Dr Giraldi Home and the prison.
Appointments
5427
4956
October to December 2014
October to December 2015
DNA
20%
18%
There has been an increase in the number of general anaesthetic sessions made
available for those patients with special needs; this has decreased their waiting time.
Optometry Department
Incoming Referrals originating from outside the Ophthalmic Unit
66 outside referrals received, 13 more than that of the last quarter.
Referral Category
Child refraction
Adult refraction
Adult out patient
Diabetic Retinopathy Screening
Glaucoma Screening
Low vision
Total
Oct
1
2
0
12
3
0
18
Nov
5
8
8
19
9
0
49
Dec
2
3
3
26
5
0
39
Total
8
13
11
57
17
0
66
Caseload
Caseload for this quarter comprises of 32 % new patients, and 68 % reviews.
DNA rate was 21%
Next available appointment as of today’s date of submission (8/1/16) varies according
to clinic type:
Refraction: 4 months, Outpatient appt: 2 months, DR Screening: 3 months.
Clinic
Child Refraction
Adult Refraction
Joint Child Clinic with Orthoptist
Adult out patient
Post op Refractions
Diabetic Retinopathy Screening
Diabetic Retinopathy Management
Glaucoma Screening
Glaucoma/OHT Management
Low Vision Refraction
Low Vision Aid assessment
Clinically required Contact lens appts
Spectacle Rechecks
Total
Total this Qtr
24
131
59
33
45
271
8
81
40
21
5
34
1
753
Page 89
Refraction Services
As per last board report.
Low vision Services
This quarter there has been only one new CVI registration.
For 2015 there has been a total of 10 Certificate of Visual Impairment (CVI) registrations
3 of which were for severe sight impairment. The table below outlines the causes of
visual impairment. This makes a total of 113 CVI registered individuals for the
population of Gibraltar at the year’s end.
Cause of Visual Impairment
Total 2015
Brain & CNS Neoplasia
1
Hereditary Retinal Dystrophy
1
Visual cortex disorder
1
Glaucoma
4
Age Related Macula Degeneration
2
Optic Atrophy
1
Degenerative Myopia
1
Total
10*
*one Px with ARMD and Glaucoma combined hence 10 total instead of 11
2015 Low Vision Statistics
Low vision aids items loaned
patients loaned LVAs
LVAs returned
Unserviceable LVAs
Referral to ROVI
Px declined ROVI referrals
CVI Registration
Px declined CVI registrations
OctDec
29
20
1
0
3
3
1
0
Training
Optometrists attended a refresher lecture on binocular vision provided by the
Ophthalmic Unit’s locum Head Orthoptist. This was open to all local optometrists, and
registered with the UK’s General Optical Council, for the optometrist to gain CET points
for their continued registration..
Patient Appliance Policy - Optical
During this quarter there was one case of GHA refunding of spectacles, due to a
prescribing error.
GHA funding of spectacles due to exceptional circumstances
Cause :Oct
Nov
Prescriber error
Intolerance
Surgical Intervention
1
Ocular Disease
Loss due to disability – Child
Loss due to disability – Adult
-
Dec
1
-
Total
1
1
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Total
2
Complaints
No official complaints have been received or clinical incident reports filed this quarter.
Orthoptics: 1st October – 31st Dec 2015
Recent developments:
 No change in staff complement.

Main Clinics still running. Despite the recent enormous increase in demand for
Orthoptics leading up to the Christmas break, the department is pleased to say
waiting times for Orthoptics are under 6weeks and urgent referrals seen same
day/day after as appropriate. It is anticipated that waiting times for Orthoptic
will return to under 4wks by Easter.
250
ORTHOPTIC-LED CLINICS
Paediatric Joint Cyclo
Adult Visual Fields
Orthoptic Clinic
Colorimeter Patients
Vision Screening
April-JuneJul - Sept Oct - Dec
50
61
53
103
104
126
121
219
179
1
3
2
63
48
28
200
150
Paediatric Joint Cyclo
100
Adult Visual Fields
50
Orthoptic Clinic
0
Colorimeter Patients
Vision Screening
OVERVIEW OF ORTHOPTIC-LED CLINICS: 4TH QUARTER 2015

Colorimetry service is fully implemented. Thanks to injection of further funds
by the GHA, the service is now fully functional with children already benefiting
from this unique service offered by the Eye Unit. The successful implementation
show the following benefits:
- Patient no longer need to fly to mainland UK to obtain the treatment (this
alone has cut waiting times by at least 50%). Savings made from this can
now be used to improve the service to the people of Gibraltar. To this end,
the GHA recently injected more funds into the service so that orders that
were being delayed could be processed within 7days.
