gha board report – january to june 2016 · qualifying service for a gha long service & good...

GHA Board report – January to June 2016

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GHA BOARD MEETING AGENDA

Venue: Charles Hunt Room, John Mackintosh Hall at 2.30pm

Wednesday 21 September 2016

1. Apologies for absence

2. Minutes of the meeting held on Wednesday 20th April 2016

3. Matters arising

4. Statement by Minister

5. Matters for discussion

5.1 Long Service and good conduct medal policy. 5.2 GHA Information Governance Strategy 5.3 Confidentiality Policy 5.4 Dementia Strategy

6. Matters for report

6.1 Report: Chief Executive 6.2 Report: Director of Public Health 6.3 Report: Director Estates and Clinical Engineering 6.4 Report: Director of Nursing 6.5 Report: Director of Human Resources 6.6 Report: UGM – Hospital Services 6.7 Report: UGM – Primary Care Services 6.8 Report: UGM – Mental Services 6.9 Report: Director of Information Management and Technology 6.10 Report: School of Health Studies 6.11 Report: Complaints

7. Date and time of next meeting 8. In Camera session


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2 Minutes of the meeting held on Wednesday 20 April 2016

GIBRALTAR HEALTH AUTHORITY Minutes of Meeting held on Wednesday 20 April 2016 at 2.30 pm in the Charles Hunt Room, John Mackintosh Hall. Present: The Hon. J Cortes (MH) - Chairman

Mr F Pitto (FP) - Chief Executive Mr E Gomez (EG) - Chief Secretary Mr C Lavarello (CL) - Non-Executive Member Dr K Rawal (KR) - Medical Member Mr E Lima (EL) - Non-Executive Member Mrs P Galliano (PG) - Non-Executive Member Mr M Netto (MN) - GTC Member

Apologies: Dr D Cassaglia (DC) - Medical Member Mr A Mena (AM) - Financial Secretary

In Attendance: Mr G Teuma (GT) - Director of Finance & Procurement

Mr E Holmes (EH) - Director of Nursing Services Dr V Kumar (VK) - Director of Public Health

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 Secretary: Ms E Fa (EF) 1. Apologies for absence: Dr D Cassaglia (DC) - Medical Member Mr A Mena (AM) - Financial Secretary Welcome from Chairman: The GHA Chairman opened meeting. 2. Minutes: Minutes of meeting held Wednesday 10 February 2016 approved as a true record. 3. Matters arising: No matters arising.


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4. Statement by the Minister:

No statement.

5. Matters for Discussion:

5.1 Chairman’s Ruling on Amended Acupuncture Policy MH – Chairman’s ruling decision discussed at last meeting upon recommendations of the Physiotherapy department and the Senior Executive Team on the Acupuncture policy to adopt this for back pain was approved by the Board. Since then a further policy to extend the current policy was approved and this was introduced as a Chairman’s ruling. AW – Gives presentation on acupuncture policy extension. Commends the Physiotherapy department for their hard work. MH – Acupuncture policy approved by the Board. 5.2 Mobile Devices Policy HW – Gives presentation on Mobile Devices Policy. This policy replaces and expands on the current mobile phone policy. Highlights this is a fluid policy. The policy might change to meet GHA demands. EL – Asks if this is going to enable staff to access clinical data remotely. HW - The policy is not the enabler the EPR programme is the enabler of this access. The policy will control the devices and how these devices are used. CL - The concern is that it will be open to abuse and that this will spiral out of control. His concern is the cost of this. FP - The reason for developing this policy was to address the introduction of the EPR for staff working in the community to be able to access patient records. Devices will be shared between staff on call. The first stage is to pilot the scheme. The Board accepts the policy as GHA policy subject to the paragraphs being adequately numbered. 5.3 Long service and good conduct medal policy MH – This policy will not be tabled today and will be postponed to the next meeting due to last minute changes to the draft. 6. Matters for Report: Chief Executive’s Report: (As per published in Board Report) CL – Surprised that there is a bigger take up to the Abdominal Aortic screening than the colorectal screening? Has there been any cases of patients that have been found with cancer and can it be brought to the publics attention to highlight the importance of doing these tests. VK – This is exactly what the GHA are doing at the moment. They have not had a good response from the public. The GHA are sending out kits and the public are not returning them. For the


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aortic screening people are given appointments. For the colorectal screening the public need to collect three samples and patients are confused how to use these kits. The public are very complacent. To date one hundred people have been detected with cancer due to the colorectal screening programme. Currently doing an infomercial and one patient has agreed to participate. MN – The care colostomy patients receive is quite poor. It is about time the GHA have colostomy nurses. FP - The gap has been identified in the service and steps are being taken to address this. All Directors’ Reports were taken as accepted.

Question Time: None this meeting MH – Explains the Board is still lagging a bit behind and suggests that the next meeting in July two quarters are discussed to catch up with the delay. Meeting ended with agreement to reconvene on Wednesday 27 July 2016. With no further business the meeting closed.


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5.1 Long Service and good conduct medal policy

POLICY NAME:

LONG SERVICE & GOOD CONDUCT MEDAL POLICY

Issued by: Human Resources

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: 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 apply to individuals not directly employed by the GHA but carrying out work on our premises, such as agency workers and external contractors.

3.

DEFINITIONS: Stated within the main policy.

RELATED POLICIES: N/A

Policy No: HRD005 Version: 2


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FURTHER INFORMATION: Director of Human Resources

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, 5th 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 The GHA Human Resources Department will provide the GHA Staff Awards Committee

with a list of potential recipients for consideration. 3.2 The process is administered by the GHA Staff Awards Committee who will evaluate each

potential recipient and verify the information against that held by the GHA Human Resources Department. Award decisions are based on time served, influenced only by conduct and disciplinary record.

3.3 Upon evaluation, the GHA Staff Awards Committee will submit their recommendations to the Chief Executive for approval, or otherwise.

3.3 The Chief Executive must authorise issue and confirm the suitability of each recipient.


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3.4 The Secretary, GHA Staff Awards Committee will communicate to the recipient in writing the approval of the award, 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 non-qualifying.

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.


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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.


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EQUALITY IMPACT ASSESSMENT TOOL To be completed and attached to 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

Ethnic Origin

Nationality

Gender

Religion or Belief

Sex

Marital Status

Disability

Sexual Orientation

Age

2. Is there any evidence that some groups are affected differently?

3. If you have identified potential discrimination, are any exceptions valid, legal and/or justifiable?

4. Is the impact of the policy/guideline likely to be negative?

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?

Name of Policy/Guidance Notes/Guidelines assessed:

Name of Assessor:

Grade:

Signature:

Date:


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5.2 GHA Information Governance Strategy

GHA Information Governance Strategy Strategy GHA Information Governance Strategy

Once printed off, this is an uncontrolled document. Please check the intranet for the most up to date copy Document Status Issued by Clinical Informatics Unit Date Approved By Senior Management Team 9th August 2016 Date Approved By GHA Board Effective Date: Review Date: Owner of Strategy Information Governance Lead (Included in IG Annual Improvement

Plan) Contents 1.0 Introduction

2.0 Principles 3.0 Information Strategy Deliverables 4.0 Management Structure and Responsibilities 1.0 Introduction The Gibraltar Health Authority (GHA) Information Governance Strategy will provide the framework for the management of information and consequentially support the GHA Information Governance Policy. It will ensure the appropriate use of organisation information and provide the necessary safeguards. In healthcare organisations, effective Information Management is critical to,

1. The provision of information central to the delivery of quality care to its patients 2. For effective resource utilisation by units and departments 3. Monitoring of performance of individuals and groups 4. Meeting the information requirements of professional regulatory bodies and 5. Provide the organisation transparency essential in intra and extra organisational quality

assurance

Effective Information Governance is central to Clinical and Corporate Governance.


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The organisational information governance requirements predicate its scope, addressing the following perspectives1:

Information Governance management Confidentiality and Data Protection Assurance Information Security Assurance Clinical Information Assurance Secondary Use assurance Corporate Information Assurance

The strategic framework covers all aspects of organisational information, including: Patient administration information, Clinical record systems (electronic and paper), Corporate information, HR (personnel) information

Information management needs to meet the standards and requirements set by with professional, mandatory, regulatory and statutory bodies. The strategic framework is underpinned by two key components:

1. The GHA Information Governance Strategy 2. The Annual Information Governance Quality Improvements Plan

2.0 Principles The principles that govern information management are described by the UK’s Department of Health’s ‘HORUS’:

Held securely and confidentially Obtained fairly and efficiently Recorded accurately and reliably Used effectively and ethically Shared Appropriately and lawfully

This applies to all GHA staff, Government departments and external partner organisations that have approved access to GHA information. 3.0 Information Strategy Deliverables 3.1 GHA staff must understand and apply best practice and the principles of information governance to manage all information to support the business activities of the organisation Requirements:

a) All staff must receive senior management support and training in information governance and any relevant information.

b) Information governance induction and update training for all staff. c) Regular communication to staff d) All staff contracts include confidentiality clauses e) Publication of IG policies, procedures and guidance on the GHA intranet

1 Perspectives are as defined by the NHS IG Toolkit


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f) Agreement and sign up senior management team of IG Policies g) Data Sharing Agreements with non-GHA bodies, compliant with relevant legislation

3.2 The GHA will undertake regular reviews and audits of how information is used Requirements:

a) Reporting of Review of information governance breaches b) Data quality checks c) IG spot checks on compliance with best policy and practice

3.3 The GHA will develop and maintain a robust management and responsibility reporting structure to ensure that information governance and associated risks are appropriately managed to support the overall risk management function of the organisation. Requirements:

a) Effective IG Board representation through the appointed SIRO b) Recognition of the key roles and responsibilities c) Informing staff of the key personnel and their responsibility d) Provision of clear advice and guidance networks e) Compliance with GHA incident reporting policy and procedure f) Information Governance policies and procedures will be developed, regularly reviewed

and maintained 3.4 Identifying where there are common areas of work will help all employees to work in a cohesive fashion towards a common goal, to the benefit of the patient. Requirements:

a) Encouraging the seamless sharing of relevant information between multi-disciplinary teams

b) Multidisciplinary involvement of staff in development of IG policies and procedures c) Creation of a collaborative culture in the development, configuration and

implementation of an integrated Electronic Patient Record d) Consultation and Involvement of patients in IG Quality Improvement programmes

3.5 The will GHA will ensure that there is an effective communication strategy to support this

strategy.

Requirements:

a) Departmental responsibility for the effective IG communication related to their area of responsibility

b) Advice, guidance reassurances made available through GHA website, information leaflets and posters to staff, patients, families and carers.

c) Information will be made available in various formats explaining how information is recorded and shared and how any concerns may be raised.

d) Patients will be made aware of the importance of providing accurate and up to date information about themselves so that appropriate and safe care is given

4.0 Management Structure and Responsibilities


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4.1. GHA Board The GHA Board has ultimate responsibility for Information Governance within the GHA and has responsibility for ensuring that the organisation complies with its statutory, regulatory and professional requirements. It needs to ensure that there are appropriate resources to support the requirements set out in the GHA Information Governance policy and oversee progress against the GHA annual Quality Improvements plan. The Senior Information Risk Officer (SIRO) has Corporate Responsibility for Information Governance. 4.2 Corporate Governance Committee (CGC) The Corporate Governance Committee (CGC) has delegated responsibility for the Information Governance within the organization and reports to the Senior Management Team. The CGC is chaired by the Director of Finance and this group has representation for clinical staff, clinical records staff, IMT Department, HR and Finance. Information governance will be a standing agenda item. The CGC is responsible for the approval of the Annual Information Governance Quality Improvement Plan and on approval by the GHA Board monitors organisational progress against the objectives set. This Committee is responsible for the development and approval of the Information Governance Policy and the benchmarking the GHA’s information governance against a National framework to define local requirements (e.g. NHS IG toolkit). 4.3. Senior Information Risk Owner (SIRO) The responsibility for Senior Information Risk Owner is held by the Director of IMT. He/she will be the Board member responsible for the Information Governance and consequentially is part of the GHA’s Risk Management Strategy. The SIRO needs to ensure that there is an effective information governance assurance framework and this includes both structural e.g. roles and responsibilities and procedural aspects. The SIRO needs to ensure that there is adequate training of staff and that the programme is appropriately resourced. The SIRO will ensure that there are robust procedures in place for reporting and learning from Information Governance incidents and breaches, complying with the GHA’s Incident Reporting Policy. 4.4. Caldicott Guardian The Caldicott Guardian (CG) role is currently being fulfilled by the Deputy Director of Corporate Services. This person acts in a strategic and advisory capacity on information management. The CG approves monitors and reviews protocols with regards to patient identifiable information and decides on behalf of the Chief Executive on situations that require the disclosure of patient identifiable information. 4.5. Managers The departmental managers have responsibility for ensuring compliance with the Information


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Governance policy, standards and guidelines. They need to identify the training needs of their staff with regards to IG and make the necessary training arrangements with the respective providers. They have responsibility in ensuring their unit’s information security, confidentiality and records management. 4.6 All GHA Staff All staff whether permanent, temporary of contracted need to comply with the organisational information governance policy, its standards and processes. Staff job descriptions should make explicit reference to the individual’s IG responsibilities. Staff should attend all mandatory Information Governance training. 4.7 Third Party Contractors All third party contractors will be subject to an Information Sharing Agreement and will be subject to the conditions set within said document. Guarantees need to be given to both the secure transfer of information but also its storage. Partner organisations need to provide the GHA explicit assurance on their organisation’s Information Governance. Any significant breaches of GHA patient identifiable information will need to be reported to the SIRO and this will be investigated by the GHA following the organisation’s Incident Reporting Procedure. Bibliography Information Governance Strategy 2012 Wirral Community NHS Trust. Available at: http://www.wirralct.nhs.uk/attachments/article/26/IG03InfoGovStrategyApprdAug12.pdf Information Governance Strategy 2014 Colchester Hospital University NHS Foundation Trust. Available at: http://www.colchesterhospital.nhs.uk/policies_and_procedures/292%20-%20Information%20Governance%20Strategy.pdf Information Governance Strategic Framework 2013 Rotherham Doncaster and South Humber NHS Foundation Trust. Available at: http://www.rdash.nhs.uk/wp-content/uploads/2014/06/IG-StrategicFramework-approved-RMSG-16.05.2013-V2.pdf Information Governance Strategy 2012 The Queen Elizabeth Hospital NHS Foundation Trust. Available at: http://www.qehkl.nhs.uk/IG-Documents/ig-strategy.pdf Information Governance Strategy 2016 Tower Hamlets Clinical Commissioning Group. Available at: http: //www.towerhamletsccg.nhs.uk/THCCG%20IG9%20-%20Information%20Governance%20Strategy%20-%20%20112015.pdf Information Governance Strategy 2015 Worcestershire Acute Hospitals NHS Trust . Available at: http: http://www.google.com.gi/url?url=http://www.worcsacute.nhs.uk/ EasysiteWeb/getresource.

http://www.wirralct.nhs.uk/attachments/article/26/IG03InfoGovStrategyApprdAug12.pdf

http://www.qehkl.nhs.uk/IG-Documents/ig-strategy.pdf

http://www.google.com.gi/url?url=http://www.worcsacute.nhs.uk/


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Information Governance Strategy 2013 Buckinghamshire Healthcare. Available at: http: http://www.buckshealthcare.nhs.uk/Downloads/policies/IG0041%20Information%20Governance%20Strategy%20V3.0.pdf


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5.3 Confidentiality Policy

POLICY NAME:

GHA Confidentiality Policy

Issued by: Clinical Informatics Unit

Date approved by Corporate Governance Group: 2.6.16

Date approved by Senior Management Group: 14.6.16

Date approved by GHA Board:

Policy Authority: GHA Board

Effective Date:

Review Date:

POLICY STATEMENT: The purpose of this Confidentiality Policy is to lay down the principles that must be observed by all who work within the Gibraltar Health Authority and have access to person-identifiable information or confidential information.

APPLICABILITY: All GHA staff need to be aware of their responsibilities for safeguarding confidentiality and preserving information security.

3.

DEFINITIONS: See Appendix D

RELATED POLICIES: See Section 7.

Policy No: CIU - 001

Policy Version: Version 1


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FURTHER INFORMATION: Document Status

Date Version Purpose Circulation

12.2.16 1.0 Consultation Executive

12.2.16 2.0 Consultation Corporate Governance

Group

29. 2.16 3.0 Consultation - Executive

-Corporate

Governance Group

- GHA Management

Group

- GHA Clinical

Informatics unit

3.3.16 4.0 Tabling for

approval

- Executive

- Corporate

Governance

Group

2.6.16 5.0 CGG approval

Policy

Corporate Governance

Group

3.6.16 6.0 Advice GRA

14.6.16 6.0 SMT approval Executive Team

7.9.16 7.0 GHA Board

Approval

GHA Board


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Contents Information Reader Box .................................................................................................................................................. Document Status.................................................................................................................................................................. Contents ................................................................................................................................................................................... 1. Introduction ................................................................................................................................................................. 2. Scope ................................................................................................................................................................................ 3. Roles and Responsibilities .................................................................................................................................... 4. Corporate Level Procedures ................................................................................................................................ 5. Distribution and Implementation ..................................................................................................................... 6. Monitoring .................................................................................................................................................................... 7. Associated Documents .............................................................................................................................................. Appendix A: Confidentiality Dos and Don’ts ......................................................................................................... Appendix B: Summary of Legal and GHA Mandated Frameworks ............................................................ Appendix C: Reporting of Policy Breaches ............................................................................................................. Appendix D: Definitions ................................................................................................................................................... Equality Impact Assessment Introduction

1.1 The purpose of this Confidentiality Policy is to lay down the principles that must be

observed by all who work within the Gibraltar Health Authority and have access to person-

identifiable information or confidential information. All staff need to be aware of their

responsibilities for safeguarding confidentiality and preserving information security.

1.2 All employees working in the GHA are bound by a legal duty of confidence to protect

personal information they may come into contact with during the course of their work. This is

not just a requirement of their contractual responsibilities but also a requirement within the

common law duty of confidence and the Data Protection Act 2004.

1.3 It is important that GHA protects and safeguards person-identifiable and confidential

business information that it gathers, creates processes and discloses, in order to comply with

the law, relevant GHA mandatory requirements and to provide assurance to patients and the

public.

1.4 This policy sets out the requirements placed on all staff when sharing information

within the GHA and between GHA and non GHA organisations. 1.5 Confidential information within the GHA is commonly thought of as health information; however, it can also include information that is private and not public knowledge or information that an individual would not expect to be shared. It can take many forms including patient level health information, employee records, occupational health records, etc. It also includes GHA confidential business information. 1.6 Information can relate to patients and staff (including temporary staff), however this is stored it is still subject to the requirements set out in this this policy. Information held on paper, CD/DVD, USB sticks, computer file or printout, laptops, palmtops, mobile phones, digital cameras or even heard by word of mouth is subject to the requirements of this policy. 1.7 Person-identifiable information is anything that contains the means to identify a person,


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e.g. name, address, postcode, date of birth, GHA number and must not be stored on removable electronic media e.g. USB sticks unless this media is GHA encrypted.

1.8 A summary of Confidentiality Do’s and Don’ts can be found at Appendix A.

1.9 The Legal and GHA Mandated Framework for confidentiality which forms the key

guiding principles of this policy can be found in Appendix B.