- Patients who have benefited from this service have said it has “changed their
lives” or “my self-esteem has been restored”; “it has put me back at equal
footing with other pupils at my school”; “I am no longer being teased at
school”; “our son has got his life back through the GHA funding of this
service”; and so on

The Ophthalmic stroke service: The new Orthoptic-led stroke service has
already benefitted some patients (with patients now able to have an eye
appointment within 3wks of referral). The initiative is part of a deliberate
strategic push to get AHPs to work more closely together so that more patients
can access the extensive and diverse service that AHPs provide.
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
Undergraduate students from two leading UK universities have continued
to rate Gibraltar Ophthalmic unit as a leading preferred location for
Orthoptic clinical placement. The placement, pioneered by Michelle Brown,
has received record placements in 2015. This unique success, though led by the
Orthoptist, continues to be the result of the combined efforts of ophthalmic
nurses, optometrists and ophthalmologists in the Eye Unit. It has continued to
raise the profile of the Eye unit, which is inspiring locals to consider a career in
Orthoptics thereby securing local recruitment in future.


Dietetic Department
The department of Nutrition & Dietetics have seen a total of 773 patients during
the months of October to December 2015.
Staffing
Interviews for the vacant maternity post were held on the 23rd November 2015.
We have chosen a senior dietitian to cover this post and we are awaiting the
necessary police and reference checks prior to her starting. She will also have to
work her 1 months’ notice period and is expected to be able to start in January.
We currently have a locum dietitian providing cover for this post.
Education/Training
A new development has been the restart of the paediatric dietitian pursuing her
Clinical Research PhD. This is funded by the department of Education and is in
conjunction with the University of Southampton.
Nutrition Support
The number of patients receiving enteral tube feeds continues to increase. We
are still awaiting the authorisation for dietitians to be able to prescribe
nutritional products to community tube feed patients.






Occupational Therapy
1. SBH IN-PATIENTS SERVICE:
In–Patient OT Referrals:
2015
July - Sept
Oct – Dec
105
72
The OT Labourer has been seconded for 20hrs / week to the Dept, he continues
to assist staff with equipment cleaning / store management / deliveries /
collections and joint visits. This has become as essential addition to the service,
saving on therapists’ time and has alleviated the need for two therapists going
on visits to fit equipment and covers all of the OT Service areas.
OT Labourer – Number of collections/deliveries + joint visits:
Oct – Dec
2014
2015
Days lost for other dept cover
52
-
96*
-16 days
*This
Page 92
does not include cleaning and store time
Hand Therapy Referrals continue to slowly increase. The OT / Hand Therapist
now works closely with the out-patient physio service and plans are being made
to make stronger links with the out-patient consultant clinics and with the
visiting Rheumatologist, this will mean an expected further increase in the
referral rate over the next year as more Consultants / Drs become more aware of
the available service.
Hand Therapy Referrals:
Oct - Dec
2014
13
2015
19
2. COMMUNITY OT SERVICE:
Having Locum cover for the Sen II OT vacant post, OT Labourer Support and the
additional 11hrs / week of OT Assistant time from SBH it has enabled the team
to work steadily through the waiting list and for this period it has now been
brought down to approx.4 months see stats below for referral details.
October 2015:
Total waiting = 50 (increase by 3 persons)
Waiting time = 28 weeks (approx.7 mnths) for routines
(increase by 2 weeks)
Nov 2015:
Total waiting = 38 (decrease by 12 persons)
Waiting time = 16 weeks (approx.4 mnths) for routines
(decreased by 12 weeks)
Dec 2015:
Total waiting = 28 (decrease by 10 persons)
Waiting time = 16 weeks months (approx. 4 months) for
routines.
Urgent
Mediums
Routine referrals
2
9
5
Urgent
Mediums
Routine
referrals
5
9
13
Urgent
Mediums
Routine
referrals
3
7
2
The OT with a special interest in Palliative Care
continues to take the appropriate referrals from Community OT, attending the
monthly Palliative Care meetings and in regular contact / visits with the CRC.
3. MENTAL HEALTH:
The winter months have bought some changes in the Arc Department. Our
Occupational Therapy Technician retired at the end of October 2015 after many
years of service. This post has been advertised and should be filled shortly.
Page 93
Christmas activities have included arts and crafts, meals out with both inpatients
and community patients and a ward party to celebrate the Three Kings. Charity
money has enabled us to facilitate these activities.
ARC*
Average number
of daily contacts
19 contacts
Dawn Ward (Rehab Wd)
10 contacts
*The ARC stats include both group settings and individual work facilitated either
in the hospital setting or in the patients’ home or community.
There has also been a steady increase of referrals and patients seen from
Horizon ward (Acute Ward) since our move to the new hospital. There are now
two afternoon sessions (Tuesdays and Thursdays) specifically for patients from
Horizon ward, to ensure they are able to make use of the Arc to facilitate their
needs and recovery. The use of the computers is very well used by these
patients.
Community patient contacts have increased over this period and have been seen
in a variety of settings. These included the relaxation sessions held in Cardiac
Rehabilitation and the Drug and Alcohol Unit (Bruce’s Farm), as well as the
Coaling Island Lunch Group and individual sessions. The Coaling Island Group
now has 5/6 community patients who attend regularly.