1.10 How to report a breach of this policy and what should be reported can be found in

Appendix C.

1.11 Definitions of confidential information can be found in Appendix D.

2. Scope

2.1 Staff of the following GHA areas are within the scope of this document:

GHA Board

GHA senior management team ;

GHA Management teams

All Clinical teams – Primary care, Secondary care and Mental Health

GHA Non – clinical Departments including Finance, Human Resources, IMT.

All clinical support staff e.g. ward clerks, receptionists, clerks

Staff working in or on behalf of GHA.

This list is non-exhaustive and this policy applies to all GHA employees.

(This includes contractors, temporary staff, secondees and all permanent employees).

3. Roles and Responsibilities

3.1 Chief Executive Officer

The Chief Executive has overall responsibility for strategic and operational

management, including ensuring that GHA policies comply with all legal, statutory and good

practice guidance requirements. Board Responsibility for ensuring compliance with this policy

is delegated to the Senior Information Risk Officer.

3.2 Senior Responsible Risk Officer (SIRO)

The role of SIRO is performed by the Director of IMT. The SIRO has corporate responsibility for

Information Governance and hence for the implementation and monitoring compliance of this

policy, identification of resource requirements and ensuring that all staff groups are adequately

trained. SIRO working closely with departments: IMT, Clinical Records, Human Resources,

Finance and Clinical Informatics Team ensuring compliance with said policy.

3.3 GHA Corporate Governance Group

3.3.1 The GHA Corporate Governance Group oversees the development and implementation

of Information Governance in GHA and ensures that the organisation complies with supporting

the Legal and GHA Mandatory requirements with regard to information Governance.


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3.4 Director with responsibility for HR

3.4.1 The Director with responsibility for HR is responsible for ensuring that the contracts of

all staff (permanent and temporary) are compliant with the requirements of the policy and that

confidentiality is included in corporate inductions for all staff.

3.5 Senior Managers

3.5.1 Senior Managers are responsible for ensuring that the policy and its supporting

standards and guidelines are built into local processes and that there is on-going compliance.

That the staff in the unit receives the appropriate training. They must ensure that any breaches

of the policy are reported, investigated and acted upon via the GHA Incident Reporting

Procedure.

3.6 Clinical Information Officer

3.6.1 The Clinical Information Officer is responsible for maintaining the currency of this

policy, providing advice on request to any member of staff on the issues covered within it, and

provide training to staff groups to further their understanding of the principles and their

application.

3.7 All staff

3.7.1 Confidentiality is an obligation for all staff. There is a Confidentiality clause in their

contract and they are expected to participate in induction, training and awareness raising

sessions carried out to inform and update staff on confidentiality issues.

3.7.2 Any breach of confidentiality, inappropriate use of health or staff records, or abuse of

computer systems is a disciplinary offence, which could result in dismissal or termination of

employment contract, and must be reported.

4. GHA Corporate Level Procedures

4.1 Principles

4.1.1 All staff must ensure that the following principles are adhered to:-

Person-identifiable or confidential information must be effectively protected against

improper disclosure when it is received, stored, transmitted or disposed of.

Access to person-identifiable or confidential information must be on a need-to-

know basis.

Disclosure of person identifiable or confidential information must be limited to that

purpose for which it is required.

Recipients of disclosed information must respect that it is given to them in

confidence.

If the decision is taken to disclose information, that decision must be justified and

documented.

Any concerns about disclosure must be discussed with your Line Manager.

4.1.2 GHA is responsible for protecting all the information it holds and must always be able


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to justify any decision to share information.

4.1.3 Person-identifiable information, wherever possible, must be anonymised by removing

as many identifiers as possible whilst not unduly compromising the utility of the data.

4.1.4 Access to rooms and offices where terminals are present or person-identifiable or

confidential information is stored must be controlled. Doors must be locked with keys, keypads

or accessed by swipe card. In mixed office environments measures should be in place to prevent

oversight of person-identifiable information by unauthorised parties.

4.1.5 All staff should clear their desks at the end of each day. In particular they must keep all

records containing person-identifiable or confidential information in recognised filing and

storage places that are locked.

4.1.6 Unwanted printouts containing person-identifiable or confidential information must be

securely stored prior to disposal. Discs, tapes, printouts and fax messages must not be left lying

around but be filed and locked away when not in use.

4.1.7 Your Contract of Employment includes a commitment to confidentiality. Breaches of

confidentiality could be regarded as gross misconduct and may result in serious disciplinary

action up to and including dismissal.

4.2 Disclosing Confidential Information

4.2.1 To ensure that information is only shared with the appropriate people in appropriate

circumstances, care must be taken to check they have a legal basis for access to the information

before releasing it.

4.2.2 It is important to consider how much confidential information is needed before

disclosing it and only the minimal amount necessary is disclosed.

4.2.3 Information can be disclosed:

When effectively anonymised.

When the information is required by law or under a court order. In this situation

staff must discuss with their Line Manager

In identifiable form, when it is required for a specific purpose, with the individual’s

informed written consent.

In Child Protection proceedings if it is considered that the information required is in

the public or child’s interest. In this situation staff must discuss with their Line

Manager

Where disclosure can be justified for another purpose, this is usually for the

protection of the public and is likely to be in relation to the prevention and detection

of serious crime. In this situation staff must discuss with their Line Manager.

4.2.4 If staff have any concerns about disclosing information they must discuss this with their

Line Manager.

4.2.5 Care must be taken in transferring information to ensure that the method used is as

secure as it can be. In most instances a Data Sharing, Data Re-Use or Data Transfer Agreement

will have been completed before any information is transferred. The Agreement will set out any

conditions for use and identify the mode of transfer. For further information on Data Sharing

Agreements see the Information Sharing Policy.


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4.2.6 Staff must ensure that appropriate standards and safeguards are in place in respect of

telephone enquiries, e-mails, faxes and surface mail.

4.2.7 Sending information via email to patients is permissible, provided the risks of using

unencrypted email have been explained to them, they have given their consent and the

information is not person-identifiable or confidential information.

4.3 Working Away from the Office Environment

4.3.1 There will be times when staff may need to work from another location or whilst

travelling. This means that these staff may need to carry GHA information with them which

could be confidential in nature e.g. on a laptop, USB stick or paper documents.

4.3.2 Taking home/ removing paper documents that contain person-identifiable or

confidential information from GHA premises is discouraged.

4.3.3 When working away from GHA locations staff must ensure that their working practice

complies with GHA policies and procedures.

4.3.4 To ensure safety of confidential information staff must keep them on their person at all

times whilst travelling and ensure that they are kept in a secure place if they take them home or

to another location. Confidential information must be safeguarded at all times and kept in

lockable locations.

4.3.5 Staff must minimise the amount of person-identifiable information that is taken away

from GHA premises.

4.3.6 If staff do need to carry person-identifiable or confidential information they must

ensure the following:

Any personal information is in a sealed non-transparent container i.e. windowless

envelope, suitable bag, etc. prior to being taken out of GHA buildings.

Confidential information is kept out of sight whilst being transported.

4.3.7 If staff do need to take person-identifiable or confidential information home they have

personal responsibility to ensure the information is kept secure and confidential. This means

that other members of their family and/or their friends/colleagues must not be able to see the

content or have any access to the information.

4.3.8 Staff must NOT forward any person-identifiable or confidential information via email to

their home e-mail account. Staff must not use or store person-identifiable or confidential

information on a privately owned computer or device without explicit and written approval

from the SMT.

4.4 Carelessness

4.4.1 All staff have a legal duty of confidence to keep person-identifiable or confidential

information private and not to divulge information accidentally. Staff may be held personally

liable for a breach of confidence and must not:

Talk about person-identifiable or confidential information in public places or where

they can be overheard.

Leave any person-identifiable or confidential information lying around unattended,

this includes telephone messages, computer printouts, faxes and other documents.


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Leave a computer terminal logged on to a system where person-identifiable or

confidential information can be accessed, unattended

4.4.2 Steps must be taken to ensure physical safety and security of person-identifiable or

business confidential information held in paper format and on computers.

4.43 Passwords must be kept secure and must not be disclosed to unauthorised persons.

Staff must not use someone else’s password to gain access to information. Action of this kind

will be viewed as a serious breach of confidentiality. This is a disciplinary offence and

constitutes gross misconduct which may result in summary dismissal.

4.5 Abuse of Privilege

4.5.1 It is strictly forbidden for employees to knowingly browse, search for or look at any

information relating to themselves, their own family, friends or other persons, without a

legitimate purpose. Action of this kind will be viewed as a breach of confidentiality and of the

Data Protection Act.

4.5.2 When dealing with person-identifiable or confidential information of any nature, staff

must be aware of their personal responsibility, contractual obligations and undertake to abide

by the policies and procedures of GHA

4.5.3 If staff have concerns about this issue they should discuss it with their Line Manager.

4.6 Confidentiality Audits

4.6.1 Good practice requires that all organisations that handle person-identifiable or

confidential information put in place processes to highlight actual or potential confidentiality

breaches in their systems, and also procedures to evaluate the effectiveness of controls within

these systems. This function will be co-ordinated by the Clinical Informatics Team through a

programme of audits identified by the Corporate Governance Committee in consultation with

the SIRO.

5. Distribution and Implementation

5.1 Distribution Plan

5.1.1 This document will be made available to all Staff via the GHA intranet site.

5.1.2 A global notice will be sent to all Staff notifying them of the release of this document.

5.2 Training Plan

5.2.1 A training needs analysis will be undertaken by individual departments with Staff

affected by this document.

5.2.2 Based on the findings of that analysis appropriate training will be provided to Staff as

necessary, including the use of electronic training programmes.

6. Monitoring

6.1 Compliance with the policies and procedures laid down in this document will be


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monitored via the Corporate Governance team, together with independent reviews by both

Internal and External Audit on a periodic basis.

6.2 The Clinical information Manager is responsible for the monitoring, revision and

updating of this document on a 3 yearly basis or sooner if the need arises.

7. Associated Documents

7.1 The following documents will provide additional information:

TITLE VERSION DATE

GHA Data Protection Policy FIMT/010 March 2009

Clinical and Quality Governance Policy GHA/CGC-8 October 2105

Reporting, Investigating, Learning from Clinical

Incidents

N/A November 2006

Internet, Intranet and Email Policy FIMT/004 October 2013

Official Secrets Act - -

Reference – NHS Confidentiality Policy. Approval obtained from NHS England 28.1.16


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Appendix A: Confidentiality Dos and Don’ts

Dos

Do safeguard the confidentiality of all person-identifiable or confidential

information that you come into contact with. This is a statutory obligation on

everyone working on or behalf of GHA.

Do clear your desk at the end of each day, keeping all portable records containing

person-identifiable or confidential information in recognised filing and storage

places that are locked at times when access is not directly controlled or supervised.

Do switch off computers with access to person-identifiable or business confidential

information, or put them into a password-protected mode, if you leave your desk for

any length of time.

Do ensure that you cannot be overheard when discussing confidential matters.

Do challenge and verify where necessary the identity of any person who is making a

request for person-identifiable or confidential information and ensure they have a

need to know.

Do share only the minimum information necessary.

Do transfer person-identifiable or confidential information securely when necessary

Do seek advice if you need to share patient/person-identifiable information without

the consent of the patient/identifiable person’s consent, and record the decision and

any action taken.

Do report any actual or suspected breaches of confidentiality.

Do participate in induction, training and awareness raising sessions on

confidentiality issues.

Don’ts

Don’t share passwords or leave them lying around for others to see.


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Don’t share information without the consent of the person to which the information

relates, unless there are statutory grounds to do so.

Don’t use person-identifiable information unless absolutely necessary, anonymise

the information where possible.

Don’t collect, hold or process more information than you need, and do not keep it for

longer than necessary.

Appendix B: Summary of Legal and GHA Mandated Frameworks

GHA is obliged to abide by all relevant Gibraltar Government and European Union legislation.

The requirement to comply with this legislation shall be devolved to employees and agents of

GHA, who may be held personally accountable for any breaches of information security for

which they may be held responsible. GHA shall comply with the following legislation and

guidance as appropriate:

The Data Protection Act (2004) regulates the use of “personal data” and sets out eight

principles to ensure that personal data is:

1. Processed fairly and lawfully.

2. Processed for specified and lawful purposes.

3. Adequate, relevant and not excessive.

4. Accurate and where necessary kept up to date.

5. Not kept longer than necessary, for the purpose(s) it is used.

6. Processed in accordance with the rights of the data subject under the Act.

7. Appropriate technical and organisational measures are be taken to guard against

unauthorised or unlawful processing, accidental loss or destruction of, or damage

to, personal data

8. Not transferred to countries outside the European Economic Area (EEA) without an

adequate level protection in place.

Link: http://www.gibraltarlaws.gov.gi/articles/2004-01o.pdf

The Caldicott Report (1997) recommended that a series of principles be applied when

considering whether confidential patient-identifiable information should be shared:

Justify the purpose for using patient-identifiable information.

Don’t use patient identifiable information unless it is absolutely necessary.

Use the minimum necessary patient-identifiable information.

Access to patient-identifiable information should be on a strict need to know basis

Everyone should be aware of their responsibilities

Understand and comply with the law.

Computer Misuse

http://www.gibraltarlaws.gov.gi/articles/2004-01o.pdf


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Crimes Act 2011, Part 15, sections 361 -368

Link: http://www.gibraltarlaws.gov.gi/articles/2011-23o.pdf

Human Rights

Gibraltar Constitution sections 1 -18

Link: http://www.gibraltarlaws.gov.gi/articles/2007-00.pdf

Appendix C: Reporting of Policy Breaches

What should be reported?

Misuse of personal data and security incidents must be reported so that steps can be taken to

rectify the problem and to ensure that the same problem does not occur again.

All serious breaches should be reported to the Senior Information Risk Officer,

If staff are unsure as to whether a particular activity amounts to a breach of the policy, they

should discuss their concerns with their Line Manager. The following list gives examples of

breaches of this policy which should be reported:

Sharing of passwords.

Unauthorised access to GHA systems either by staff or a third party.

Unauthorised access to person-identifiable information where the member of staff

does not have a need to know.

Disclosure of person-identifiable information to a third party where there is no

justification and you have concerns that it is not in accordance with the Data

Protection Act

Sending person-identifiable or confidential information in a way that breaches

confidentiality.

Leaving person-identifiable or confidential information lying around in public area.

Theft or loss of person-identifiable or confidential information.

Disposal of person-identifiable or confidential information in a way that breaches

confidentiality i.e. disposing off person-identifiable information in ordinary waste

paper bin.

Seeking Guidance

It is not possible to provide detailed guidance for every eventuality. Therefore, where further

clarity is needed, the advice of a Senior Manager should be sought.

Reporting of Breaches

All confidentiality breaches need to be reported using the GHA Incident Reporting Policy

A regular report on breaches of confidentiality of person-identifiable or confidential

information shall be presented by the executive heads of the respective directorates to the GHA

corporate governance committee on a biannual basis.


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The information will enable the monitoring of compliance and improvements to be made to the

policy and procedures.

Appendix D: Definitions

The following types of information are classed as confidential. This list is not exhaustive:

Person-identifiable information is anything that contains the means to identify a person, e.g.

name, address, postcode, date of birth, GHA number, National Insurance number etc. Even a

visual image (e.g. photograph) is sufficient to identify an individual. Any data or combination of

data and other information, which can indirectly identify the person, will also fall into this

definition.

Sensitive personal information as defined by the Data Protection Act 2004 refers to personal

information about:

Race or ethnic origin

Political opinions

Religious or similar beliefs

Trade union membership

Physical or mental health or condition

Sexual life

Commission or alleged commission of any offence, or

Any proceedings for any offence committed or alleged to have been committed, the

disposal of such proceedings or the sentence of any court in such proceedings

Non-person-identifiable information can also be classed as confidential such as confidential

business information e.g. financial reports; commercially sensitive information e.g. contracts,

trade secrets, procurement information, which should also be treated with the same degree of

care.


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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

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 discrimination, are any exceptions valid, legal and/or justifiable?

No

11. Is the impact of the policy/guideline likely to be negative?

No

12. If so can the impact be avoided? No

13. What alternatives are there to achieving the policy/guideline without the impact?

No

14. Can we reduce the impact by taking different action?

No

Name of Policy/Guidance Notes/Guidelines assessed: Name of Assessor: Grade: Signature: Date:


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5.4 Dementia Strategy

NATIONAL DEMENTIA VISION AND STRATEGY FOR GIBRALTAR 2015


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H M GOVERNMENT OF GIBRALTAR

NATIONAL DEMENTIA VISION AND STRATEGY FOR GIBRALTAR 2015

Introduction

Gibraltar is rightly proud of the community we have built, just as we are proud of our citizen-

based approach to delivering public services. HM Government of Gibraltar recognises that

most of the people who experience dementia wish to live near their family and carers, to

remain within their community for as long as possible and in the home of their choice. It is

within this context that the Government has committed to further developing a Dementia

Strategy in partnership with dementia patients with their carers, along with professional and

voluntary bodies.

The Government has taken the initiative making major investments in developing services for this

sector, which include:

The 54-bedded John Mackintosh Wing, which opened in early 2015, which can be

utilized for dementia service users.

The Dementia Residence at the former Royal Hospital Campus which will be completed in

late 2015; and will be composed of 52 beds, including eight respite beds.

A Day Care Centre for people living with Dementia, to be completed in 2015 and open in

early 2016.

The Government is focused on improving existing services, especially within the community and

wishes to integrate all health and social care services for optimum care.

Dementia is a Public Health and Social priority for people living with dementia and their carers, and

will be recognized as such.

Health and Social Service providers, which include the Department of Social Services, the

Gibraltar Health Authority, the Care Agency and Elderly Residential Services, have worked, and

will continue to work, in partnership with the Gibraltar Alzheimer’s and Dementia Society

(GADS), to increase public dementia awareness, and to remove the stigma that some associate with

the disease. The Government is keen to continue working with the society to further facilitate

public awareness.

The Dementia Vision and Strategy is the framework with which to promote the aims and

objectives needed in the development of policies governing the services which are to be

provided. By integrating services, working together and in collaboration, we can develop

these, to enable them to be efficient, cost effective, but most importantly to meet the needs of our

community.


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The rising numbers of people with Dementia in Gibraltar is a trend which is common across the

world. There are some challenges that are specific to Gibraltar, including the need to

understand our environment and our culture.

Dementia

Dementia is a decline in mental intellect characterised by loss of memory, speech and reasoning

along with other cognitive functions. Dementia is an umbrella term for several illnesses, the most

common of which is Alzheimer’s disease (www.mayoclinic.org). There are numerous types of

dementia, including Lewy Body Dementia, Vascular Dementia and Frontotemporal Dementia,

which are among the most common. Age is a prominent risk factor for the development of

dementia.

The Prevalence of Dementia

In 2013, the Alzheimer’s Disease Society UK reported a greater prevalence of dementia in:

Older people: Dementia is more common as people age. 1 in 14 people over the age of 65,

1 in 6 people over the age of 80, and 1 in 3 people over the age of 95 have a form of

dementia.

Younger onset dementia: The cause of early onset dementia under 65 years of age

includes Alzheimer’s disease, dementias relating to alcohol and conditions such as

Parkinson’s Disease

Learning Disabilities: Studies have reported increased rates of dementia in people with

Down Syndrome

The World Alzheimer Report 2015 gave the updated age distribution by region as shown

below:


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In 2015 Alzheimer’s Research UK reported that 1 in 3 people born in 2015 will develop

dementia and:

32% of people born in the UK 2015, or one in three, will develop dementia during their lifetime

27% of males born in 2015 will develop the condition

37% of females born in 2015 will develop the condition The onset of dementia is devastating for the individual and their families, profoundly affecting

their quality of life and taking a severe economic toll. Treating and caring for Dementia costs

over $600 billion per year worldwide (World Health Organisation Dementia: a public health

priority, 2012). This estimate includes the cost of providing health and social care as well as loss

of income of the people with dementia and their care givers.

Alzheimer’s Disease International urges countries to focus on improving early diagnosis,

raising public awareness about the disease, reducing stigma and providing better quality of

care to people who live with dementia and their carers.

Dementia Worldwide

According to the World Health Organisation (WHO) in November 2012 there were over 35

million people living with Dementia across the globe. They estimate that this is expected to

more than triple to reach 150 million by 2050. This is fuelled by declines in fertility and

increases in life expectancy. The share of the world’s population aged 65 years and over is on

track to jump from 8% today to nearly 17% by 2050. (US Census Bureau, Estimates of

Population Growth,2010 Census).

The World Alzheimer Report 2015 provides an update on the figures as below

(http://www.alz.co.uk)

By 2050 the population of every world region except Africa will resemble Europe today, with

elderly population (aged 65 years or over) outnumbering children under 15. Therefore this will

shift towards an older population bringing with it changes in disease patterns. The share of


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death from infectious diseases of childhood is decreasing while the share from non-

communicable diseases of adulthood, including dementia, is on the rise. (US Census Bureau, 2010)

In the UK there is currently estimated to be over 850 000 people with dementia, and this is

projected to rise to over 1 million by 2025.

It is important to note that the effect on the individual is different in each case. People who

have dementia are not alone and they and their carers can still have a good quality of life with our

support. It is evident that Dementia is not only affecting Gibraltar, it is a worldwide situation.

Dementia in Gibraltar

There are currently just over 370 people living with dementia in Gibraltar (as of May 2015).

This at the current trend is increasing on an average of 2 new patients identified each week.

The Challenge of Dementia

In UK, the current annual financial cost of dementia to the economy is estimated to be over

£20 billion. However, there is considerable evidence (in particular from people with dementia

and their families) that when patients receive early diagnosis and are helped to access

information, support and care, they are often able to adapt to living well with their condition.

(Alzheimer’s Society 2014, Dementia UK: Second Edition)

The symptoms of dementia can be managed and improved if it is identified as early as possible.

Those with dementia and their families can also be helped by having access to appropriate

information and a responsive service. It is also very important that we make our society, and in

turn our community, aware and supportive by working to remove any stigma associated with

this condition. Anyone in society can be affected by dementia, irrespective of gender, ethnicity or

other status. It can affect adults of working age as well as older adults, and people with

learning disabilities are a group particularly at risk. It must also be noted that many people

with dementia will also have other underlying health needs and conditions.

Our Dementia Vision for Gibraltar

Vision The Government of Gibraltar is committed to the continuous development of a strategy to

meet the challenge of meeting the needs of the growing number of people living with dementia in

our community. Our Vision is to enable individuals to continue living in a supportive

community for as long as possible. When this is no longer possible or practical it is then our

intention to provide Dementia units where the care given will be in accordance to the special and

individual requirements of dementia sufferers. Our vision calls for multiple agencies

working in tandem, at all stages of the condition, in the manner of a seamless service providing, in

relation to dementia, the right care at the right place at the right time.


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The Gibraltar Dementia Strategy This strategy, aimed initially as a rolling three-year plan, will set the path for the development of

dementia services. This will involve the creation of new services in some aspects, but will more

importantly involve the greater cooperation and integration of services into one seamless

service. Key and fundamental to this policy are the requirements for

A National Dementia Committee- To coordinate the efforts of the relevant

governmental agencies which should be involved in delivering services in the manner of

a seamless package to persons whose lives are affected by dementia. It is envisaged that

this committee will work closely with service users and their representatives. This will

be enshrined within the terms of reference of this group.

Greater Integration of health and Elderly care (now under same ministry).

Reshaping of services of the elderly - This involves services and institutions having

clear and specific entry and discharge points according to the needs of the patient and

their stage of the condition. The right care being provided at the right time with

suitably competent staff.

Support for carers- Carers must be supported and their vital role in maintaining

patients with dementia at home for as long as possible must be recognized and invested

in. Equally the needs for professional carers to be able to establish a rapport with their

dependents, and to be suitably competent, must be instilled in the dementia pathway.

Housing- suitable housing units which create the adequate environment for dementia

sufferers and which support the provision of cost effective domiciliary health care must

be part of the strategy. These units (achieved by refurbishing their existing residence

and /or the incorporation of new units in new estates), must be allocated early enough

on diagnosis to allow for the dementia patient to maximize the learning of their new

environment.

Greater efforts via public health education- aimed at helping individuals identify risk

factors which may make them prone to developing the condition. Another aim of this is

raising public awareness of the condition thereby making Gibraltar a more dementia

friendly society.

Essential Outcomes for this Strategy will be

1. More patients receiving an accurate diagnosis earlier

2. More patients receiving more effective care.

3. Improvements in patient and staff experiences as the service users navigate through a

seamless process.

4. Carers and staff feeling valued, trained and supported to be able to champion

suitable changes and innovation of services in accordance with latest best practice.

5. To create the framework for the inclusion of patients and their carers in all aspects of

their treatment.

6. To allow those with dementia the best possible opportunity to continue living at

home or in the community within their family unit for as long as possible.


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7. To create through training and education, the right conditions whereby dementia

patients are still considered and treated as individuals with all the rights and

considerations they deserve.

8. Greater cooperation with voluntary organisations and service users.

Critical Success factors for this strategy

It is imperative that people have awareness of those health risk factors which may make them

prone to developing the condition. It is essential to prepare the service user and their carers with

suitable skills, training and equipment to allow them to anticipate, plan for and keep ahead of

eventualities in tandem with the natural progression of the illness. Achieving this implies close

coordination between professionals, relatives, carers and most importantly the person with

dementia.

Care must be provided at the right time and place and at the right level, in accordance with

the patient’s chosen lifestyle and choices. Care will be provided in the manner of a continuous

process, with all services coordinated by a link person in the initial stages of the condition and a

dementia coordinator in the later stages. This will reduce the need for people with dementia or

relatives of needing to encounter multiple waiting lists or an excess bureaucracy as they are

referred to support services on an individual basis.

Service providers will be provided training at a suitable level of competency in accordance and

consistent with their professional role. This will ensure that the service users are always

treated appropriately and with dignity. All interactions with the clients will be on a therapeutic

basis, aimed at soliciting the maximum participative value for the service user as possible, with the

aim of extending their functional abilities as long as possible.

Most importantly, the strategy depends on diagnosing dementia cases as early as possible. This will

involve greater levels of dementia awareness and training at all levels, which includes primary

care. Only by doing so will it be possible to have the time to work with families and those

experiencing dementia to make a significant difference to present outcomes.

Achieving a seamless service Management structures of service providers to the elderly generally, and dementia clients

specifically, will be simplified to allow for a quicker and more efficient decision process. The

main emphasis of these reforms will be:

1. Greater integration and cooperation between health and social services with

simplified referral processes- Both organisations will coordinate their services

allowing for the identification of needs in present services and planning to meet these.

Referral pathways and service provision will be clearly drawn out and understood by all

professional groups. This will create the conditions in which the dementia coordinator

and the link person can make a significant difference in guiding families and service

users through the dementia care process. This will also in turn make the difference in


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keeping family units together, in the community, enjoying a better quality of life for as

long as possible.

2. Developing care for older people- will require all participative organizations to make

the necessary adjustments to their services to make them friendly for seniors generally

and dementia friendly specifically. This will mean amongst other things

incorporating environmental features into facilities to increase the functional

independence of clients; investing in services to reduce and if possible arrest the

degeneration of abilities experienced by the elderly with dementia when hospitalized;

and also having their GP needs met in an environment more in accordance with their

needs as they arise due to their condition. In terms of domiciliary care it means

allowing the service user to develop a rapport with dementia skilled carers, by

keeping the same carers working with the same clients.

Housing- is an essential component in the strategy, often overlooked in the past. Dementia

sufferers if diagnosed early can be rehoused into more suitable dementia friendly

accommodation. By moving them quickly, it will allow the client to form a bond with the

new accommodation whilst they still retain capacity to do so. Accommodation designed for

dementia users will allow the client to be as functionally independent as possible with safety

in mind and allow service providers to cater for groups of families within a close

geographical location.

A National (Gibraltar) Dementia Committee composed of representatives from all relevant

agencies, under the offices of the Ministry for the Health and the Elderly, will be set up to

coordinate the development of the strategy, provide a structure with which to champion

dementia issues and provide a focal point with which to interact with charities, volunteer

organizations and the public as a whole.

Gibraltar - A Dementia Supportive Community

Our community has the capacity to support people affected by dementia so they can enjoy the best

possible quality of life.

We must do all we can to ensure that people who need treatment receive it at the right time and

in the right place. We need to plan services to take into account the needs of people who live in

our close community, and ensure that language, cultural needs and preferences are catered for.

It is a priority therefore that we develop more closely integrated services; more

comprehensive programs of care; and a greater awareness and understanding of the needs of

people with dementia and those close to them, such as their families, friends and carers.

Gibraltar’s response will also be firmly rooted and grown from its communities. Our long term

Vision is to create a “Dementia Supportive Community”. To do this requires a change in

attitudes and behaviours towards dementia at all levels of society, which reflect the challenge of

demographic change and the impact of dementia.


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It needs to involve the wider community, individuals, groups, estates and tenants’ associations, non-

governmental organizations, trade unions and businesses. It requires a society in which people

with dementia, and those who care for them, are treated with the dignity and respect they

deserve, along with the help and support they need.

Summary of Strategy in action points

Our Strategy is…to reform the lines of accountability for services for the elderly into one

unified and simplified structure, with all services working in tandem in one common

dementia care process.

Our Strategy is….to call for the improvement of service user outcomes by the earlier

diagnosis of dementia cases and by investing in necessary community support.

Our Strategy is… to improve services by:

o Improving the quality of care received by people with dementia in hospital and other

facilities:

1. Creating dementia friendly environments.

2. Promoting opportunities to reduce the effects of institutionalisation.

3. Creating the right service structure to facilitate early supported

discharge into the community, once there the necessary resources and

structure will be in place.

4. Education and training of health and social care professionals in dementia care.

5. Involving Allied Health Care Services (including Occupational Therapy,

Physiotherapy and District Nurses ) in the care of people with dementia

and their families.

o Reducing inappropriate prescribing of psychoactive medications

o Developing on the opening the 52 bed John Mackintosh Home, designed as a dementia

ward, offering respite care and a safer and more suitable environment for dementia

patients in preference to a hospital ward, by:

o Opening the new Dementia Residence, designed as a dementia nursing home making a

further 54 beds available with 8 respite beds, which will support carers.

o Opening a Day Care Centre to care for people with dementia, and provide support for

their carers. This will house a dementia assessment unit, the memory clinic and serve as the

referral and coordination point of dementia community services, including GP

practice.

o Continued respect and promotion of rights in all settings, together with improved

compliance with legal requirements in respect of treatment.

o Explore and where feasible invest in the use of assistive technology for people with dementia.

Our Strategy is…to raise awareness by:

o Informing the community about dementia and how to recognize it.

o Including the contribution of people with dementia in our community activities.

o Working with the Gibraltar Alzheimer’s and Dementia Society and other groups to

raise the profile of dementia.


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o Encouraging individuals, organizations and businesses to be “Dementia Friendly”.

o Engaging with young people in schools, clubs and youth organizations to increase their

awareness and understanding at the earliest possible age.

o Ensuring that the community is consulted and listened to.

o Introducing a ‘Dementia Friend’ initiative.

Our Strategy is…to reduce anxiety for sufferers and their families by: o Listening to the voice of the people affected by dementia and their families/

representatives.

o Ensuring more people with dementia and their families are involved as equal partners in

care throughout the patient journey.

o Ensuring that people with dementia are included in community activities, and that they, and

their carers are supported by the community.

o Creating dementia enabled and dementia friendly communities that create greater

awareness of dementia and reduce stigma.

o Being attentive of carers needs

o Working as equal partners with family, friends and carers of people with dementia.

o Minimizing and responding appropriately to stress and distress by creating appropriate

support mechanisms and simplifying the process via which people with dementia and

families can request and receive this care.

o Evidencing the impact of change against patient experience and outcomes.

Our Strategy is…..to prevent or prolong the development of dementia by raising awareness

to its risk factors and promoting a healthier lifestyle by:

o Stimulation of the mind through activity in all stages of life.

o Reducing alcohol intake and the prevention of falls.

o Adopting a healthy diet to prevent diseases such as diabetes and heart conditions that can

lead to vascular dementia.

Our Strategy is…to support people who have been newly diagnosed with dementia by:

o Providing a One Year post Diagnostic Support Package

o Providing better post-diagnostic support for people with dementia and their families.

o Working in partnership with voluntary groups, including the Gibraltar Alzheimer’s and

Dementia Society (GADS).

o Promoting awareness of, and early management of the symptoms of Early Onset Dementia.

Our Strategy is…to monitor progress of Our Vision for a Dementia Supportive

Community by:

o Continually evaluating the impact of our interventions via a National Dementia Committee:

a. Initiating any changes necessary in a timely manner.

b. Having a commitment to take forward transformational changes and report

progress.

c. Carrying out research on different aspects of dementia care.


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References World Health Organisation, Dementia: a public health priority 2012

US Census Bureau, Estimates of Population Growth, 2010 Census

Alzheimer’s Society (www.alzheimers.org.uk)

Alzheimer’s Society 2014, Dementia UK: Second Edition

World Alzheimer Report, Alzheimer’s Disease International, 2009


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Appendix 1

Initial Identified and potential gaps in the system -

a. Education/training for all staff on dementia;

All staff working in health and social care, whether in an institution or in the

client’s own home must have an awareness of dementia generally. The greater the

professionals role in dementia the greater the depth of understanding in

dementia which the professional should possess. Using the Scottish definition for

ease of description the different levels could be as described in table 1. The table

describes the manner in which the developing Gibraltar Dementia Strategy will

provide differing training packages in accordance to job roles, however the exact

standards and the number of levels which may be provided will differ.

Level Staff which should be covered Dementia aware level Should cover all staff in health and social care , including domiciliary

services Dementia skilled practice level

Would be the basic level for all staff who have substantial and direct contact with people with dementia

Enhanced Dementia practice level

Would be the level of training required by health and social services staff who have intense contact with people with dementia and are required to manage services/ deliver specific interventions

Expert in Dementia Professionals who by virtue of their position play an expert specialist role in the delivery of care to persons with Dementia.

b. Greater role of primary care in dementia services

It is essential for primary care services to become more dementia friendly and

accessible .General Practitioners (GPs) must play a leading role in the coordination

of services and the provision of continuity of care for persons with dementia. To

achieve this, each person with dementia should have a named GP who (especially

immediately post-diagnosis) would have a complete oversight of the full care

being provided for the person. The GP together with the link person for

dementia (based in the day centre) will provide the consistency of contact with

the carers and the service users which would be further supported by Allied

Health Professionals (AHPs) and other professionals as and when required.

c. Dementia Champions

Especially in institutions there is a need to appoint dementia champions. These

would be members of staff trained to at least dementia practice skilled level.

Their role would be to assist in developing dementia friendly facilities in

their area of work. They would also , if a person with dementia is admitted into

their area i.e. an orthopaedic ward as a result of a fall, help ensure that all

measures which can be taken to ensure the best possible care for the patient are

provided.

d. Referral to support systems/ groups for carers;


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Dementia is a condition which affects the whole family unit. Under the present

system not enough is being done to support carers in the community either with

physical or emotional support. The new strategy calls for greater respite services,

simplification of the processes via which help can be obtained and for psychological

help among other possible supportive mechanisms

e. Appropriate domestic help to keep patients at home for longer

Domiciliary help is a vital service with which to assist families struggling to cope

with a family member with dementia. However potential failings in these

services are:

Carers who do not have experience or an understanding of dementia.

Families may receive different carers rotated periodically. It is a desired

standard for the same carer to be dedicated to a family / person so that the

person becomes accustomed to the carer and the carer forms an

understanding of the client. This will enable carers to deliver their service in a

daily routine, hence providing effective care.

Care as a means to facilitate hospital discharge can be slow in being provided. In

cases of dementia especially it is desirable for many reasons to discharge the

person home as soon as possible.

f. Appropriate housing for patients with dementia

It is essential to design new dementia housing units and refurbish pre-existing

units in the community. The aim is to create mutually supportive communities

for whom it would be easier to provide domiciliary care for than present

arrangements with care being provided across a wider geographical area. This

would allow couples, one member of which could have dementia, to stay

together in the community for as long as possible. Housing is a vital component in

the care of dementia.


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Appendix 2

Table 2. The prevalence of patients with known dementia in Gibraltar (December 2014 & 2015)

Number of patients Number of patients

Dementia patient location December 2014 December 2015

Community 171

Jewish Home 5

KGV/ Ocean Views 13

Mt Alvernia Floor 1 22




John Cochrane Ward 19

Calpe Ward 11

Captain Murchison Ward 15

Victoria Ward 8

John Ward 2

Dr Giraldi 1

Total* 328

*These are patients diagnosed and known to community


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Appendix 3 – service user expectations

All people living with Dementia in Gibraltar should say

Early referral and assessment at the JMC

I was diagnosed early

The information at diagnosis was in a form I could understand

I understand, so I make good decisions for the future

Those around me and looking after me are well supported

The team is

always available

to provide the

support for my

carers

I am treated with dignity and respect

I have the

confidence that

the team listens to

my concerns and

wishes

I know what I can do to help myself and who else can help me

I can enjoy life

I feel part of a community and I’m inspired to give something back

I am confident my end of life wishes will be respected.

I get the treatment and

support which are best

for my dementia, and

my life


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Appendix 4 – Strategic Objectives

Objective Actions by year

Desired Outcomes

Key objectives Yr 2015 Yr 2016 Jan-Jun

Yr 2016 Jul-Dec

Creation of a National Dementia coordination Body

Adoption of principles of dementia strategy in health, care, social services, elderly care, housing and volunteer groups as main partners

Adoption of service standards for Health/care providers with regulation body(Clinical Commissioning Group )

Improvement in Health and social care.

To set up a formalised body committed towards the development and maintenance of dementia services

Each Department to develop services consistent with Dementia needs

Ensure that once standards in all aspects of dementia care are set that these are maintained and monitored.