4. PAEDIATRICS:
Our Basic Grade OT received her most deserved re-grade to a Sen II OT which
allows her to continue her work at a higher level, to further develop her skills,
take on additional responsibility and assist with service development.
A project has started in liaison with Westside School in order to assess and
advise on wheelchair access for its pupils and visitors.
All OT staff completed the GHA DCRT Conflict Resolution 1 day course held in Dec and
eagerly awaiting the dates for the DCRT 3 day follow up course to be released.
Speech & Language Therapy
Staffing
During this period there have been no changes to the staffing complement of this
department.
SLT Service Map as follows:
Page 94
Training
During this period this service has benefitted from the following:
 Both Paediatric Senior II therapists attended Child Protection Tier 1 training
 Acting Head and Senior II Paediatric Special Needs therapists attended Safe
Guarding Adults Training.
 Acting Head attended National Autistic Society Conference on Communication, in
Leeds November 2015. Attendance at this event was self-funded.
 Senior II Special Needs attended Managing Conflict Training.
During this period this service has delivered the following training:
 4 week, 12 hour Makaton Training workshop for parents and carers during
November and December 2015.
 Floor time/ Sensory Bags Workshop to staff at St Martins School.
Paediatric Mainstream Caseload
During this period the focus of this service has been to reduce waiting time for therapy
and to ensure that the service is equitable across schools. This is being successfully
tackled by offering blocks of therapy both in school and at the PCC. Blocks enable
frequent rotation of provision and help prevent “bed blocking” of services.
DNA’s to the outpatient service are being tackled with reminder letters making families
responsible for re-engaging with the service. The campaign appears to have been
successful and the high number of failed attendances has recently reduced.
Paediatric Special Needs Caseload
The SLT provision to Learning Support Facilities (LSF) within mainstream provision in
schools continues to develop and during this period our department has been involved
in the setting up of weekly EMDT (Educational Multi-Disciplinary) meetings for
individual children attending the LSF’s. These are collaborative sessions incorporating
both professionals and parents.
Our department continues to inform and support the Autism –pathway from diagnosis
to intervention. These working party meetings are held on a monthly basis and the
Acting Head SLT represents SLT interests within this forum. The pathway remains a
work in progress.
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Adult Caseload
This service continues to be understaffed and representations were made to the
Minister who very kindly met with the team. Following this arrangements were made
for locum cover to be made available as from January 2016. This provision will
relinquish the 18 hours currently taken from the paediatric special needs caseload and
will in effect increase the special needs service.
In September 2015, the Clinical Lead within the adult service was selected and
successfully audited by HCPC.
Stats for the Adult Service during this period are as follows:
In patients:
October 81
November 72
December 63
Out patients:
Aphasia
Dysarthria
Dysphagia
Voice
Laryngectomy
Total
October
5
15
22
17
7
November
6
17
36
14
5
December
3
11
23
13
7
66 + ECA
(including
13home visits)
78 + ECA
(including 10
home visits)
57+ ECA
(including 7 home
visits)
Adam Wink
PCC UGM
Page 96
6.9 UGM - Mental Health Services
Introduction
The following quarterly report represents the final 3 months of 2015, a hectic but
exciting period following our move at the beginning of February. This last 3 months,
(Oct-Dec) saw further changes in operational issues as we settled in to a more conducive
environment with patients, carers and staff participating in the continued positive
changes to the way we deliver our services. The design of all wards and departments
encourages and creates an atmosphere that aids and facilitates the process of recovery,
providing greater privacy in more relaxed and comfortable surroundings. A team of
professionals from different disciplines meeting regularly with patients and carers to
review care packages and develop a better therapeutic relation. More open spaces both
in terms of the ward environment and the garden area have been enjoyed by all with
afternoon teas in the garden for some patients from Dawn and Sunshine to an
introduction of ward based groups in other areas.
This report represents the work carried out in all departments of the mental health
services (in-patient, community and the ARC). It presents the activities from some of
these groups, the visits completed in the community by the multi-disciplinary team and
the work which we hope to develop over the coming months.
Monthly activity
Community Mental Health Team (CMHT) – Patient contact/staff activity.
CMHT - Patient Contact/ Staff Activity table
180
160
140
Axis Title
120
100
80
60
40
20
0
Dr Segovia
Dr Lillywhite
Dr Diaz
Dr Ruiz
Dr Marin
Community
Visits
22
Patients
seen in
Clinics
151
Oct-15
44
92
16
44
Nov-15
39
50
27
70
12
167
141
Dec-15
48
42
22
39
11
169
153
Psychology therapy offered with the mental health services.