Appointment of group development of terms of reference and implementation of working processes

Services to interpret dementia development of own services in accordance with national dementia strategy

----------------------------

Ongoing Setting up of a dementia section within elderly ministry

National Dementia Body to assume control of development of services and coordinate across all participating services

--------------------------

National Dementia Body to begin work with departments with regards maintenance and monitoring of standards

Ensure that services in dementia develop in a coordinated manner across all agencies and that the cooperation is sustained


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Health promotion Earlier diagnosis

Public health Campaign aimed at the reduction of risk factors leading to dementia

To diagnose dementia as early as possible

Have the appropriate support mechanisms for the affected person and carers

Identify those factors increasing risk of developing dementia relevant to local population

Create database and supporting mechanisms to harness data from local service providers

Increase competency of staff in recognising dementia symptoms

Comparison of local diagnosis rates (numbers and stages of illness[PI1])

Introduce Dementia link person as part of dementia day care centre

Initiation of specific locally relevant campaigns

Collation of Data

Develop dementia KSF framework in accordance to level of awareness required

Review of Data and plan improvements

Introduction of support roles in response to identified need as part of improved data collection

Review and plan longer term strategy

Review and analyse to steer longer term Strategy

Ongoing

Full adaptation of locally based 5 pillar model

Dementia service users to have a named GP. Greater dementia awareness in

Our Aim is to allow people to understand how they can lower their risk of developing Dementia

We need to understand Dementias in our locality by Consolidating the data of all service providers. This will allow for a more locally specific public Health campaigns and better care provision.

Have early diagnosis to allow dementia sufferers to make decisions for their continuing care and for staff to develop memory strategies whilst the person still has capacity

Ensure right interventions happen in the right place at the right time in the right intensity.

Increase the early support and understanding also for carers.

Dementia sufferers having


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Support for carers Creation of dementia friendly institutions

Avoidance where possible of premature institutionalisation of people with dementia due to carer “burnout”

Create a range of facilities catering for the various different stages of dementia

Staff/ professional development

Provision of support through education, early domiciliary support as required and respite opportunities, day occupation. (DAY CENTRE)

Training of link person in dementia centre/adoption of Dementia day centre staffing plan.

Completion of new dementia day centre.

First stage of opening of Day centre

Completion of new dementia residential home

Commissioning of community

Consolidation of pathways to facilitate access for users to required services

Direct carer access to support through counselling

Study into impact of introducing carer friendly hours/ flexible work opportunities for people caring for persons with dementia

Continuation of planned opening of facility to full opening

Residential home fully operational

Ongoing Ongoing

Introduction of identified model with appropriate controls and limitations

Review of dementia residential home facilities v service user needs Continuation of refurbishment program

Restructure of community services in relation to dementia initiated

Mount Alvernia

The aim is to develop a service where the day centre can serve as a one stop shop for carers of as well as service users.

Carers to be well supported to prevent burn out. By developing trust in professionals to provide support carers may feel less desperate and be less willing to give up.

By having reduced stress in meeting work and care obligations nominated carers may feel happier to cope.

Ensure Institutional wards / spaces do not accelerate the cognitive degeneration in the elderly and inhibit function.

All hospitals and care homes to meet criteria to becoming dementia friendly

Aim to ensure staff have the correct competency level consistent with job role


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Housing options

Dementia awareness programmes

Developing of dementia friendly community services

Plan for dementia friendly housing options and communities

Plan training for the local population, businesses and public services not directly linked to dementia

Planning of mandatory dementia awareness training programs for hospital/ elderly care staff

Develop a template of dementia friendly flatlets to be built amongst new developments

Appointment of Hospital[PI2] dementia special interest group

Initiation of building/ refurbishment programme

Use the opportunity created by the setting up of new services to create interest in dementia

Development of services as identified by group

Allocation of first few units

National dementia body to lead in the Development of a public education strategy

Implementation

Allow dementia sufferers to stay in the community for as long as possible by having a facility which will over daily therapeutic activities.

Make domiciliary care more cost effective by having people with dementia and couples living within mutually supported communities

For families and the local population to have greater awareness of the needs of the elderly and issues affecting dementia. This will create a more supportive environment and allow people to realise there is still life even with dementia.


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Dementia Education , training and workforce development

Provide a range of training packages in accordance to the different job roles/ exposure to dementia of professionals[PI3]

Initiate training packages for the carers / professionals due to work in new dementia facilities

Initiate further training packages for dementia skilled level

Develop further training to dementia expert level as required

Training at all levels to be on-going

To develop the workforce primarily in health and social care, but also raise the awareness of all service providers in all relevant government agencies.


21

Reduce inappropriate

prescribing of psychoactive

drugs

Easier Referral Pathways and

Coordination

Dementia Champions Training and Education

Adopt new

research

Regular audits

Keep couples

together

Easier

domiciliary care

GP consistency

GP with link person will

provide continuity of

care

Support from MDT

Research

Appendix 5 – Dementia Strategy Map

Appropriate housing allocation

Patients at home & in community for as long as possible

Early planning for the future with capacity

Out-patient day centre services

Early diagnosis to extend functional abilities for as long as

possible

Consistency of care with domiciliary services

1 year post-diagnostic support package

Dementia day centre services

Moderate

The John Mackintosh Wing

The new dementia hospital

Patient

diagnosed

early with Carers

dementia

Staff

Better domiciliary care/

support

Support from GADS

Dementia link person to

avoid complication

Dementia day centre respite

One point service for dementia care

Joint decisions with patient and carer on treatment and future plans

Psychological support

Simplified pathway of care

National Dementia Committee

Coordinate efforts of Governmental agencies

Composed of representatives from relevant agencies

Coordinate development of dementia strategy

Promote dementia champions

Interact with charities, volunteers and the public

Future Plans

Dementia friendly adjustments

Increase functional independence

Consistency of care

Preferences to be catered for

Environment Housing Primary Care Service

Final stage


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This is a Vision and Strategy jointly developed by the Gibraltar Health Authority,

Department of Social Services, the Care Agency and Elderly Residential Services in

consultation with the Gibraltar Alzheimer’s and Dementia Society.

©HM Government of Gibraltar, Ministry for Health and the Elderly, St Bernard’s

Hospital, Gibraltar


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6.1 Chief Executive

Mr Chairman, Board members, this report refers to the first two quarters of 2016 (January to March and April to June) and the final quarter for financial year 2015/2016 and the first quarter for financial year 2016/2017. The following is a summary of the Director’s reports highlighting some of the main points which are enclosed in the main body of this document.

1. Health and Lifestyle Survey

The report of the second Health & Lifestyle Survey is now complete. The process of designing and printing has gone out to tender. The report is expected to be published this summer.

2. Health Promotion Activity

As reported at the last Board meeting, the Health Promotion Department continues to be involved in a number of Health improvement campaigns. Key programmes have included;

‘Go Fit’ initiative

World Cancer Day 2016

Dental Health

No Smoking Day 2016

Skin Cancer Screening Day

Nutritional Awareness

Sun Safety

Health & Wellbeing Day

World Asthma Day 2016

Mental Health Week

Heart Health Campaign

These are just a few examples of the extensive work being undertaken by the Health Promotion Officers.

3. Improving the Nursing Skill Mix in Mental Health

This period saw the successful completion of enrolled nurse training of 6 nursing assistants within Mental Health. This increase in qualified staff has led to an enriched skill mix which is in lines with the audit recommendations of the skill mix exercises undertaken in Mental Health.

4. Chemotherapy

The new Chemotherapy Unit is now in its final stages of completion. Specialist equipment is now being installed and commissioning of the Cytotoxic Isolator is being undertaken. Final snagging and fitting and furnishings are being completed.


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Workshops have also taken place with all clinicians to develop the operational plan for the unit and agree on the patient pathway.

5. Dementia Day Facility

Works on the Dementia Day Facility are now complete with plans to hand over the building to the GHA in August 2016. The procurement of equipment and furniture has already been done and recruitment for the staff has already commenced. Weekly meetings with all stakeholders are being undertaken to ensure everything is in place for the planned opening in September 2016.

6. New Primary Care Appointment System

The 1st January 2016 saw the introduction of the new 48 hour pre-bookable appointment system, with the aim of improving access to GP’s and NP’s by increasing the number of, and making more available to the public clinic appointments. The first indications are extremely positive with the main aim of making appointments more readily available being achieved. However we are aware that no system is perfect and there is always room for improvement. The Primary Care management team will be monitoring the new process and making adjustments as required.

7. New Blood Appointment System

In order to address the long waits being experienced by service users and the need to queue which was leading to congestion outside the clinic areas, a new advanced appointment system was introduced both at St Bernard’s Hospital and at the Primary Care Centre. The initial feedback from both staff and service users has been positive.

8. Transfer of the GFRS Ambulance to the GHA

The GHA welcomed the decision taken to transfer the GFRS emergency ambulance to the GHA. Both the recruitment of staff and procurement of a new emergency ambulance is in progress.

9. Ambulance Staff Training

Ambulance staff training remains top of the agenda in order to continue to improve pre-hospital emergency care and the ability of the service to respond to major disasters. Training during this period has included;

Clinical Reasoning in Physical Assessment

Ambulance Intervention Team and Marauding Terrorist Firearms Course

(MTFA)

Health & Safety

10. Validation of the Enrolled Nurse Programme and Nursing Degree Programme


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The external advisor for the Enrolled Nurse training programme from the University of Salford visited the GHA to undertake an external assessment. The findings concluded that the provision of the course is fit for purpose, innovative and reputable. The report went on to provide complimentary feedback to the teaching team at the School of Health Studies (SHS). The SHS also hosted the visit of staff from St Georges’ University of London and Kingston University of London who undertook a review of the BSc (Hons) Adult Nursing degree programme. The outcome of the review was excellent with the Panel expressing confidence in the team delivering the programme, the quality assurance elements and the practice experience.

11. ISO Accreditation

Staff in the Department of Pathology have been working hard with issues related to ISO accreditation. May saw the first working visit of ‘Innocam’ Group for the ISO 15189 accreditation of the Department of Pathology’s Donation and Transfusion services. This was the first of a series of scheduled meetings following on from the external audit undertaken by ‘Innocam’ in January.

12. Staff Awards

The GHA Staff Awards ceremony took place on Monday 16th May 2016. I would like to thank Mr Peter Linares, his staff, the Award’s Committee, and all the Sponsors for making this event a success. All the details for each category and the winners are included in the report provided by the Director of Human Resources.

13. Financial Performance

This report covers the GHA’s financial performance over two financial years. Firstly the full year’s performance for financial year 2015/2016 running from 1st April 2015 to 31st March 2016. Secondly the first quarter performance for financial year 2016/2017 from 1st April 2016 to 30th June 2016. As forecasted and reported previously to this Board, the financial performance for 2015/2016 showed an overspend, mainly influenced by the patient demand led budgets and in order to maintain the additional beds operational to meet the on-going bed occupancy pressures. This has been essential in order to continue to maintain emergency capacity and avoid disruption to the elective programme. The first indication for the first quarter of financial year 2016/2017 is a forecast overspend following the pattern of the previous financial year. The full details of this are explained in the report provided by the Director of Finance.

14. Staff Announcements


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i) Dr Tadeusz Biedrzycki, Consultant Pathologist sadly passed away on 24th May

2016. Dr Biedrzycki had worked for the GHA for over 15 years and was

instrumental in the development of the Laboratory and Pathology service in

Gibraltar. He was a talented and highly experienced pathologist, highly

regarded by peers and colleagues and will be missed.

ii) On a brighter note, the GHA welcomes Dr Daniel Cassaglia as the new Medical

Director of the GHA.

iii) I am also delighted to announce that the Head of the School of Health Studies,

Professor Ian Peate has been awarded an OBE in the UK list of the Queen’s

90th Birthday Honours, 2016 for his services to Nursing and Nurse

Education.

To conclude, I would like to thank all of 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 GHA CEO


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6.2 Director of Public Health Health and Lifestyle Survey The Report of the Health & Lifestyle Survey is now ready and the process of designing and printing had gone out to tender. It is expected that the Report will be published by the autumn. Colorectal Cancer Screening Programme First Quarter (January to March) During the period spanning the months of January to March, a total of 1037 invitations were mailed to eligible participants inviting them to take part in the Colorectal Cancer Screening Programme. During this same period 1076 test-kits were prepared and mailed to the participants and 365 samples were returned to the hospital laboratory for analysis. The breakdown of the results is as follows:

- 309 Negative for occult blood results - 28 Inconclusive for occult blood results - 28 Positive for occult blood results

Of those participants invited to participate, 8 categorically refused to participate in the screening programme. In accordance with the protocol, the person will be re-invited to participate in two years. Of the 13 invitations extended to eligible participants residing in Spain, six individuals expressed interest in participating in the screening programme. One additional individual aged over 74 and therefore not in the routinely invited group, approached the screening office requesting to be included electively in the CRCS programme. During this period the programme found:

- 18 participants with adenomas - 2 participants with cancer

Second Quarter (April to June) Figures are not available yet for the month of June at the time of writing. During the period spanning the months of April to May, a total of 689 invitations were mailed to eligible participants inviting them to take part in the Colorectal Cancer Screening Programme. During this same period 684 test-kits were prepared and mailed to the participants and 301 samples were returned to the hospital laboratory for analysis. The breakdown of the results is as follows:

- 258 Negative for occult blood results - 23 Inconclusive for occult blood results - 21 Positive for occult blood results -

Of those participants invited to participate, 6 categorically refused to participate in the screening programme. In accordance with the protocol, the persons will be re-invited to


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participate in two years. Of the 53 invitations extended to eligible participants not resident in Gibraltar, 8 individuals expressed interest in participating in the screening programme. One additional individual aged over 74 and therefore not in the routinely invited group, approached the screening office requesting to be included electively in the CRCS programme. Response Rate The Response Rate of the Colorectal Cancer Screening programme continues to be disappointing at 44.0%, when compared to that of the UK, which is around 60%. The following are some suggested reasons for this: a) Some people could be confused about the test kits and how to use them. In response,

the Public Health department is now including (since December 2015) a DVD with every test kit pack sent out, containing a video clip depicting in cartoon form every step of using the test kit.

b) Some people held back from taking the test because they take aspirin or anti-inflammatory medication that can cause bleeding as a side effect. In response, the Public Health department has produced an updated instructional booklet in which the use of the test kit alongside taking anti-inflammatories or if suffering from piles is supported.

c) Some people have declined participating in the programme simply because they feel well and have no symptoms to cause worry. Lethal progression in the absence of symptoms is the very reason for screening programmes to exist and such complacency can be countered only by education. The public health department is currently developing a new infomercial based on an interview with a cancer patient.

Abdominal Aortic Aneurysm Screening Programme First Quarter (January to March) During the period of January - March, 126 invitation letters were mailed to eligible participants and 44 accepted their invitations (35% response). All these participants were issued with ultrasound appointments. One ‘Please Reconsider’ letter was issued to participant who did not reply. No expressed refusals were recorded during this period. However, 26 invitees, who did not respond to either the invitation letter or the reconsider letter were marked as ‘Inactive’ and notified. Requests were received from 2 individuals aged 66-74+ years (outside the invitation range) to take part in this initiative as elective cases. During this period, 70 men were screened. One medium sized aneurysm detected in the previous quarter was found during re-screening not to have grown in size and is being kept under 3-monthly surveillance as per policy. No other aneurysms were found. Second Quarter (April to June) Figures are not available yet for the month of June at the time of writing. During the period of April - May, 35 invitation letters were mailed to eligible participants and 22 accepted their invitations (63% response). All these participants were issued with ultrasound appointments. A total of 44 ‘Please Reconsider’ letters were issued to participants who did not reply. No expressed refusals were recorded during this period. However, 43 invitees, who did not respond to either the invitation letter or the reconsider letter were marked as ‘Inactive’ and


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notified. Requests were received from 2 individuals aged 66-74+ years (outside the invitation range) to take part in this initiative as elective cases. During this period, 43 men were screened and no aneurysms were diagnosed. Seaman Incident On the afternoon of Sunday 10th January 2016, the GHA was informed by the Port Authority that a semi-conscious man had been brought ashore in a launch without their knowledge or assent, bearing a note that he might have an infectious disease. The ship, on which he had been travelling, had carried out the transfer outside Gibraltar waters, had left the scene and was not taking calls. The last port of call of the ship had been Abidjan on the Ivory Coast, which is not an Ebola affected country, but which harbours other lethal viral haemorrhagic fevers like Lassa Fever and serious endemic diseases like malaria and dengue. Given the absence of any clinical information and the potentially high personal risks to staff from a serious infectious disease, the GHA deployed ambulance personnel to the scene wearing full personal protective equipment. The man was found to be seriously ill and efforts were made to stabilise him before transfer to hospital. Despite these efforts, soon after arrival to hospital, the man passed away. As a precautionary measure, all the ten personnel who were involved in managing the deceased were appropriately decontaminated and given self-monitoring health advice in accordance with their individual circumstances. All premises were decontaminated in compliance with GHA environmental protocols. Four days after the event, the Reference Laboratory in the UK returned a diagnosis of malaria. Malaria is not infectious to other persons in the absence of the mosquito vector, and in retrospect, it was a matter of relief that there had been no risk to any staff. The GHA put out a Press Release reassuring the public that there was no residual health risk to anyone from this incident, to the GHA or Port staff in particular, and to the population of Gibraltar in general. In the aftermath of the incident, multiple reviews and enquiries were conducted. Three key system failures were identified as contributing to the occurrence of the incident: 1) Breach of International Maritime Protocol by the Ship: The Port Authority was not

alerted by the ship before the ill person was transferred into Gibraltar waters and ashore.

2) Breach of Port Protocol by the Shipping Agent: The Shipping Agent decided to consult a port doctor directly without clearing the matter with the Port. This could have enabled safer berthing and examination under better conditions.

Influenza Sporadic cases of Influenza continued to occur and seven cases were admitted to hospital during the period Jan-May (H1N1). In response, the Influenza vaccination programme was extended to the end of May 2016.


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There is still a disproportionate public fear and misunderstanding about “swine flu”, combined with a paradoxical reluctance to take the vaccine. Since 2009, when swine flu first emerged as a novel virus causing human influenza, it has rapidly taken over as the main cause of human flu. It is estimated that 85% of all flu today is due to swine flu. Therefore the virus is extremely widespread and exists everywhere. This has been the case for over five years now. The matter has been made public from 2010 onwards and is included every year in the GHA press releases on influenza. In essence, swine flu is not a rare or unusual virus, but the most common flu virus circulating today. The vast majority of persons who get swine flu infection suffer an illness that is often milder than what human influenza caused before 2009. But a very small number of swine flu patients get severe disease and some have catastrophic outcomes. As yet, it is not possible to predict who will have the severe form. Hence the public health message to all vulnerable groups is to take the flu vaccination and prevent the disease. The vaccine has included swine flu protection since 2010. Influenza spreads very easily and hospitals are places with many vulnerable patients. Prevention of influenza by immunising staff is a well-known and widely accepted strategy to protect such patients. However, staff uptake has been uniformly poor in Gibraltar for many years. The Public Health department carried out an audit of staff receiving seasonal influenza vaccine during winter 2015/16 and found that uptake amongst healthcare workers involved in direct patient care was 19.5%. Despite sustained campaigns to educate staff and remind them that immunisation protects vulnerable patients, annual uptake figures in Gibraltar remain around 20%, whereas annual uptake rates in other countries are around 30% (Spain), 50% (Australia), 55% (UK), 55% (Canada) and 70% (USA). Health Improvement PUBLIC EVENTS First Quarter (January to March) • The Health Promotion Officer participated in the ‘GoFit’ initiative organised by the

Bayside School PE Department on 27th January 2016 at the Tercentenary Hall. • The Health Promotion Officer supported the World Cancer Day event at the Piazza

organised by Cancer Research UK, Gibraltar Branch on Thursday 4th February 2016 • Copies of the dental health book educational book titled ‘Tooth time’ was presented to

the head/deputy head teachers of the First schools in Gibraltar. • A variety of posters on various aspects of health were also presented to Loreto convent

for display in the school. • A number of health topics were covered on GBC Radio health file, including Obesity,

Heart health, Tinnitus, Noise induced hearing loss, Head lice, Bug busting, oral health; salt awareness

• No Smoking Day 2016 was celebrated on Wednesday 9th March, 2016 outside the

International Commercial Centre. Staff from the GHA Health Promotion team, the advanced nurse practitioner and a number of nursing students participated. An extensive display was mounted and Carbon monoxide monitoring was available for


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members of the public who smoked. The event was covered by the Chronicle and GBC TV.