Month
Number of referrals received
October
77
November
61
December
43
Page 97
132
Source of referrals
Primary Care
Community Mental Health Team
Secondary Care
Paediatrics
Other
Number of referrals received
128
16
24
7
6
As in previous months the table above shows that over half of the referrals to Clinical
Psychology and Counselling are received from Primary Care. Most of these referrals are
for psychological help with problems such as mild to moderate depression, anxiety,
bereavement, stress or problems with adjustment to difficult life circumstances. These
patients are most appropriately allocated to the Counsellor based in Primary Care who
can offer various time limited, solution focused approaches to help people with these
types of problems.
In-patient data and activities
As previously described in earlier reports, despite many community activities, both in
terms of consultant contacts, nursing visits to patients home and the psychological
intervention provided, some patients will continue to need admission to Ocean views for
periods of time. This is seen as part of the journey patients take in their recovery, which
is not about eliminating admissions altogether but hopefully reducing the time spent in
hospital, for some this may manifest in terms of days or weeks in hospital or in a
reduction in the number of times per year they need to be admitted. The mental health
teams have strived hard (and will continue to strive) to provide an ever improving
service to those who need it, when they need it and how they need it.
The charts below capture a number of demographic details, such as; admissions,
diagnosis, mental health act status, route of admission for Horizon and Sky ward. Apart
from this, also presented are just some of the groups developed with patients which
would be in addition to the ARC activities.
In-patient quarterly data – Horizon / Sky
Axis Title
Horizon Ward Admissions Oct-Dec 2015
20
18
16
14
12
10
8
6
4
2
0
Male
Female
Oct
13
Nov
9
Dec
10
6
7
3
Page 98
Other groups / activites held on the Horizon and Sky
 Arts and crafts x2 sessions every week

Interactive games x2 every week

Bingo x2 every week

X1 patient meeting
Rehabilitation in-patient services - Dawn Ward Data
Dawn ward provides an environment that enables 5 patients to have their own room
(single) and 8 patients who share a room (double room). Whereas previously (KGV), the
accommodations were the Florence nightingale style wards. The team here has
observed tremendous changes in the patient’s behaviour and attitude towards their
recovery, a greater willingness and motivation to want to be more involved in ward
groups, social integrating outings, cooking groups, art, exercise and relaxation groups.
Patients are encouraged to attend the weekly community meeting, held on both Dawn
ward and Rockside flats.
The data provided in these charts represent the current monthly totals of patients on
the ward per month and their current level of dependency, the identified risks (such as
Page 99
falls, aggression or self-neglect) and the mental health diagnosis of the patients we
currently have.
9 male and 3 female (sometimes 9/4)
Dependency level Oct - Dec 2015
14
12
Axis Title
10
8
6
4
2
0
4
Oct
7
Nov
7
Dec
7
3
2
3
2
2
2
1
2
1
1
2
1
Elderly care services - Sunshine ward
As described above and in previous reports the environment now afforded the patients
has changed in-patient experience dramatically, this is true also of the elderly services,
patients enjoy a more homely environment, sharing bedrooms with one other person
and having the space to sit quietly in a few different areas or watch TV with fellow
patients. Visiting continues to take place in the reception, where patients are taken by
staff from the ward to enjoy visits from family members in quiet and comfortable
surroundings, garden areas, and on ward terraces, when patients could enjoy chatting
and engaging with family and friends.
The data below provides information on contacts patients have had at any time with the
services to mental health.
With the current patient acuity on Sunshine ward the level of dependency and risk over
the 3 month period presented in this quarterly report has not change, the high
dependency noted each month is felt to link with the risk of falls and chocking. As a
result patients contact with other services across the GHA is monitored and recorded (as
per charts below).
Page 100
Specialist clinics held and Elder care patients seen by colleagues within ocean
views.
Oct 2015
Clinic
Number of patients seen
General Practitioner
20
Dietician
1
Speech & Language Therapist
1
Physiotherapist
8
120
Catheter Clinic
1
Specialist clinics held and Elderly care patients seen by colleagues within ocean
views.
Nov 2015
Clinic
Professional
Dr Haider/ DR Marin
14
Dietician
Kate Langdon
1
Speech & Language
Julie Bradford
1
Therapist
Physiotherapist
Jan Wink
8
On-going treatment
116
Catheter Clinic
District Nurses
1
Specialist clinics held and Elderly care patients seen by colleagues within ocean
views.
Dec 2015
Clinic
Professional
Dr Haider/ DR Marin
22
Dietician
Kate Langdon
2
Speech & Language
Julie Bradford
2
Therapist
Physiotherapist
Jan Wink
8
On-going treatment
124
Catheter Clinic
District Nurses
2
Monthly sessional attendance by patients to the ARC.
The winter months have bought some changes in the Arc Department. Our Occupational
Therapy Technician retired at the end of October 2015 after many years of service.
Christmas activities have included arts and crafts, meals out with both inpatients and
community patients and a ward party to celebrate the Three Kings. Charity money has
enabled us to facilitate these activities.