• A new infomercial on antibiotic use and misuse was completed and broadcast on GBC TV

from March 2016 • Articles written by the Health Promotion Officer for the Gibraltar Chronicle included:

o National Obesity Week o Bug Busting o Love your heart o Tinnitus Awareness week o Look out for Hidden Salt o No Smoking Day o ‘World Oral Health Day

• The Department organised a workshop on Thursday, 17th March 2016 for senior

teachers and heads of schools on health issues relevant to children at the lecture theatre of the School of Health.

Second Quarter (April to June) • The Health Promotion Officers were involved in the Skin Cancer Screening Day held on

Saturday 16th April 2016. New posters and leaflets were designed as well as a patient information sheet on ‘self-skin examination’. An information stall with leaflets and posters was mounted outside the ICC on the day. The event was covered by the Chronicle and GBC TV.

• A nutritional awareness day was held at the ICC Building on Wednesday 20th April with

specific focus on food labels and nutritional contents of foods. This event was jointly organised by the Health Promotion and Diabetes Teams with support from the dieticians and students from the School of Nursing.

• Health topics covered on GBC Radio health file- included Sun safety, pollen allergy,

nutritional awareness in diabetes, asthma, men’s health, heart health, World Blood Donor day

• The Health Promotion Officers supported Notre Dame School at their Health and

Wellbeing Day on 26th April 2016. Several Healthy Eating resources were displayed and the children were encouraged to participate in an interactive discussion on healthy eating habits and general health issues such as hygiene, sun safety and the importance of being active.

• The Health Promotion Officers organised a public awareness campaign on Tuesday 3rd

May 2016 to observe World Asthma Day for the first time in Gibraltar. The Advanced Nurse Practitioner and Asthma Nurse was present to offer advice and individuals with concerns about asthma were given the opportunity to leave their contact numbers.

• The Health Promotion Officer supported the Citizens Advisory Bureau (CAB) initiative

‘Be Safe with Advice’ for senior citizens. This included a presentation on important health improvement and health protection issues for senior citizens at Albert Risso


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House and Bishop Canilla House. The Health Promotion Officers also supported the CAB public awareness event at the Piazza on 18th May 2016.

• The Health Promotion Officers met with the Gibraltar Sports and Leisure Authority to

discuss a series of health promotion sessions during the summer sport program at the stadium this year.

• The Health Promotion Officers participated in the regular meeting held with the Mental

Health Services and Social Services to discuss events for the forthcoming year and plan for Mental Health Week in May. They also attended the annual report presentation of Clubhouse on Thursday 12th May at John Mackintosh Hall and participated in the ‘Yellow Walk’ on Saturday May 14th. Furthermore, they operated a Mental Health Awareness stand at Casemates with support from the Mental health Nurse and the Practice Development Nurse.

• The Health Promotion Officers met with support groups to discuss a breastfeeding

awareness campaign at the end of June 2016. • A Heart Health campaign was organised on Friday 10th June 2016 by the Health

Promotion department in conjunction with several professionals from the GHA (Cardiac Rehabilitation team, Diabetes nurses, Blood Pressure Clinic nurses from the Primary Care Centre, Prescription Advisory Unit, Smoke Cessation Clinic and representatives from Gibraltar Sports and Leisure Authority). The event was held at Casemates Square.

• Articles written for the Press included:

o World Allergy Week 4th-10th April 2016 with focus on Pollen Allergy o I am diabetic, should I eat ‘diabetic food’? o World Health Day 7th April 2016 o Here comes the sun… o World Malaria Day 25th April 2016 o World Immunisation Week 24th-30th April 2016 o World Asthma Day 3rd May 2016 o World Mental Health Week 13th-19th May 2016 o National Smile Month 16th May-16th June 2016 o World Blood Donor Day 14th June 2016 o Men’s health week 13th-19th June 2016 o Balancing work and life o Heart Health Day 2016 o ‘An insight Life into food labels’

• The Health Promotion Officer delivered a presentation on Health Promotion to First year nursing students on May 3rd 2016.

NEW RESOURCES First Quarter (January to March) • A new leaflet titled ‘Your weight matters during pregnancy and after birth’ was designed

for the Maternity department at the request of Dr Tosson.


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• A new poster on portion sizes for infants based on the HENRY Guide to portion sizes for the under 5s was designed for the Child Health Department.

• The new poster on colon cancer was distributed to the senior citizens clubs and also

given to Michelle Turner from Gibraltar Sports and leisure Authority for display at the Victoria Stadium.

• A new poster on sun safety was designed and printed in readiness for the annual skin

cancer screening day in April. • An infomercial on Depression was completed in January 2016 and broadcast on GBC TV. • An infomercial on antibiotics and antibiotic resistance, commissioned to Piranha was

also completed and relayed in March 2016. Second Quarter (April to June) • A new leaflet titled ‘Your weight matters during pregnancy and after birth’ was printed

for the Maternity department at the request of Dr Tosson. • A new poster on Heart health was designed and printed. • An infomercial on Depression was broadcast on GBC TV during May 2016. • A revised and combined English and Spanish leaflet was designed and procured for the

Colon Cancer Screening Programme. More instructional DVDs were also ordered. ON-GOING WORK • A programme aimed to promote exercise and good nutrition for older adults is under

discussion with the Atlantic Suites health club. • An initiative to promote involvement of nursing students in health promotion events in

2016 is under discussion with the Principal. • The new Health Promotion Website is being readied for launch. • Meetings were held with several professionals from different departments to plan for

forthcoming health awareness events ( Skin Cancer Screening/Nutritional Awareness/Heart Health).

ASSISTANCE TO SUPPORT GROUPS • The Health Promotion Officer supported a public event organised by Clubhouse

Gibraltar titled ‘Let’s talk about Mental Health’ at Kings Chapel on Thursday 4th February 2016.

• The Health Promotion Officer delivered sun awareness leaflets to Cancer Relief Gibraltar

for use during the Med Step Challenge event.


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Respectfully submitted, Dr. V. Kumar Director of Public Health


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6.3 Director of Estates & Clinical Engineering

1st & 2nd Quarters January – June 2016.

1. Department 3 year Strategic Plan work-streams.

Over the last 6 months as a department we have been working as a team to develop our quality manual and all of the core procedures which underpin it. In order to drive progress we have formed a monthly Strategy and Quality group, by which we monitor and drive progress. We are currently formulating the final draft for the main quality manual and the 9 procedures that will underpin it; 6 Mandatory and 3 Operational (based on ISO9001:2008 requirements). Forming part of our quality based approach we are working to fully develop and utilise our CAFM system with a particular focus on; asset management, lifecycle planning and planned maintenance. We have also been working with IM&T to develop a reactive ticketing system based on the current technology IM&T have in place. This is the status to date for both systems: Mechanical CAFM - asset register now 70-80% complete; PPM’s 20% Electrical CAFM asset register now 80-90% complete; PPM’s 10% Clinical CAFM asset register now 100% working status; PPM’s 100% A bespoke Lifecycle plan is also currently in development which will clearly identify and track each assets lifecycle plan and prioritise its replacement based on both risk and cost .

2. External Specialist Maintenance – completed in the last six months:

Month Due Equipment Service Provider

December Anaesthesia Equipment Avance GE Healthcare

Olympus Endoscopes Drying Cabinets Olympus

Electrical Air Circuit Breakers ACB In House

January Patient Hoists Tyre Repairs Services

XR AMX 4 Plus GE Healthcare

Arco Fluorostar GE Healthcare

Autoclaves / Washers/System 1 / EPS Steris

Dialysis Body Composition Monitor Fresenius

February Philips Radiology equipment Philips Healthcare

All Dental Clinics Chairs Graham parsons

Operating Theatre Laminar Flow Weiss Klimatechnik

Fire Extinguishers / Dry Risers checks Darion / UGMS


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March Fire Alarm System in SBH G4S

Fire Alarm System in PCC G4S

Fire Alarm System in Catering Unit G4S

Fire Alarm System at CMHT G4S

Oxygen Tanks Linde

Philips Monitoring Equipment Philips Spain via Medsys Ltd

Lifts Certification Otis - David Reyes

April Drager - Various Medical equipment Drager

Hyp'Air Pulmonary Function System Vitalograph

May ManSafe equipment testing and certification PSTG ltd

Medical Gases Midland Medical

Standby Generators x 4 Vesertec SL

Mammography equipment GE HealthCare

Voluson Ultrasound 730 Pro GE HealthCare

Autoclaves / Washers/System 1 / EPS Steris

HVAC Verifications to HTM03-01 AirisQ

3. Clinical Engineering –

Feasibility for outsourcing wheelchair maintenance

CT scanner – resolved leakage between scanner room and control room – waiting for QA

reassessment of the area.

Roll out of new syringe pumps to ITU in progress ( Lifecycle Plan)

Following a review of decontamination procedures at the PCC dental chairs – we are

installing and commissioning hydrogen peroxide decontamination units for all GHA

chairs.

QA tests on medical gas system programmed for week commencing 26th June.

4. Electrical Engineering –

Pathology Lab – looking at wiring solutions to deal with the capacity issues;

PAT testing – PAT testing of our portable appliances is on-going;

Relocation of Fire Alarm computer terminal from switchboard to workshop offices –

waiting for G4S to carry out works;

Upgrades to lifts internal panels;

LED lighting stair well lobbies;

LED lighting trial for ward corridor;

Calculate essential loads for sizing of generator of the cancer centre;

Replacement of cafeteria with BS7671 compliant cooker isolators;


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5. Mechanical Engineering –

Lifecycle Replacement of hospital common extract fan boxes and controls

Installation of A/C for server and UPS/IPS rooms; Theatres, Maternity, ITU, 3 No. IM&T

server rooms.

General maintenance of HVAC systems pre-validation

Arrangements for PCC A/C maintenance outside of normal hours

Installation of mag-flow water purification units to AHU humidifiers

6. Projects –On-Going

St. Bernard’s Hospital: New Chemotherapy Suite The contractor is now finalising the final snagging issues and work on final fittings & furnishings is underway. The Specialist equipment is now being installed and commissioning of the Cytotoxic isolator is being arranged. Installation of negative air pressure system for the cytotoxic preparation area is being progressed.

New Oncology Suite Waiting Area


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Open Chemo Suite.

St. Bernard’s Hospital: Redevelopment Plan for A&E

The contractor has now commenced works on site following delays with site access and preparatory arrangements. A new concrete slab is being prepared to allow for the extension as well as a new up-stand beam to take the loading of the new curtain walling. The curtain walling will be installed week commencing 20th June. Completion is currently estimated for August/September 2016.


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7. Projects – Presently at Design / Feasibility stages

Fire Escape plant room 5, provision of secondary means of escape – currently

obtaining quotes.

Sponsored Patients – Redevelopment of unit, to improve patient access and data

protection. Currently obtaining quotes and approval to proceed.

A&E Containment Suite – Feasibility within the existing patient assessment area,

integrate into main A&E project.

Electrical Resilience- Feasibility study to install emergency generator at rooftop plant-

room level.

PCC – Main Reception Re-design to improve Security and Data protection, currently

awaiting quotes.

Respectfully submitted, Derek Alman Director of Estates and Clinical Engineering


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6.4 Director of Nursing

Child Health: This Half Year has continued with the two additional vaccines, Meningitis B which was included in the childhood programme and Meningitis CY125 which replaced the meningitis C and is administered from age 13. The team will continue with the catch up exercise over the next 18 months vaccinating years 9; 10; 13; the Hebrew school and the College students. Influenza vaccination programme: The overall uptake of vaccines at Primary Care and Community from October to December has totalled 1035. In addition the total numbers of vaccines administered from January to June is 904. The grand total is 1939. The figure is reduced from previous years despite the vaccine been offered almost a month earlier than in 2014 and flu awareness campaigns. EHR: Nursing staff are now more familiar with the working processes and templates that have been incorporated within the electronic health system. There remain some small issues regarding information retrieval and the templates are being adjusted according to the required needs as they are highlighted. Dermatology: Staff Nurse Nuria Campos continues seconded to dermatology and has completed her MSc in dermatology and is waiting for her final grading. With the additional support the workload remains high but the introduction of the cosmetic policy is enabling the discharge of patients with benign lesions giving more time for more serious lesions and chronic diseases. For this reason the current work structure and remit has been reviewed to ensure appropriate use of this specialist service for the ultimate benefit and safety of patients. The Skin Cancer screening open day was held on the 16th of April with very positive patient satisfaction outcomes and early detection of Malignant Melanomas, Squamous cell carcinomas and Basal cell carcinomas. Diabetic Service: The Nursing team has been working to update the existing annual review register incorporating EMIS into the recall system. Patients are now being called to advice of forthcoming recall before sending the letters. An audit will be carried out to see if this reduces DNA’s. A Health promotion day was held on the20th of April on Nutrition awareness Nurse Practitioners: Lynn Angove attended a Women’s Health course early May and Elizabeth Borges with the health promotion Department took part in a NO Smoking day on the 9th of March and an Asthma awareness day on May 3rd. Elizabeth also did a HRT update in January.

Primary Care Report January – June 2016


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Training: Several updates and training modules specific to Primary Care Nursing services have been commenced with the SHS. In addition, several members of staff continue undergoing independent studies in their specialist fields. On the 12th April 2016 the ear syringing day course was provided by Kirsty Armstrong lecturer practitioner in Rotherham Primary care centre. This was organised by the school of health studies. A total of 7 registered nurses from Primary care attended the day course. There were three from the District department and four from the Primary care clinics. On the 12th April S/N Romina Moreno delivered a leg ulcer presentation and workshop training to the BSN student nurses. According to the students the quality of the teaching is highly commendable. On the 13th April the immunisation day course was provided and organised by the school of health studies. A total of ten registered nurses from Primary care attended the day course. There were three from the Primary care clinics and seven from child health clinic. On the 20th April 2016 the Telephone triage day course was provided by the Charles Bloe training LTD organised by the School of health studies. A total of nine registered nurses from Primary Care attended the day course. There were three from the District department and six from Primary care clinics. The purpose for this training is that we would like to implement an appropriate telephone triage service in the Primary Health care clinics. Although still in the early stages proposals will be submitted to the nurse executive team and UGM for approval. In the Primary care clinics two pupil nurses currently training for nurse enrolment successfully passed venepuncture procedure assessed by Sister Suzanne Romero. District Department The number of patients requiring palliative care services or end of life care is increasing in demand in the last year. The district team are now discussing the possibility of either implementing an on call rota or increasing staff compliment to meet the requirements of the service. The latter will have to be further discussed with the nurse executive team, acting CNM and district team leaders. The District department team members are currently attending weekly training sessions at the palliative care clinic in regards to care, maintenance and management of a patient with a porta-a- cath. There is an increase patient demand for this type of service in the community. C/N Glen Mor is currently teaching safeguarding adults at risk at the Gibraltar University. Both the District team and some staff members from the clinics have attended this session which was found to be very informative and interesting. Cardiac rehab Cardiac rehabilitation is a complex intervention offered to patients diagnosed with heart disease, which includes components of health education, advice on cardiovascular risk reduction, physical activity and stress management. Evidence that cardiac rehabilitation


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reduces mortality, morbidity, and unplanned hospital admissions in addition to improvements in exercise capacity, quality of life and psychological well-being is increasing, and it is now recommended in international guidelines. For this same purpose both the cardiac rehab service CNS and acting CNM have identified gaps in the care and delivery and are currently analyzing a service review for the following reasons:

Develop an appropriate strategy to identify who is eligible for the cardiac rehab programme

Advertise an Internal vacancy for a secondment to be able to provide an appropriate structured service in the community

Appropriate patient care pathways for patient returning from treatment or investigations from xanit, UK hospitals or hospital discharges.

Ensure that all patients eligible for cardiac rehab are referred appropriately. Introduce a 5 year succession planning. These would involve cardiac rehab training and

development, ensuring the organization is prepared with a plan to support service continuity.

Implement Advisory clinics offering counseling and support. Enable the development of primary prevention to reduce cardiovascular incidents. Providing healthy heart education in schools.

In view of these we will be working closely to reap all the benefits and improve and continue a service delivery for this group of patients. Primary Care Nursing workload Activity January to June 2016

Jan 16 Feb 16 March April May June Child Health Dept Dr's Clinic 56 49 46 65 87 Health Visitors/Nurse Team

Weighing Clinic 691 672 500 476 481 HV Assessments 239 212 187 67 73 HV Primary Visits 35 35 27 33 31 School children assessed 60 76 4 0 0 School Health visits 56 72 0 60 565 Eneuresis Clinic 3 2 2 3 4 Immunisation Clinic 599 1331 580 794 756 Total 1,739 2,377 1,346 1,498 1,997 Cardiar Rehab. Nurse 12- 12 12 12 66 Diabetic specialist Nurse 687 698 607 720 719 Nurse Practitioner 550 695 646 797 880 Practice Nurses

Treatment Room 827 950 1054 985 849

Phlebotomy Clinic 1064 1205 1360 1371 1254


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Ear Syringing Clinic 57 60 71 102 60 ECG Clinic 152 141 137 116 135 Vaccinations 89 6 5 3 2 Nurse clinics 418 424 496 323 305 Total 2607 2786 3123 2900 2605 Cryotherapy (Dermatology Nurse) 692 562 668

728

698

MWO 98 89 102 110 115 District Nursing Team Diabetic/Insulin 161 170 171 119 140 Dressings 218 269 307 322 339 Injections 133 65 91 52 73 Visits- Support/Monitoring 117 132 162 112 128 Terminal Care 9 42 9 58 3 Catheter Care 8 4 3 3 5 INR and Blood Samples 106 96 86 76 91 Admissions 0 0 0 16 8 Influenza vaccination 2 0 0 0 0 Total 754 778 829 758 787 Grand Monthly total 7,139 7,997 7,333 7,523 7,867

Total until end of May

31,989

Ophthalmics: The Ophthalmic team continue to undergo in- house training to ensure high quality standards of patient assessments, treatment and better flow of patient’s 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 compliment has been under revision as a result of the workload and the number of patients seen and treated within the department and as a consequence there has been an additional Registered Nurse joining the Ophthalmic team who is also a trained scrub nurse with experience in Ophthalmic Surgery. Additionally there is one of the Nursing assistants presently undergoing Enrolled Nurse Training to further enhance the Nursing complement with additional qualified staff. Furthermore one of the Registered nurses within the department recently underwent further ophthalmic training with Hull University in the United Kingdom and represented the Gibraltar Health Authority at an Ophthalmic Conference in Manchester as well attending a clinical placement in the Imaging / Casualty unit at the Royal Manchester Ophthalmic Hospital. This clinical expertise is currently offered to patients locally within St Bernard’s Hospital.