The statistics below show the patient contacts seen in the Arc. This includes both group
settings and individual work facilitated either in the hospital setting or in the patients’
home or community. Averages of 19 patient contacts have been seen daily in the Arc.
The majority of the patients seen are from Dawn Ward as this is the rehabilitation ward
and where we have most input. Averages of 10 patient contacts a day have been seen
from Dawn ward.
Page 101
There has also been a steady increase of referrals and patients seen from Horizon ward
(Acute Ward) since our move to the new hospital. There are now two afternoon sessions
(Tuesdays and Thursdays) specifically for patients from Horizon ward, to ensure they
are able to make use of the Arc to facilitate their needs and recovery. The use of the
computers is very well used by these patients.
Community patient contacts have increased during Oct/Nov/Dec and have been seen in
a variety of settings. These included the relaxation sessions held in Cardiac
Rehabilitation and the Drug and Alcohol Unit (Bruce’s Farm), as well as the Coaling
Island Lunch Group and individual sessions. The Coaling Island Group now has 5/6
community patients who attend regularly.
Activities completed per month by Arc for ward / community patients
Oct
Nov
Dec
Horizon
41
57
21
Dawn
199
237
164
Sunshine
31
51
19
Community
102
111
64
EDUCATIONAL DEVELOPMENTS
 Training- as previously mentioned staff CPD plays an important role in the
service delivery, ensuring that staff are fully up to date with changing practices
and in some instances looking at forging these changes themselves – this is
something we hope to tackle in 2016.

Mandatory training, this has continued throughout the period (Oct-Dec), with
staff attending a number of sessions from DCRT, BLS and MH to other sessions
such as dignity and awareness and safeguarding adults. All of these have been
attended by a cross section of the multi-disciplinary team.

Conference attendance – Again a cross section of the multi-disciplinary team
attended a 3 day national congress on managing violence and aggression. This
generated a number of ideas for on-going development, some of which have
already been implemented on their return. It is hoped the next year 2016, we
will be able to not only attend the next congress, but to actively participate by
presenting one of the sessions ourselves.
CLINICAL DEVELOPMENTS
 Electronic Patient Records – mental health, phase two, as part of the continued
commitment from Government and the GHA the mental health services have
identified ‘leads’ in all areas. These leads from across the multi-disciplinary
teams have been and will continue to work closely with the existing EPR team in
order to develop the requirements for mental health services.

Rockside flats – Both flats are now in use for the 3 months that this reports
pertains to, patients are developing skills and a better understandings of a
number of social skills and daily activities. This is completed through joint
working of health care professionals both on the ward, in the ARC and the close
liaison with community and social care teams.
Page 102
Plans for the next 3 months
In the New Year and during the first quarter of the year will see even more positive
changes to the service. Staff are looking to develop more ward based activities and
community outings, the successful appointment of newly qualified staff (both in terms of
the RMNS and ENs) will only enrich what is already a very positive service of care to are
most vulnerable group within Gibraltar.
These are just a few:
 Supporting the newly qualified enrolled nurses and staff nurses in their post,
through some aspects of preceptor ship.
 The continued involvement of 1st and 2nd year BSc students who are due to
commence student placements with us over the next 6 months.
 We have been approached by a number of students from overseas, who are
requesting a short placement in mental health services in Gibraltar, this is seen
as extremely positive and something the teams want to encourage more of.
 Supporting 2 nursing assistants who are currently undertaking their 18month
pupil nurse training.
 Maintaining staff CPD, mandatory training and any high educational courses staff
identified as part of their yearly appraisals.
 Maintaining the work already started in 2015 with respect to the introduction of
EPR, reviewing and implementation improved documentation. A number of
staff will be working in conjunction with the EPR team.
Developing and maintain the work carried out previously on polices pertaining to
mental health or GHA as a whole.
Chris Chipolina
UGM - Mental Health Services
Page 103
6.10 Information Management and Technology Directorate
Information Technology
The backlog of works and outstanding projects which amassed due to the focus on
works for the implementation of Phase 1 of the EPR project on 24th June in Primary Care
and Accident & Emergency were completed during this quarter.
During the 4th quarter the increase in the number of calls to the IT Helpdesk has
remained. This is mainly due to a greater number of users actively using the computer
systems and a greater need for constant availability of computers and the underlying
systems.
The remaining works in the hospital Wi-Fi project have been progressing. Quotes for the
remedial works were received and a contractor has been engaged based on the quotes
submitted. These works will be completed in January 2016. The revised Wi-Fi Policy has
been submitted for approval and is due to be presented to the GHA Board on 10th
February 2016. It is intended to enable the hospital Wi-Fi, pending approval of the
policy, within the 1st quarter of 2016.
The planned upgrade of the Radiology Information System (RIS) in 2016 has required
the IT department to work closely with the Radiology department to ensure all
Radiology workstations were upgraded in readiness for the upgrade. This has now been
completed laying the foundation for the upgrade to go ahead in the new year.