Surgical Directorate


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Operating Theatres: The Gibraltar Health Authority in collaboration with Edge Hill University were able to deliver locally an acclaimed academic module to four Registered Nurses / experienced Theatre Practitioners. The modules were based on the Surgical First Assistant role as outlined by the U.K perioperative Care collaborative. The course covered 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 principle aim of the modules were for the Theatre Nursing staff to be recognised for their role / lead they currently undertake which is the equal of the NCHD role within Theatres. All four candidates passed the academic modules and have received their Surgical First Assistant (HEA 3055) part 1 qualification and are now looking towards undergoing the part 2 Enhanced Surgical skills module (HEA 3056) which allows them to become advanced practitioners in wound closure, Knot tying / suturing, direct Diathermy, wound infiltration (LA) as well as the academic aspects of the legal, ethical and professional issues associated with surgery. 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 in September 2017. Historically all Operating Department practitioners have been trained and recruited from the United Kingdom as it has not been possible to do so in Gibraltar. The training programme would consist of a three year 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. There has also been re scheduling of Theatre sessions due to the commencement of a new General Surgeon and additional Urologist. This has resulted in Management together with the Theatre Management Group exploring the possibility of building an additional Theatre suite within the existing department to allow Theatre 3 to be kept free every day solely for the utilisation of emergency CAT 1 Obstetric cases in keeping with Clinical Governance to minise risk and optimise patient safety. Day Surgery: The Day Surgery unit continues to expand its services by undertaking Cardiac procedures such as Cardio versions, Urology surgical lists as well as General Surgery and Maxillofacial General Anaesthetic lists within its own Theatre suite. The Day Surgery Unit continues to undertake on average 88 – 95% of all elective patients requiring surgical procedures of all sub specialities with even more surgical procedures now being performed under laparoscopic techniques which allows for patients to heal in the comfort of their own homes, with the assurance of a quality aftercare service provided by the Day surgery Team.


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During the period of January 2016– May 2016 a total of 1,198 patients have been admitted through Day surgery with 1,095 surgical procedures undertaken within the Day Surgery Theatres its self. (A total of 2,487 surgical procedures had been undertaken within the Day Surgery Unit during 2015) DSU Monthly Statistics 2016:- Month Total Day Surgery %

Percentage as Day Surgery Patients

JAN 260 248 95.38% 87.30%

FEB 230 210 91.30% 90.94%

MAR 231 214 92.64% 88.16%

APR 234 206 88.03% 83.18%

MAY 243 217 89.30%

84.03%

Following an initial article in the Gibraltar Chronicle two years ago covering “ A Day in the Day Surgery unit” the Chronicle Published a second article on the 16th May 2016 titled “Day Surgery on the increase in the GHA” This article provided the local community with an update on the number of surgeries performed within the last two years as well as the positive patient feedback received about our patient focused service. Out Patients Clinics / Department: With the appointment of additional surgeons including an urologist and visiting vascular surgeon we have recruited Registered Nurses who have clinical backgrounds in Urology, Tissue viability / wound care and Vascular Nursing. Our Vascular Nurse is an independent practitioner who is able to assess, evaluate and treat patients with Peripheral Artery disease as well as provide an educational link with the G.Ps to assist vascular referrals and chronic disease management.

MIU / Out Patients 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 and our own General Surgeon' 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. 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.


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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


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Victoria Ward: Ward Activity: The beginning of 2016 has seen a continued high inpatient capacity with

the ward now expectantly catering for 34 complex/long stay patients.

Training: Staff continues to access training with the majority attending mandatory

training days such as Dignity, manual handling and Infection control.

Maternity Services: Ward Activity: The beginning of 2016 has seen a higher rate of booking of Pregnancies leading the team to believe a new record delivery rate for Gibraltar. New Initiatives: Ward Managers: Nadiushka Saccone completed successfully her LSA

placement in the UK and has disseminated numerous ideas to the midwifery team. Pat

Rice is developing the audit of calls and attendance of all maternity patients to the unit.

Training: Georgina Sims and her team from Kingston attended Gibraltar in April to deliver two days training to a total of 8 midwives. Subjects covered where:

The midwife and the concept of accountability Assertiveness and advocacy Documentation and the midwives responsibilities Legal aspects of midwifery practice Administration of medicines Guideline development and review – Foetal Surveillance policy, CTG policy,

Escalation policy for the unit

New Staff: With the high level of Maternity leave predicted for 2016 (Total of 8

midwives will required replacing). Recruitment commenced early. To date 4 new staff

have joined the bank rota (Araceli Ruano; Maria Guzman; Sara Mayorga: Sara Alvarez)

and interviews booked for June to recruit the necessary backfills.

Donations: One Cub Stool…Description: comfortable upright birthing stool donated by a

grateful families. Plus; regular donations of chocolates, biscuits and cakes.

Maternity Statistics Jan-May 2016… Total Nº

Total births 173

Male 77

Female 96

Medical Interventions/Deliveries 152

Midwives Deliveries 118

Medical Directorate


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Critical Care Unit: Ward Activity: The beginning of 2016 has seen a steady inpatient capacity at a high. All

guidelines are being updated with the Non-invasive ventilation guidelines being the first

to be revalidated. This project has been undertaken by all the CCU staff, with SN Arantxa

Velez leading this task. Teaching sessions have been provided by product

Representatives with staff from A&E & JMW invited. An algorithm has been produced

and this has been disseminated to A&E.

Training: SN Michael Gil & SN Maria Jose Valera are both doing the mentorship module.

SN Zahira Robles attended the ‘With Dignity course’ held at Gibraltar University. SN

Lyzanne Victory has attended the ILS course.

New staff: CCU welcomed two new members to the team SN Diane & SN Holly Hernberg.

John Ward

Ward Activity: The beginning of 2016 has seen a steady inpatient capacity at a high.

Acting Sister Helena Kelly has developed the new student pack.

Training: Acting sisters Helena Kelly & Nicola Oliva attended - safeguarding manager’s course, ILS, dignity in care, fire training & dysphasia training. Nursing assistant Charmaine Hernandez- Safeguarding basic course. Staff Nurses Soraya Gualda, Selina Reyes and Faisa Lamrini undertook both ILS and Dysphagia training. With both Staff nurses Emily Munro + Shaira Gibson passing the Acute Medicine module. New staff: JMW welcomed two new members to the team Nursing Assistants Christian Parody + Randy Franco. Rainbow Ward: Ward Activity: Multidisciplinary collaboration has been in the forefront of Paediatric services. The sad death of an oncology Patient saw the team work with the Palliative care team, District Nurses and Macmillan nurses to offer home care at the end of her life. Outpatient waiting times and activity has shown an increase compared to this period in 2015. EPR Process mapping commenced for implementation aimed for late 2016. Staff Movement: The beginning of 2016 saw staff leave the department… Tanya Olivares travelled to Australia to further her experiences and knowledge. Rebecca Egan returned to her home town of Birmingham. Stephanie Mor commenced her Maternity leave and Patricia Hollands hung up her uniform and retired after over 30 years working for the GHA, a sad day for the Paediatric team, however we wish her well in her new period of her life. Training: PILS Training is being held in May with 4 of the team booked to attend the sessions. SR Sarah Smith completed the EPLS and is now a qualified Generic instructor. Donations to the Department: Rainbow once again has been inundated by the kind generosity of the public.


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The Guardian Angel Foundation inaugurated the new play room. Present was the Minister for Health Dr Cortes, staff and special guests the children using the services. The donation has funded the refurbishment and development of the existing playroom, including the purchase of new toys, art and craft materials, two laptop computers, a music system, a soft play area and child-friendly furnishings. A large proportion of the money donated by the Guardian Angel Foundation funded the construction and equipment of a sensory room within the original play area. The sensory room provides a relaxing space that helps to reduce agitation and anxiety; feelings often experienced by hospitalised, sick children. An interactive aroma panel activates smells, colours, sounds and breezes for aromatic, visual, audible and tactile stimulation while the bubble tube and LED projector wheel lighting is soothing and relaxing. Paediatric Statistics January – May 2016…

2016 Paed HDU ENT Dental Ortho Eye Surg Total Ward Attender

January 36 4 7 18 2 - 2 59 60 February 36 3 6 10 3 - 9 64 77 March 49 3 1 17 1 - 3 71 47 April 57 6 10 8 1 - 5 81 55 May 45 1 5 20 2 - 6 78 53

A&E Department: Department Activity: The beginning of 2016 has seen a steady patient flow through the

department, as evident in the statistics table illustrated below. Staff Nurse Raquel Gavira

returned to the department following the birth of her son.

Training: Teaching sessions have been provided by product Representatives to the A&E

team. Staff Nurses Elaine Ferro, Stacey Rothwell, Laura Netto as well as Enrolled Nurse

Amalia Peacock, Melanie El Bakali & Joanna Munoz have attended the ‘With Dignity

course’ held at Gibraltar University, the ILS course.

New staff: The beginning of 2016 saw the introduction of new staff to the department:

Staff Nurses Laya Mate & Maria Cantador. In- house training continues with the

Paediatric training sessions delivered by the Consultant Paediatrician as well as ‘cast’

appliance.

Month AE Statistics Period: 01/01/2016 to 31/03/2016 New Attendances 6528 Planned Return Attendances 305 Unplanned Return Attendances 299 Clinic Attendances (Arrived) 639 Total Attendances 7771

Injury at Work Attendances 110 Visitor Attendances 205 Attendances for Children 15> (non MOD) 1372


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Attendances for MOD 16< 21 Attendances for MOD 15> 41 Presenting Complaint - Bite Ape/Monkey Bite 3 Dog Bite 18 Insect Bite 14 Human Bite 3 Cat Bite 5 Presenting Complaint - Sting Sting Fish 1 Sting Jelly Fish 0 Presenting Complaint - Other Chest Pain / Palpitations 351 Intoxication Alcohol 5 Cardiac/Respiratory Arrest 5 Attendance Reason Overdose 19

Road Traffic Collision 31 Referral 166 Arrival Mode 190 Ambulance 1035 Non Urgent Ambulance 36 Admissions Surgical 113 Medical 302 Paediatric 64 Gynaecology 7 Orthopaedic 63 Total Admissions 549

Treatment Dress/Bandage or Splint 478 Dressing or Wound Cleaned or Wound Closure

105

Plaster of Paris 104 Outcomes Referred to Trauma Clinic 211 Phlebotomy – Blood Department Department activity: January initiated the pilot study of the appointment system. The department’s aim is to diminish attendance to the unit without an appointment. During this time the public are being informed of the new system which officially commences in June. These changes are showing to be successful and well received by service users. Training: All the team attended and completed the fire safety training.


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Patient Satisfaction Survey (DTW) snapshot for period February to April 2016. Questionnaire Score Sheet.

Period:

Feb/April 2016

Ward/Dept:

DTW

Number of sample questionnaires:

X17 snapshot

Completed by:

DDNS W Barton Facilitated by Mrs I Lavagna (DTW Clerk)

Theme Total Score Highest Possible Score

% of Max Possible 0% = Poor 100% = Excellent

1) Quality rating of Info (Dr’s)

82 85 96%

2) Quality rating of Info (Nurses)

84 85 98%

3) Understanding of info (Healthcare professionals generally)

76 85 89%

4) Courtesy & Bed side Manner

85 85 100%

5) Privacy & Dignity

84 85 98%

6) Recognition of Staff Grading

69 85 81%

7) Confidence & reassurance (Nursing)

84 85 98%

8) Attention to Buzzer

84 85 98%

9) Food

63 85 74%

10) Clean environment

75 85 88%


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Comments:

Theme

Comments

1) Quality rating of Info (Dr’s)

“Was not treated very well by a Dr in A&E”

2) Quality rating of Info (Nurses)

3) Understanding of info (Healthcare professionals generally)

“Communication between consultants and nursing staff is at times slow”

4) Courtesy & Bed side Manner

5) Privacy & Dignity

6) Recognition of Staff Grading

7) Confidence & reassurance (Nursing)

8) Attention to Buzzer

9) Food

10) Clean environment

11) Micellaneous “congratulations Dr’s, Nursing staff and cleaning staff for the level of professionalism”

“overall it has been an excellent experience”


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0%

20%

40%

60%

80%

100%

Patient Survey 96% 98% 74% 89% 98% 81% 98% 88% 96.00% 100%

Comm

Dr's

Comm

Nurses

Food

Quality

Understan

ding Info

Privacy &

Dignity

I D of

Staff

Confidenc

e & Tust

Clean

Ward

Att to

Buzzer

Courtesy

& Bedside

Manner

Issues requiring most attention:

1. Food: (74%- an improvement from 39% in last survey June 2015).

2. ID Staff: (81%- an improvement from 61% in last survey June 2015).

3. Clean Ward: (88%- an improvement from 79% in last survey June 2015).

Bed Management Report for period January 2016: 1.1 The month of January 2016 has demonstrated a continuation in high bed

occupancy for adult patients at SBH. Extra beds have been in use persistently during the month.

1.2 January continues to see high bed occupancy with the average adult occupancy at 108%.

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, JMW and VMW remains as a consequence of: A constant high number of long stay/complex cases populating acute hospital

beds (‘snapshot’ 88 beds held on 31/1/16).


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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 delays 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/KGV. A dedicated multidisciplinary team to include the social worker

1.3 Total admissions for January 2016 for SBH are as follows:

Data captured on Bed Management Database. Fig 1. Occupancy levels (adult wards & CCU calculated @ 30 & 10 beds respectively) Jan 2014- Jan 2016.

Admissions all areas

324 Admissions via A&E 242

Admissions Adult & CCU


Paediatrics

59 Admission via A&E 36

Maternity

65 Non elective 36


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85.00%

90.00%

95.00%

100.00%

105.00%

110.00%

115.00%

Average Occupancy Adults 2013 96.90% 99.46% 103% 100% 96.70% 102% 101% 102% 101% 110% 109% 111% 108%

Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov Dec-15 Jan-16

Note: 85% sealing for occupancy as per DOH 2001 recommendations. Fig 2: Average (Adult) Bed Occupancy SBH inclusive of CCU January 2011 to January 2016.

0%

20%

40%

60%

80%

100%

120%

Average Occupancy 2011-Adults 97% 94% 96% 93% 92% 89% 95% 94% 96% 95% 109% 103%


Average Occupancy 2013-Adults 96% 97% 98% 102% 100.70 99% 102% 97% 95% 90% 97% 92%

Average Occupancy 2014- Adults 102% 104% 96% 85.30%95.20% 95% 94% 97% 99.60%97.60%88.70% 91%

Average Occupancy 2015- Adults 96.90%99.46% 103% 100% 96.70% 102% 101% 102% 101% 110% 109% 111%

Average Occupancy 2016-Adults 108%

Jan Feb March April May June July Aug Sept Oct Nov Dec

Fig 3.1. Distribution of elderly long stay/dementia/complex by ward-snapshot @ 31/1/2016


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Fig 3.2 Distribution of elderly long stay/dementia/complex by cohort-snapshot @ 31/1/2016


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Fig 4. The collective breakdown of this cohort of patients is as follows. Complex Discharges

30

Elderly Long-Stay

29 Average age 85 years

Dementia Long-Stay

29 Identified from nursing assessment.

Total Beds Held 88 130 adult beds SBH – 88 = 42 acute beds available Fig 4. Total Admissions SBH January 2014- January 2016 (adult wards)

Total Admissions per ward 2014 -2016

0

20

40

60

80

100

120

140

Nu

mb

er

of

pa

tie

nts

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 89

ADMISSIONS Capt.M 1 10 1 0 0 2 1 4 0 1 3 1 4 2 3 8 3 3 2 1 1 1 5 0 0

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 66

ADMISSIONS VICTORIA 2 3 2 0 6 2 2 1 3 0 3 1 5 14 3 6 0 1 1 1 0 0 3 0 0

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 43

Ja

n-

14

Fe

b-

14

Ma

r-

14

Ap

r-

14

Ma

y-

14

Ju

n-

14

Jul-

14

Au

g-

14

Se

p-

14

Oc

t-

14

No

v-

14

De

c'1

4

Ja

n-

15

Fe

b-

15

Ma

r-

15

Ap

r-

15

Ma

y-

15

Ju

n-

15

Jul-

15

Au

g-

15

Se

p-

15

Oc

t-

15

No

v-

15

De

c-

15

Ja

n-

16

*BM programme not updated same highlighted at ward clerk/nursing level

1.4 DTW average admission rate per month (last 6 months) = 100.3 patients per month JMW average admission rate per month (October 2015) = 41.5 patients per month Fig 5. Total Cancellations elective inpatient surgery January 2014 to January 2016 due to bed shortage


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Total cancellations due to beds 2014-2015

.

-2

3

8

13

To

tal N

um

be

r o

f P

atie

nt's

Cancellation 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 0 0 4 3 0

Jan- Feb- Mar- Apr- May-Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May-Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan-

1.6 Patient flow out of VMW & CMW remains dependent on transfers to The Care Agency & successful rehabilitation candidates. 1.7 There have been 0 cancellations of elective inpatient surgery specifically due to bed unavailability in January 2016. 1.8 VMW continues to utilise its day room for rehabilitation patients. 1.9 Bed management meetings continue to incorporate Sister’s & Charge nurses in the format. This continues to be welcomed as first hand input on current & future dynamics can be discussed in a mutually supportive manner. Medical attendance is unfortunately limited. 2.0 Care Agency: Social Services Adult services team: Team Lead: Ms Debbie Guinn Senior Social Worker: Mrs Jennifer Poole Social Workers: Gretta DeFerry, Lianne Cano, Vanessa Hitchcock & Julie Scott Administration support: Mrs Christine Bottino All referrals regarding hospital discharges or any concerns to be sent to: E-mail: [email protected] Telephone number: 20060286 Bed Management Report for period April 2016:

The month of April 2016 has demonstrated a continuation in high bed occupancy for adult patients at SBH. Extra beds have been in use persistently during the month. Total admissions for April 2016 for SBH are as follows:

Admissions all areas


Admissions Adult & CCU


Paediatrics

74 Admission via A&E 43

Maternity

52 Non elective 38

mailto:[email protected]


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(Data captured from Bed Management Database).

April continues to see high bed occupancy with the average adult occupancy at

106%.

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, JMW and VMW remains as a consequence of: A constant high number of long stay/complex cases populating acute hospital

beds (‘snapshot’ 88 beds held on 31/1/16).

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 delays 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/KGV. A dedicated multidisciplinary team to include the social worker

Fig 1: Occupancy levels (adult wards & CCU calculated @ 30 & 10 beds respectively) Jan 2014- April 2016.


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85.00%

90.00%

95.00%

100.00%

105.00%

110.00%

115.00%

Average Occupancy Adults 2013 96.90% 99.46% 103% 100% 96.70% 102% 101% 102% 101% 110% 109% 111% 108% 106% 104% 106%

Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov Dec-15 Jan-16 Feb-16 Mar-16 Apr-16

Note: 85% sealing for occupancy as per DOH 2001 recommendations. Fig 2: Average (Adult) Bed Occupancy SBH inclusive of CCU January 2011 to April 2016.