Activation of the new door access system is now expected during the 1st Quarter of
2015. The contractor and GHA administrative staff continue to work on the door
configuration and access lists on the main server and once this is completed works will
commence to move over to the new door access controllers installed around the
hospital.
The department has been closely involved in the introduction of the new Chemotherapy
Suite.
All IT infrastructural requirements have been installed. This is in preparation for fitting
out of the suite with necessary IT and clinical equipment which will require connecting
to existing GHA systems and infrastructure.
The programmed replacement of the aging hospital CCTV system with a modern IP
network based system is on-going. Infrastructure works are completed and camera
replacement and configuration will take place during the 1st Quarter of 2016.
Work in the Pathology Department continues, assisting in expanding the
computerization to a point where the suppliers of the main Laboratory Information
System are using the installation as an example of cutting edge implementation of their
systems. The dept. is currently assisting with the computerisation of Microbiology.
The upgrade of all Microsoft Windows XP workstations to Microsoft Windows 7
continues. The upgrading of hardware and installed applications, when necessary, is
conducted hand-in-hand with the migration of individual departments.
95% of all GHA workstations have been migrated with the final 5% programmed for
completion in the 1st Quarter of 2016.
Page 104
Incompatibility of legacy clinical software applications with Windows 7, and the need
for the suppliers of these systems to update and test, has delayed the programme and
prevented completion by the original target of the end of 2015.
Migration from our two aging file servers onto the new GHA file server, with greater
storage capacity and much improved performance, is continuing. The remaining server
will continue to be migrated into the 1st Quarter of 2016. This goes hand in hand with
the migration to Windows 7 on all GHA PCs. Once the Windows 7 migration is complete
so will be the file server migration and subsequently the decommissioning of the old
server.
Due to a number of failures of the Primary Care telephone system throughout 2015,
mainly due to overloading of the advanced appointments line first thing in the morning,
it was decided to move the incoming feed from Gibtelecom to the PCC. This feed now
goes to the Hospital site and maintains a much more stable connection. This seems to
have addressed the overloading issue experienced on the advanced appointments line.
Over the last months the team has been designing and building a replacement for the
GHA internal Intranet. It was widely felt that the existing Intranet, which was designed
and built a number of years ago, needed to be modernised with the look and feel of the
GHA external website with increased features and functionality. This is almost complete
and is due to be implemented in the 1st Quarter of 2016.
Additionally, phase 2 of the GHA website is now being worked on. This phase will enable
content management of the individual departmental sections to be devolved to the
relevant departments.
This will empower departments to keep content as up-to-date as possible without
having to ask for changes to be made by the GHA webmasters.
The Backup/recovery system continues to function well. Data recovery times have been
drastically reduced for whenever data or system restoration is required, greatly
strengthening the GHA’s disaster recovery strategies and enabling the GHA to recover
from any potential disaster in a greatly reduced time frame.
However, increases in the amount of data stored by the GHA is putting pressure on the
storage capabilities of the backup system. Backup retention times, before being
overwritten by a newer backup, are having to be reduced so that the backups can fit on
the existing storage systems. This reduces the capability to go back to a specific point in
time and increases the risk of not being able to recover lost files or go back to a point
before data corruption occurs if the loss or corruption is not discovered within a couple
of days.
Expansion and upgrading of the backup system is now planned for the next financial
year. A request for funding has been submitted in the 2016/17 estimates submission to
be able to undertake this essential project.
Page 105
IMT Helpdesk
Our helpdesk continues to be at the core and central to our department. They continue
to handle in excess of 600 support calls per month. This continues to demonstrate the
GHAs increased use of IT systems and the reliance that our clinicians and administrative
staff now have on these systems in order to fulfil their duties.
As can be seen in the two tables below the number of calls received has increased due to
the installation and troubleshooting of the EMISweb EPR systems which impacts on the
helpdesk’s ability to respond in a suitable time frame. It can be seen that the number of
support tickets created has risen from under 200 per month to between 350 and 600
per month, up to a 200 per cent increase in support requests. Additionally, a comparison
of calls received in Quarters 2, 3 & 4 of 2014 and the same Quarters in 2015 shows that
calls have increased by between 100 and 200 calls per month, an increase of 25 to 50
per cent. This continues to negatively impact the helpdesks ability to respond to support
requests as swiftly as they have in the past.
Page 106
IMT Routine Maintenance
It was hoped that, as manning levels have been re-established, the department would
now be able to embark on the planned routine maintenance schedule for all our
desktops and peripherals. The additional burden of support placed on the department
since the implementation of the EPR systems has unfortunately not allowed this to be
undertaken.
Currently much of the current maintenance being undertaken is being done so as part of
the Windows migration, as PCs are upgraded to the new operating system.
Patient Entertainment System
Daily checks continue to be carried out, and a high level of availability and service is
provided to patients on this system. Requests to install TVs in the Elderly Care Agencies
Cochrane Ward and Calpe Ward are still received but have reduced considerably due to
the fact that a large number of the beds now have the installation completed.
The movement of many TV channels to HD Video is resulting in the gradual loss of
channels as the broadcaster migrates to the better quality format. This is due to the fact
that the all of the TV decoders at the patient bedside in GHA Wards cannot receive and
decode HD TV signals.
Investment in the Patient Entertainment System will be required imminently in order to
ensure that a service can continue to be provided.
Once the broadcaster has completed moving all channels to HD TV, expected during the
course of 2016, then we will no longer be able to provide Patient TV in the GHA wards at
the bedside with the current installed equipment. Funding for this has been requested in
the estimates submission for 2016/2017.
General
Regular backups of our main servers and databases continue to ensure the integrity and
safety of our data.
The growth of data stored on our servers is now beginning to put pressure on our
capability to back up all of our data and comply with recognised industry standard
intervals. Expansion of the backup systems are required and funding is being requested
for this in the next financial year.
Our on-call staff are alerted of any equipment issues, alarms, faults via pager, SMS and
email avoiding any delay when taking action.
Staff training in existing and new systems continues to keep abreast of the fast and
changing healthcare technologies.
IS Projects
Below is an update of the programme of works highlighted in the previous report.
Hospital Stores Inventory and Stock Control System
Work continues on phase 1 of this project. The intention is to carry out a pilot phase
within Stores in the 1st Quarter 2016. Operational requirements in the stores
department meant that the pilot phase had to be delayed and was not possible to launch
in the 4th Quarter of 2015 as originally intended.
Full roll-out of phase 1 of the system will be dependent on the success of the pilot phase
and implementing any changes / fixes that arise as a result of this.
Page 107
Stores & Procurement personnel are currently carrying out a revision of their entire
product catalogue for importing into the new system. Phase 1 go live is entirely
dependent on completion of this work stream.
In Phase 2 of the project an internal website will be created. Staff will be able to use this
to submit their stores requests which will be received electronically in the stock control
system. Discussions are on-going on required features and scope for this phase which is
envisaged to commence mid-2016.
Human Resources System
The IS team has begun working with the HR department to develop a HR System that
pulls together all of the numerous spread sheets, documents, templates and any other
form of data repository, be it electronic or paper, and combines everything into one
seamless, user friendly system that removes much of the data gathering and repetitive
tasks that takes up so much of the HR personnel’s valuable time.
Currently at an embryonic stage this project will revolutionise the way the HR
department are able to go about their work.
By developing it in house we will be able to minimise the need for HR resources to
populate the database. by importing existing data, and will also be able to tailor the
system to the needs of the department rather than the department having to adapt to
the rigid structure of an off the shelf system.
As part of this development we will be building a centralised Annual Leave system
which will standardise the annual leave process across the organisation. It will also give
the HR department immediate access to up-to-date leave records for all GHA staff
without having to request from individual directorates or departments.
GHA User Account online requesting
We have been piloting a replacement for a paper based user account request and IT
systems access request form with the Medical HR department. This pilot has proved to
extremely successful and it is now planned to implement across the whole organisation
during the 1st Quarter of 2016.
Cancer registry patient management system –
This continues as previous and there might be an opportunity to also populate this
register with the introduction of new systems in pathology and radiology.
CanReg5 is still being considered as a replacement by the Public Health Department
Pathology System ( Vitropath ) –
Completed
HL7 interfacing for demographics completed, tested and approved, still work in
progress since project not yet complete in operational elements.
Sponsored Patients –
Whilst the Sponsored Patients system is now live, additional requirements and
improvements are constantly being identified by the sponsored patients department as
they use it in their day to day work.
At the request of the department a new feature has been developed and added which
allows ‘Guarantee Letters’, for all patients due to attend Xanit on a particular day, to be
produced in bulk. Previously users had to go into each Xanit travel one by one and
generate the letter.
Adding features such as this greatly reduces the manual processing required in routine
processes being undertaken by the staff.
Enhancements to Screening application –
Page 108
Re-development of the screening application is on-going, providing additional features
and functionality in a rolling programme. It is currently used for Colorectal and AAA
screening programmes. As other screening programmes are introduced these will be
incorporated as and when needed. Also, additional functionality for recall management
and general screening programme is being developed.
Labels –
There is a growing need to provide utilities to print labels of various denominations for
several departments. This development continues with additional departments.
Working with EMIS/Ascribe teams –
There continues to be a great deal of interaction regarding the outstanding elements of
Phase 1 of the EPR project such as the Prescribe/Dispense/Reimburse module.
Since the 24th July the level of involvement required from the IS team has reduced but
remains constant.
Due to the intricacies of some of the existing systems, such as the aforementioned
module and also the GHA Health Card printing functionality, the IS team’s involvement is
and will continue to be relatively high. This is to enable the EMIS Group’s developers to
fully understand what is being replaced and to ensure that they develop and provide the
same degree of functionality if not more.