0%

50%

100%

150%



Average Occupancy 2013-Adults 96% 97% 98% 102% 100.70 99% 102% 97% 95% 90% 97% 92%

Average Occupancy 2014- Adults 102% 104% 96% 85.30 95.20 95% 94% 97% 99.60 97.60 88.70 91%

Average Occupancy 2015- Adults 96.90 99.46 103% 100% 96.70 102% 101% 102% 101% 110% 109% 111%

Average Occupancy 2016-Adults 108% 106% 104% 106%

Jan Feb March April May June July Aug Sept Oct Nov Dec


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Fig 3.1: Distribution of elderly long stay/dementia/complex by ward-snapshot @ 20/04/2016

Fig 3.2: Distribution of elderly long stay/dementia/complex by cohort-snapshot @ 20/04/2016


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Fig 4: The collective breakdown of this cohort of patients is as follows.

Complex Discharges

30

Elderly Long-Stay

32 Average age 85 years

Dementia Long-Stay

33 Identified from nursing assessment.

Total Beds Held 95 130 adult beds SBH – 95 = 35 acute beds available

Fig 4.1: Total Admissions SBH January 2014- April 2016 (adult wards)

Total Admissions per ward 2014 -2016

0

20

40

60

80

100

120

140

Nu

mb

er

of

pa

tie

nts

ADMISSIONS DTW 12 10 11 10 11 95 10 10 10 11 93 91 11 12 12 10 11 12 11 12 12 99 90 84 89 99 79 86

ADMISSIONS Capt.M 1 10 1 0 0 2 1 4 0 1 3 1 4 2 3 8 3 3 2 1 1 1 5 0 0 1 0 0

ADMISSIONS JOHN 57 63 62 69 61 36 84 66 11 83 69 66 88 53 69 37 44 35 9* 30 32 45 36 40 66 38 56 53

ADMISSIONS VICTORIA 2 3 2 0 6 2 2 1 3 0 3 1 5 14 3 6 0 1 1 1 0 0 3 0 0 1 1 0

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 43 36 49 53

Ja

n-

14

Fe

b-

14

M

ar-

14

Ap

r-

14

M

ay-

14

Ju

n-

14

Ju

l-

14

Au

g-

14

Se

p-

14

O

ct-

14

No

v-

14

De

c'1

4

Ja

n-

15

Fe

b-

15

M

ar-

15

Ap

r-

15

M

ay-

15

Ju

n-

15

Ju

l-

15

Au

g-

15

Se

p-

15

O

ct-

15

No

v-

15

De

c-

15

Ja

n-

16

Fe

b-

16

M

ar-

16

Ap

r-

16

DTW average admission rate per month (last 4 months) = 88.25 patients per month JMW average admission rate per month (last 4 months) = 53.25 patients per month Fig 5: Total Cancellations elective inpatient surgery January 2015 to April 2016 due to bed shortage


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Total cancellations due to beds 2015-2016

.

-2

8

18

Tota

l N

um

ber

of

Patient's

Cancellation due to unavailability of bed 0 0 10 0 0 3 0 0 0 0 4 5 6 2 12 13

Jan-15 Feb-15 Mar-15 Apr-15 May- Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec- Jan-16 Feb-16 Mar-16 Apr-16

Patient flow out of VMW & CMW remains dependent on transfers to The Care Agency & successful rehabilitation candidates. There have been 13 cancellations of elective inpatient surgery specifically due to bed unavailability in April 2016. VMW continues to utilise its day room for rehabilitation patients. Bed management meetings continue to incorporate Sister’s & Charge nurses in the format. This continues to be welcomed as first hand input on current & future dynamics can be discussed in a mutually supportive manner. Medical attendance is unfortunately limited. Care Agency: Social Services Adult services team: Team Lead: Ms Debbie Guinn Senior Social Worker: Mrs Jennifer Poole Social Workers: Gretta DeFerry, Lianne Cano, Vanessa Hitchcock & Julie Scott Administration support: Mrs Christine Bottino All referrals regarding hospital discharges or any concerns to be sent to: E-mail: [email protected] Telephone number: 20060286

mailto:[email protected]


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6.5 Director of Human Resources

1. RECRUITMENT & SELECTION ACTIVITY Vacancies for 40 posts have been processed during the operating period covered by this report. Details of these vacancies are contained in the Part II of this report. 2. DISCIPLINARY ACTIVITY An update of the Disciplinary activity is contained in the Part III of this Report. 3. STAFF AWARDS Around 120 members of GHA staff and their guests came together on Monday 16th May 2016 at the John Mackintosh Hall to celebrate the long and loyal service of staff who have worked for the GHA for more than 25, 30 and 35 years and a range of individual and team acts of outstanding performance in 2015/16 in the 8 individual award categories. The Director of Human Resources, assisted by members of the Staff Awards Committee, presented the Staff Awards Ceremony, whilst the Minister for Health, together with the Chief Executive and representatives from the main sponsors Restsso Trading Co Ltd, The Beacon Press, MH Bland, Basewall Ltd and Mrs Margaret Ayling presented the individual awards on the night. Awards were presented to the winners in each category as follows: Qualified Nurse of the Year:

Estela Cascado Martinez (Registered General Nurse)

Nursing Assistant/Auxiliary Nurse of the Year:

Lorraine Wood (Nursing Assistant)

Doctor/Dentist of the Year:

Dr Daniel Cassaglia (Consultant Paediatrician)

Allied Health Professional/Healthcare Scientist of the Year:

Pamela Knowles (Senior Biomedical Scientist)

Support Services Employee of the Year – Frontline:

Ivana Lavagna (Ward Clerk)

Support Services Employee of the Year – Behind the Scenes:

Zarajan Lopez (Administrative Assistant)


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Ward/Department of the Year:

District Nursing Team

Employee of the Year:

Frances Catania (Clinical Nurse Manager)

The winners each received a certificate, a glass trophy, a £600 Travel voucher, a meal voucher and a hamper. Work on the program for 2016/2017 is now well under way and the Director of Human Resources is now inviting staff members from as many grades and as many sections of the GHA as possible to actively participate in the new Staff Awards Committee’s work. A good representation of different grades is being requested in order to ensure the continuity of openness and transparency of the programme. The committee will meet around 4 times in the next 6 to 8 months to evaluate the nominations sent by GHA staff, members of the public and patients and/or relatives, for the different categories of staff awards and make the actual decisions to determine the winners. The HR Department is now receiving nominations by patients, relatives and staff and the 31st July 2017 has been set as the closing date for the 2016/17 program. The 2017 Staff Awards Ceremony is scheduled to take place in late October 2017. 4. HR DEPARTMENT 4.1 Advanced Employee Investigations Interviews The Director of Human Resources recently attended a course in the UK on advanced employee investigation interviews. This course follows on from the course on employee investigations attended in the UK in November 2015. The number of internal investigations is steadily increasing and the complexity of these is also on the rise. Conducting witness interviews is often the most time consuming and complex element of evidence gathering and investigators rely solely on witness evidence to reach conclusions. We must therefore ensure that investigations focus on the facts. Presentations will now follow with the aim of disseminating the learning outcomes to others in the organisation who are involved in conducting employee investigations. 4.2 Annual Leave - Internal Audit The internal audits in order to inspect and check consistency in the recording and management of Annual Leave have now commenced. As expected, the recording of annual leave is inconsistent and irregular and workshops are now being scheduled with those responsible for the recording of annual leave in order to bring records to an acceptable standard.


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Staff will be given an update on the Guidelines on Managing Annual Leave in order to ensure that the recording of annual leave is consistent throughout the organisation and within the principles enshrined in both General Orders and Industrial Regulations.

4.3 HR IT System As outlined in the last report by the Director of IT, Mr Stuart Cornelio from the Information Systems Section of the IT Department is developing a bespoke HR system for the department. The system will pull together and consolidate the numerous spread sheets, documents, templates and other form of data repository, be it electronic or paper that we hold, and combines everything into one seamless, user friendly system, removing much of the data gathering and repetitive tasks that consume so much of our time. The system is currently at an advanced stage and training sessions are now taking place in order to familiarise HR staff with the system. It is expected that the new system will be fully functional by September 2016. Once operational the system will speed up and streamline processes in the department thus improving our overall functionality. I would like to express my gratitude to the GHA’s IT department and specifically Mr Stuart Cornelio for his contribution to this project. Respectfully submitted, Peter Linares Director of Human Resources


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6.6 UGM Hospital Services

1. Introduction

This board report covers the final 4th Quarter period of Financial Year 2015-16 from January to March 2016 and the 1st Quarter period of the Financial Year 2016-2017 from March to June 2016. The new blood appointment system was launched on the 2nd March 2016 at both St. Bernard’s Hospital and Primary Care Centre Phlebotomy Clinics following an awareness campaign. Patients who require blood tests are now provided with an advance appointment and no longer need to attend the clinics in the early hours of the morning or wait in a queue. There are still slots available for walk-in patients and this is managed by the clinic on a daily basis. In the first month of activity 1743 (1117 PCC and 626 SBH) appointments had been booked from 1st March 2016 to 2nd April 2016 A successful visit to St. George’s University Hospital and Queen Mary’s Hospital in London during April 2016 was held to review Orthotic and Prosthetic services and the NIPT Safe Test. A pilot orthotic clinic was subsequently held on the 31st May within St. Bernard’s Hospital Physiotherapy Department and an internal quality review is being conducted on the NIPT Safe Test offered by St. George’s. The GHA welcomed the news at the beginning of May 2016 that GoG have agreed the transfer of the 3rd Emergency Ambulance from GFRS to the EAS / GHA and that approval has been given for the recruitment of 7 ACA’s and the purchase of a new Emergency Ambulance. Both the recruitment process and procurement process have been initiated. The completion and commission of the external stores for refuse, clinical waste and cardboard was handed over by the contractor to the GHA in mid-April 2016. Works begun on the 25th May 2016 on the extension and expansion of the Accident and Emergency Department and will provide extra treatment beds, doctors clinics, staff workstation and a dedicated infusion room. Works also continue with the Chemotherapy Day Unit and workshops have been taking place between Xanit and GHA to discuss operational and clinical matters in preparation for the completion and opening of the new facility. The GHA has also been involved in two Major Incident Exercises during March 2016 including a MFTA Table Top Exercise (Marauding Firearms or Terrorist Attack) and an Aircrash Table Top Exercise simulating an airplane crashed at sea of the eastern side of the runway. GHA and EAS staff participated in the Gold, Silver and Bronze Command posts that included strategic and tactical application. Following many months of preparatory and development work the Radiology Information System (RIS) and PACS Upgrade went “Live” on the 13th June 2016 after a change over during the Queen’s Bank Holiday weekend. The previous RIS system is called CRIS and the PACS was upgraded to its latest version called Intellispace.


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Further developments, projects and service improvements will be considered once the Estimates submissions for 16-17 are approved and funding provided.

2. Facilities Fire Prevention GHA Senior Management continues to review and improved the general management of Fire & Emergency Evacuation. The stairway emergency evacuation chairs arrived in January 2015. A Fire Course was held on the 20th April 2016 – led by GFRS with 26 GHA Head of Departments attending. The commissioning of the Fire Safety Management Plan is due to be completed by June 2016 for final review and implementation. Health & Safety The Health & Safety Committee continue to carry out Risk Assessments across GHA sites. Reception / 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. All 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. (a) Catering Services The new Catering Unit has been operational since October 2015 and the transition from the old facility to the new one has been seamless in terms of the provision of service to patients and clients and no service user has been affected negatively by the move. The introduction of the bulk food system and catering assistants has been welcomed by all, especially the inpatients. The Catering Unit meets regularly with the contractor and Facilities Manager to monitor the progress on the structure and fabric of the building, the equipment, planned preventative maintenance schedule, response times and other operational matters. Monthly reports monitor the key performance indicators for sub-contractors and service providers and the last report now shows a steady decline in the number of emergency call outs received as systems are now stabilizing as with any new building. For example, from total call-outs received (112), target achievements indicate Amber response (109 completed). Overall, 97.32% of reactive tasks were completed in the relevant target achievement periods.


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SBHBreakfasts

SBH

Ocean

Views

Ocean

Views

breakfast

On-duty

DoctorsDialysis Prison

St

Martin`s

St

Bernade tte ’s

Cancer

relief

Sa ndwic he s

(wa rds)

Catering

staff

Day

Surgery

Kosher

Prison

Kosher

SBHFunc tions

9280 725 1740 1740 116 240 6662 431 391 160 1800 80 450 174 28 0

9280 580 1740 1740 116 240 6214 483 483 160 1800 80 450 174 105 24

9300 580 1860 1860 124 300 6220 276 276 160 1860 80 450 186 100 12

8700 580 1740 1740 116 240 5006 460 460 160 1860 80 450 174 51 20

9300 725 1860 1860 124 300 5082 460 460 160 1860 80 450 186 29 260

45860 3190 8940 8940 596 1320 29184 2110 5070 800 9180 400 2350 894 313 316

TOTAL 119,463

Jan-16

Feb-16

Mar-16

Apr-16

May-16

Building and construction defects continue to be addressed by the contractor and project director. Statistics of meals prepared for the period Jan to June 2016

Feedback Once again we continue to receive positive feedback from patients, see below.


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Environmental As per the last report the Catering Service continues to monitor its environmental impact.

Eco-friendly sandwich packs have been introduced.

Eco-friendly waste bags have been introduced at a lower price than those not Eco-friendly.

An initiative to commence with our own herb area has commenced and Jillian Helm one of our cooks has voluntarily started this great initiative.

A new tender for disposable tableware and other items has been

awarded, most items in such are environmentally friendly.

A very important consideration to the environment and to cost is the substantial savings made in terms of electrical consumption, the trend continues for the period of this report. The trend continues for the last two quarters.

Period Total Period Total Saving for new facility

Oct-14 £7,989.60 Oct-15 £5,102.88 £2,886.72

Nov-14 £7,989.60 Nov-15 £5,850.13 £2,139.47

Dec-14 £7,109.60 Dec-15 £3,875.63 £3,233.97

Jan-15 £8,435.10 Jan-16 3711.13 £4,723.97

Total £12,984.13

Old Facility New Facility

A similar exercise is to take place for gas and water consumption. Ward Catering Assistants The Catering Assistants continue to undertake all catering services duties in the wards and their role is continually reviewed and assessed in conjunction with the Nursing Staff. Training and CPD The department has undergone more training in the last year ever before and together with the department of nutrition, dietetics and infection control team there will be further training in June/July 2016. These training sessions are geared to educate catering staff at ward level on the basics of health related diets. Below are some examples of the training undergone. Hobart Induction; Bonnet Induction; ELRO Induction prior to occupation of new premises and retraining on February 2016; Thermo mix Induction; SUTTER Cleaning training with certificate; Karcher Induction; Vienne Ventilated ceiling operations and troubleshooting.


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2. (b) Domestics Services

General Improvements and initiatives introduced by the Domestic Service Management in this last quarter include:

Dementia Day Facility

The curtains for Phase 1 i.e. Ground Floor and Fourth Level, outpatient activity, have now been completed and ready for installation.

2. (c) Hospital Attendants & Messenger Services

Security Door Access System The final commissioning of the new door access system is still on going and the Facilities Management team are currently preparing all the new ID/Access cards for distribution.

2. (d) Medical Records Library

Grooming Health Record File/File Tracking Filetrail has now been implemented and commissioned for all external users i.e. 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. 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.


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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 Table 2.

2. (e) Release of Records

Statistics on the number of requests received from January 2016 to May 2016 are as follows. Average number of requests received on a monthly basis is still within 78 per month.

Month No of Requests Requests Completed Requests ActiveJan-16 85 85 0

Feb-16 78 78 0

Mar-16 66 66 0

Apr-16 76 76 0

May-16 87 87 0 The requests are divided as follows:

Jan-16 Feb-16 Mar-16 Aprl 16 May-16

10 9 5 6 8

1 3 3 3 3

6 0 5 2 4

0 2 0 0 0

0 0 0 2 0

68 64 53 61 72

0 0 0 2 0

85 78 66 76 87Total

Private Clinic

Patients

Requests

Lawyers

Insurance Companies

DSS

RGP

GHA Management

2. (f) Minor Works

A total of 413 works requisitions excluding those arising from department/ward inspections have been received this period, 1st January 2016 to 31st May 2016. Added to the above figure, since the beginning of the year, an average of 28 requisitions/defects per month have arisen as a result of investigations on


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clinical areas at SBH, a slight rise compared to the last quarter of 2015. A further 46 defects/repairs per month arising from the TMV maintenance regime has also been completed, although this figure is not realistic. We are still awaiting the renewal of the hot water supply pumps by the mechanical section as presently the system is not balanced therefore the works resulting from the TMV’s inspection only represents minor adjustment to these, and adjustment of temperature. Having said this, there is therefore a greater amount of minor adjustment to TMV’s not defects than the last quarter of 2015. Shower flex and heads together with the inspection of all ward gullies continue to be done as part of the maintenance regime. Continued monitoring of TMV’s throughout the GHA facilities and weekly inspection of areas is an on-going procedure. During this first five months, Dudley Toomey Ward, stairs in block 1, Victoria Ward, the public areas in level 1 block’s 1 to 4 have been refurbished. These works require as previously stated on other reports liaising closely with clinical staff in order to avoid disruptions to the daily outpatient’s and inpatient activity. Works to reinforce all pertinent door edgings is still on-going. The programme of works has been prioritised by the Estates Officer and is currently being completed by an external contractor. Liaison with the main contractor for the A/E extension works is also on-going. The Estates Officer has been involved in the design, of all plumbing/waste services together with the recommendations for the waterproofing of the new extension in relation to the existing podium waterproofing system, which have been taken on board. The old domestic services department in Zone 1, Level 2 has been refurbished into the new Oncology Unit. Although works have been assigned to an external contractor the Minor Works team have been involvement at both design stage and during construction, daily inspections have been on going. The Estates Officer has designed the plumbing specifications for this unit and works have been completed as planned. The team are currently involved in minor works matters such as external painting of facades, (waiting area), curtain rails, locking system and new double door so as to allow patient bed/couch access to the new unit. Dialysis, Dudley Toomey Ward, School of Health together with other common areas have been inspected and completed during this period. Again as previously stated, the non-reporting of defects and misuse of facilities continues to produce a high amount of defects within wards. Monthly checks conducted demonstrate that the maintenance regime varies considerably between areas. There are areas were a six to eight week cycle will suffice whilst only a two week cycle would maintain other wards. The increase in defects arising from shut downs affecting both the potable and brackish water supply continue, however the new system of shutdown has been effective and issues have now decreased. The Estates Officer is currently preparing an ironmongery schedule in order to address items that require urgent renewal.


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Completed works during this quarter include the following:

Works for waterproofing block 1 and 3 level 5 New escalators at the building entrance which is now operational The old records library has been refurbished to temporary accommodate

the ambulance team The Estates Officer continues to be involved in all new design schemes pertaining to both major and minor works and all matters which in any way require technical input regarding decisions affecting the building use, both structural and aesthetically, liaising with private contractors, conducting inspection/surveys to areas as instructed by the UGM to SBH, Mental Health and the PCC.