There are regular meetings between the EPR programme management teams and the IS
team and a good relationship of cooperation and team work has been fostered between
all.
Medical Registration Board –
The MRB are working with an external contractor to create a public facing website for
the Board. Development work is being undertaken to export information from the MRB
system to the website seamlessly. This is currently a manual process undertaken by the
IS technical staff but eventually this will be able to be triggered by the MRB staff by
selecting a button in the system.
Staff Recertification Database –
Work is on-going on a module to record and maintain re-certification and qualifications
of GHA staff.
This is progressing well and is expected to go live in the 1st Quarter of 2016.
Respectfully Submitted,
Heath Watson
Director of Information Management & Technology
Page 109
6.11 School of Health Studies
The first cohort of BSc (Hons)/BSc (Adult) Nursing students have completed their
programme of study and graduated in November 2015. Nine have secured employment
with the GHA, 1 is undertaking midwifery training and 1 teacher training. Three
students graduated with a first class honours degree.
The second year cohort is progressing well. First year students have commenced their
first clinical placements. Evaluations of clinical placement are positive. The third cohort
of Pupil Nurses (eighteen month programme) is working towards completion of their
QCF level 3 qualification. The QCF Level 2 training programme, in response to local
needs, is progressing- this has a work based learning focus assisting staff in developing
their knowledge and skills. This programme has been developed to work with the GHA
and other government agencies.
The Head of School visited KULSGUL to attend the Board of Studies and presented the
progression of Gibraltar students. There is parity with student progression in the UK
and in Gibraltar. KULSGUL are currently in the process of validating a new curriculum in
alignment with NMC standards. The SHS will be required to undergo review of provision
in June 2016 and are currently working to ensure this is a success.
Two modules, as part of the Continuing Personal and Professional Development (CPPD)
portfolio (multidisciplinary), have been run. For the first time a level seven, thirty credit
module was offered. A further module identified by senior clinicians, open to the
multidisciplinary team is to run early 2016. The Surgical First Assistance module (Edge
Hill University) is due for completion early 2016. The SHS are encouraging GHA staff to
access CPPD information via Moodle a SHS devised platform for teaching and learning.
The two year part time MSc Leadership and Healthcare continues with students now
working on their final submission and their chosen dissertations.
We continue to work closely with the Medical Director addressing the need for
revalidation activity as well as through the UGMs regarding other non-nursing health
care professionals (Allied Healthcare Professionals), the Gibraltar Ambulance Service
and our Midwifery colleagues.
In November 2015 the first cohort of preregistration nursing degree students
graduated. At this ceremony 4 RNs had successfully completed and been awarded a
Diploma in Healthcare Practice and 12 RNs who have continued with academic studies
graduated with a BSc Healthcare Practice.
One student is publishing her column for the British Journal of Nursing and one Pupil
Nurse has published her piece in the British Journal of Healthcare Assistants. Academic
staff in the SHS are publishing work in a variety of health care journals and a range of
text books.
Finally, up to 3 technical staff from the Estates and Clinical Engineering Department will
shortly be undertaking UK accredited training for Medical Gas Authorised Persons. This
is a Level 4 BTEC programme and facilitates technicians with obligatory health and
safety competency.
Page 110
6.12 Complaints Handling Scheme
Volume of GHA Complaints/Enquiries 4th Quarter
The Complaints Handling Scheme – Health Office has received 57 complaints and 25
enquiries in the last quarter of the year (4th Quarter - 1st October 2015 to 31st December
2015). The busiest month in this quarter was November 2015 with 25 Complaints; this
actually was the busiest month of the year since the office opened to the public. The
average number of complaints for this last quarter is 19.
Page 111
Page 112
Table 1 - Complaints/enquiries received by department
GHA Departments
Orthopaedic
Surgical Unit
A&E
PCC
Opthalmology
Radiology
Dental
Dudley Toomey Ward
Rainbow Ward
10
8
7
7
6
5
4
4
4
ENT
MI Unit
Gynaecology
Facilities
Maternity Ward
John Mac Ward
Pain Clinic
Sponsored Patients
Others
TOTAL:
3
3
2
2
2
2
2
2
9
82
Page 113
Classification of complaints resolved through informal action
Page 114
Table 2 – Nature of Complaints
Category of Complaints/Enquiries
Waiting times/appointments
Poor Communication
Clinical Issues
Bad attitude
Loss of records/test results/referrals
Cancelled procedure/tests/appointments
Loss of property
Services
Poor Service
Phone unanswered
Refusal to attend call
Records not in clinic
Welfare
Delay in obtaining results
No replies
External Agency
Policy Issue
Resources
Poor Coordination
TOTAL:
19
16
14
4
4
4
3
3
3
2
2
1
1
1
1
1
1
1
1
82
Page 115

Meeting - Gibraltar Health Authority

Transcription

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