3. Ambulance Services

The latest issue of the Emergency Ambulance Service newsletter was published in April 2016.

Training

During this period staff has undergone training in different areas.

Paramedics: Four out of the five paramedics have completed their clinical reasoning in physical assessment 30 credit modules at level 6 with merits and distinctions. MTFA: The first ever course outside UK on Ambulance Intervention Team and Marauding Terrorist Firearms course was held on March with a


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specialist team from NARU. The course will enable the ambulance service to be able to attend to firearms incidents.

Health & Safety: Five line managers attended a health & Safety course Level 3. The aim is to establish a better safe working practices in the work place

Ambulance Operations

Table 1

AMBULANCE BOARD REPORT – January 2016 –May 2016

Emergency Ambulance Deployments

Month Total Average per

day

Jan 462 15

Feb 396 14

Mar 445 14

Apr 451 15

May 422 14

Total 2176


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Table 2

AMBULANCE BOARD REPORT – January 2016 – May 2016

Summary of Patient taken for Scans and or Transfers to Spain

Table 3

AMBULANCE BOARD REPORT – January 2016 – May 2016

Summary of Local Patient Transfers.

Jan Feb Mar Apr May

Algeciras 30 42 45 56 35

Benalmadena (Xanit) 44 32 29 39 27

Cadiz 2 1 0 0 1

Gibraltar 7 10 8 18 12

Jerez 2 0 2 3 4

La Linea 0 0 0 2 0

Malaga 4 2 1 6 1

Seville 0 0 0 1 0

Totals 89 87 86 125 80

Month Total Average per

day

Jan 126 6

Feb 143 7

Mar 152 7

Apr 224 11

May 167 8


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Table 4 Paramedic Administered Medication

Meds Jan-16 feb Mar April May

Amiodarone 1 0 0 0 0

Adrenaline IM 1 0 0 0 0

Adren IV/IO 3 1 0 1 0

Atropine 0 1 1 1 0

Nalaxone IM 1 0 0 0 0

Diazepam 1 1 1 1 0

Odansetron 10 6 5 10 7

Glucose IV 0 0 0 0 0

Paracetamol 7 5 6 8 6

Morphine 6 9 5 6 5

Chlorphen 0 1 1 0 0

Saline 3 2 7 3 4

Total Meds 33 26 26 30 22

total patients 19 18 14 16 15

Analgesia 9 9 6 9 8

PS red >50% 67% 75% 79% 60% 88%

Table 5

EMT Administered Medication

2016 salb atrovent

GTN aspirin glucagon Epipen

January 12 3 5 6 0 0

February 5 1 3 4 2 0

March 6 2 6 7 2 0

April 8 3 3 2 1 0

May 5 3 6 8 0 0

4. Pathology Services

Dr Tadeusz Biedrzycki, Consultant Pathologist, sadly passed away on the 24th May 2016. He was a very talented and highly experienced pathologist, highly regarded by peers and colleagues and will be missed. Dr Biedrzyki has worked with the GHA for over 15 years and was instrumental in the development of the Laboratory and Pathology Service in Gibraltar. Dr Duran, Consultant Hematologist was employed on a full time basis on the 9th May 2016. Dr Duran will now work with the Laboratory and Consultants on developing areas such as the Warfarin and Hematology Clinics, hospital bed rounds and blood bank services amongst others.


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Testosterone The Department has introduced the in-house analysis of Testosterone which is used to diagnose a range of conditions including: •Delayed or precocious (early) puberty in boys •Decreased sex drive in men and women •Erectile dysfunction in men •Infertility in men and women •Testicular tumors in men •Hypothalamus or pituitary disorders •Hirsutism and virilization in girls and women Testosterone is a steroid hormone (androgen) produced by special endocrine tissue (the Leydig cells) in the male testicles. It is also produced by the adrenal glands in both males and females and, in small amounts, by the ovaries in females. Testosterone levels are diurnal, peaking in the early morning hours (about 4:00 to 8:00 am), with the lowest levels in the evening (about 4:00 to 8:00 pm). Levels increase after exercise and decrease with age. About two-thirds of testosterone circulates in the blood bound to sex-hormone binding globulin (SHBG) and slightly less than one-third bound to albumin. A small percent (about 1-4%) circulates as free testosterone. ISO Accreditation Staff in the Department of Pathology have been working hard with issues related to ISO accreditation for some time and the 27th of May saw the first working visit of the Innocam Group for the ISO15189 accreditation of the Department of Pathology’s Donation and Transfusion services. This was the first of a series of scheduled meetings following on from the external audit undertaken by Innocam in January 2016. During this visit a work schedule for the drafting of the Quality Policy, Quality Manual, portfolio of services and works to the Pathology Stores were established. We expect the full range of works to be completed by early 2017 when the United Kingdom Accreditation Services (UKAS) will be engaged for the ISO15189 accreditation of both Donation and Transfusion services.

5. Radiology Services

In January 2016 a new Aide commenced employment. Radiology initiated neurology MDT meetings with visiting team from St Georges Hospital and the Radiology system has been upgraded in June. The new system is called CRIS and is provided by HSS UK. This system is used within the majority of radiology departments in the UK and replaces the previous PACS system. A Senior 2 vacancy has been advertised pending recruitment. Training and CPD

3 x Radiographers attended Fire Training course.

Radiographers attended the mandatory manual handling course at Gibraltar University


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A radiologist attended “The Breast Course” for a week in Prague.

A radiologist attended MSK ultrasound course for a week in San Diego USA.

Radiologist attended MRI prostate and MRI body imaging courses.

5 days The Breast Course including MRI breasts cases review Course – Prague.

1 day MSK in Sports Imaging Course Royal College of Radiologists/ St Georges Hospital UK

4 Day Clinical attachment Radiology Department St Georges Hospital UK

5 days ESGAR European Society Gastrointestinal and abdominal Radiology Conference Prague.

1 day Data protection seminar provided by GOG.

Radiologist visited St George’s to consolidate ties for tertiary level opinions on imaging done locally.

In January our radiologist organised a CXR teaching session to A&E staff.

6. Sponsored Patients Services

The Sponsored Patients Department activity continues to grow based on the demand for tertiary services. There have been no significant changes to the provision of services, staff complement or changes to operational procedures. The refurbishment and expansion of the Sponsored Patients Department has been included in the 16-17 Estimates and awaiting final budget approval. It is intended to complete this project by end of 2016.


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SUMMARY OF FIGURES FOR THE PERIOD 1ST JANUARY 2016 - JUNE 2016

Spain Referrals 2084

Spain Patients 874

UK Referrals 780

UK Patients 620

Flights 2623

Spanish Ambulance (Flying Drs) 16

Air Ambulance (Atlas Jets) 2

Holiday Dialysis 0

GHA Ambulance Request (GHA, St Johns, SSGA plus Others unconfirmed)

296

UK Taxi Requests 1074

Tourists Insurance Spain 5

Visa Applications 23

Retrospective Sponsorships 1

Translations (Link Europe) 205

Assessments Average 3-4 per day

Respectfully Submitted,

Darion Figueredo UGM – Hospital Services


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6.7 UGM Primary Services

This Directorate has shown significant improvements during this period. Highlights include the ability to release in the region of 100 advance appointments daily. Doctors report a greater turnover of patients, with the new system. On average between approximately 9 thousand patient GP attendances are recorded monthly. Instrumental in these achievements have obviously been the pcc staff and Gps who have really been extremely flexible in considering and putting into practice all changes, suggested . The PCC has always been, and always will be a challenge but this past year it has also been productive with steady steps taken to improve patient services considerably compared to previous years. There is still significant improvement to be made but we have projects and ideas which we are striving and aiming to carry out to provide the best service possible. Ahps also continue to be at the forefront of development leading on , amongst other projects: - a stroke rehabilitation pathway. - autism - improvement on the orthotic service - optometry assessment initiative carried out in Ocean Views. The latter being an example on how small things can lead to big improvements in the quality of life on individuals. The provision of glasses after assessment, highlighted that service users who were not engaging in activities generally, suddenly become more interactive. I would therefore congratulate this head of service, for this initiative on behalf of the patients. Primary care Centre REGISTRATION The Registration Department which continues to be a core administration sector of the PCC is now well into the transition to the CAMIS Programme and facing new developments satisfactorily To date, there are nearly 53,032 registered persons of which nearly 34,429are active records in our Central Demographic Database and 18,603 are expired EHIC cards. CLINICS IN GENERAL& APPOINTMENTS The General Practitioners complement currently stands at 22 GP’s with 1 of them on a part time basis. They are still divided into three groups of 6/7 Practitioners each. Together with PCC management GPs are working towards developing their own policies with regards to the following:-


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Improved patient access to doctors and nurses Better communication with hospital and other services Standardisation of treatments Improved repeat prescription system Quality, Improvement and Increase of Appointments

It is envisaged that this will improve access to a GP or Nurse of choice. It is expected that structured standardisation of practice will lead to more efficient and more effective management of long term diseases like diabetes, Heart Diseases, asthma etc. As we informed you in our previous Board Report and following our move to the EPR Programme, changes were required to be made to include a ‘catch-up slot’ for all clinicians clinic sessions. This consisted of a pattern of 2 patients + 1 ‘catch up slot’ commencing in June 2015 and continuing up to 2016. This has been changed to a pattern of 3 patients + 1 ‘Patient Admin Slot’ with this slot being used as both catch-up or to call patients with their results, advice etc. It also allows the GP flexibility in being able to spend a bit more time on cases which require it. We have also changed some of the emergency overflow appointments to Advance Slots which has increased availability significantly. Most patients that cannot obtain a doctors appointment is more often than they cannot see a chosen one, rather than they not being able to see a doctor at all. We introduced a ‘Critical Illness Appointment System’ whereby a slot was added to each GP clinic at the end of each session. This is used on rotation on par with the Daily House Call Roster. It benefits those patients who are deemed to be critically ill and are seen promptly by a GP on site at that particular time. The Introduction of the WALK IN CLINICS (WIC’s) has proved to be very satisfactory and successful initiative. This consists of a full clinic made available for one doctor per area on a daily basis which is automatically released daily at 8.15am. This greatly facilitates patients who have been unable to book with their GP of choice. We provide this information in advance for our users to be aware of when their GP has a walk in clinic. We accept however that we should improve the availability of information as to what GPs are available in what days, so that a patient can exercise their choice. We have also increased the Dermatology Clinics undertaken by our on-site GP specialising in Dermatology. These sessions previously consisted of 4 monthly sessions and has been changed this year to 7 sessions per month. In this increase of sessions we have added the following:-

Dermoscopy Minor ops Review pre-Derm Patients New ‘Chronic Disease’ Any New skin ailment


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Regardless of all these improvements, further moves to improve the Primary Care Centre are continually evolving. Although there has been a marked improvement in access as a result of all these measures, we are still not completely satisfied and feel there is still more room to improve our services. For example, although there are still some appointments left at the end of the day which suggest we are meeting the demand satisfactorily, the complaints that come in suggest patients are still struggling to obtain appointments with their GP of choice and this is attributed to the uneven distribution of patients seeking specific GP’s. In view of this we are currently discussing and looking into the possibility of Patient Registration and Allocation to specific GP’s in order to allow for appropriate patient distribution. This plan consists of changing from the present system of having patients registered to a particular area to having them registered with a particular GP instead. Advanced appointment system Although it is true that we encountered our teething problems at the onset of our new 48-hour Advanced Appointments System, we now find that all efforts were sustained. This new system together with some minor adjustments following brainstorming sessions and continuous deliberations of the dedicated Team under the leading guidance of our UGM, resulted in a most significant increase in availability of consultation slots for all of our users. On average we are pleased to say that we are releasing a staggering 100+ Advance Appointments daily for our patients and this gives us all immense satisfaction. Not all advance appointments are being booked every day, allowing us the ability to reaffirm that though there are problems getting an appointment with a chosen doctor, we can usually offer another in his stead. ADMIN MATTERS A new EO was recruited and started working at the PCC on 2nd May 2016. The post is Records Administrator and has taken on the role of Line Manager to all of the admin staff with the responsibility amongst others, of co-ordinating, supervising and training the staff together with arranging their Allocation Rotas etc. This has allowed the PCC Administrator/ Practice Manager time to concentrate on the GP side including the GP Rotas and Allocations that due to recent significant increases in the number of GP’s required more time. New clerks are trained as soon as they start working in Records as the system is used by all of the clerks on a daily basis. Eight clerks also recently undertook a course on Safeguarding at St Bernard’s Hospital.


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CAMIS All Records clerks have been trained in CAMIS to be able to create visitor files. This avoids delays when booking patient’s appointments that require these files, especially during weekends and Public Holidays when only one clerk is at the PCC. This training will now be given to clerks as part of their induction when commencing work at Records. STAFF MEETINGS Continuity of Meetings held by the Records Administrator and Records Staff remain with one held every week. This is beneficial to all involved. It gives the staff an opportunity to discuss with the Administrator any problems that may have been encountered, and possible solutions that if need be can later be taken to senior management. It also gives the Administrator time to pass on any information or instructions for the Section and sort out staff allocations and weekend cover. BOARDS IN WAITING AREA Two white boards were put up in the waiting area and another at the Main Counter. The first board has the following information: Doctors with Walk In Clinic for that day Doctor on first emergency Doctors on site Doctors not available The second board is used for the 48hr Advance Appointment System and displays the list of doctors available for booking that day. The Third Board shows details of all The Walk In Clinics to make users aware of when their particular GP is available. The boards are updated daily, so that the information is available to the public when the PCC opens in morning. This helps the counter staff to deal with the Public quicker as they do not have to deal with so many queries regarding which doctors are available. DATA PROTECTION The PCC Data Protection Policy Document has been introduced which covers all aspects of patient confidentiality, including manual and electronic records. All staff have read and signed a copy of this document. This is now given to staff as part of their induction when they commence working at the PCC. Seven members of our staff recently attended a Data Protection Seminar held at Bleak House.


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ACHIEVEMENTS All the staff are now aware of the importance of the Data Protection Act and it is being adhered to by all the PCC staff. The new staff have all shown very good results , especially in the area of customer care where they have been able to cope very well, diffusing difficult situations and always being polite and helpful. CONCLUSIONS We are always working very hard to improve our service to the public, continuously making any changes that we feel would help towards this. There are some projects that are starting to get underway that once in place will also help towards our aim of improving our services. Optometry Department Incoming Referrals originating from outside the Ophthalmic Unit 119 outside referrals received, again 13 more than the previous quarter. Referral Category Jan Feb Mar Total Child refraction 0 8 0 8 Adult refraction 1 8 6 15 Adult out patient 0 2 3 5 Diabetic Retinopathy Screening 27 28 15 70 Glaucoma Screening 2 5 12 19 Low vision 0 0 0 0 Medical Contact lenses 0 2 0 2 Total 30 53 36 119 Caseload Clinic Total this Qtr DNAs %DNA Child Refraction 34 1 3 Adult Refraction 134 39 29 Joint Child Clinic with Orthoptist 19 9 47 Adult out patient 28 16 57 Post op Refractions 41 3 7 Diabetic Retinopathy Screening 257 105 41 Diabetic Retinopathy Management 20 2 10 Glaucoma Screening 81 5 6 Glaucoma/OHT Management 52 4 8 Low Vision Refraction 31 0 0 Low Vision Aid assessment 13 3 23 Clinically required Contact lens appts 37 9 24 Spectacle Rechecks 2 0 0 Total 749 196 26 DNA rate for DR Screening was 41% and for the rest of the clinics 18%


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New Developments The eye care services provided to mental health has typically been outpatient appointments in our hospital clinics as per all patients. We have in the past tried to accommodate patients in bulk by designating one day exclusively for patients from Ocean Views, with all eye care staff involved in the examinations, including consultants, in order to provide a one stop shop and eliminate the need for further visits. A repeat of this has been years overdue. Based on this experience in which we found that most patients required Optometric examination, and found being in our waiting area quite stressful, we thought it best to bring our services to patients this time round by providing on-site domiciliary testing. This would avoid patient transfers to our Unit, reduce stress involved for patients and therefore improve patient cooperation for examination, release consultant and nursing time as well as clinics. The initiative involved transferring sight testing equipment to Ocean Views and setting up 2 clinics conducted by 2 Hospital Optometrists, to see 33 patients over the course of 3 consecutive days in March. The table below shows the success and value of such an initiative, with 76% of patients requiring spectacles, 16% of which has vision poorer than driving standard. Only 4 out of the 33 patients seen required referral to our consultant ophthalmologists. We hope to be able to continue to provide such a service in future. Ocean Views Domiciliary Examination Initiative Audit Total %

Total no of Patients seen 33 -

Able to carry out subjective testing 23 70

Unable to be tested subjectively 9 27

unable to be tested - no cooperation 2 6

Current spectacle wearers 9 27

No prescribed spectacles 25 76

No requiring spectacles who were not previous wearers 17 52

No significant change in prescription in existing spectacle wearers 1 3

No with significant change in prescription unable to communicate any change/deterioration in sight

18 55

No diabetics requiring DR Screening 7 21

No with non-sight threatening DR 2 29

No with sight threatening DR 0 0

No with existing vision worse than driving standard (out of the 20 we were able to get an actual vision level)

16 80

No improving to driving standard or better with Rx change/New spec correction

8 50

1 line improvement in Visual Acuity 2 10






Referred to Consultant Ophthalmologists 4 12

…for Cataracts 2 6


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…for Glaucoma 2 6

Low vision Services This quarter there has been 3 new CVI registrations as Sight Impaired. One due to age related macula degeneration (AMD) and another due to AMD and Glaucoma, and another with degenerative myopia. Cause of Visual Impairment Jan- Mar 2016

Glaucoma 1

Age Related Macula Degeneration 2

Degenerative Myopia 1

Total 3*

*onePx with ARMD and Glaucoma hence total 3 instead of 4 2015 Low Vision Statistics Jan- Mar

2016 Low vision aids items loaned 38

patients loaned LVAs 21

LVAs returned 2

Unserviceable LVAs 0

Referral to ROVI 12

Px declined ROVI referrals 3

CVI Registration 3

Px declined CVI registrations 2

Patient Appliance Policy – Optical During this quarter there has been one early application for assistance with the cost of spectacles, on account of cataracts in order to delay surgical intervention. There was also a replacement of one lens for due to intolerance to a balance lens, in a patient with large difference in prescription between eyes i.e. anisometropia. GHA funding of spectacles due to exceptional circumstances

Department of Nutrition & Dietetics Staffing We have recruited a senior dietician into the vacant Maternity post. She started on 25th January and will be with us till mid-August. She has a varied dietetic experience and has

Cause :- Jan – Mar 2016 Prescriber error - Intolerance 1 Surgical Intervention - Ocular Disease 1 Loss due to disability – Child - Loss due to disability – Adult -


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been an asset to our department. She has taken on adult and paediatric clinics and has an interest in Diabetes. Education/Training As part of her continuous CPD our senior Gastroenterology specialist dietician attended a self-funded study day in January: British Society for Allergy & Clinical Immunology Adult Allergy workshop. Three dieticians attended GHA Mandatory Training in January 2016. All dieticians are currently up to date on mandatory training. Speech & Language Therapy Staffing Funding for an adult locum was kindly provided for two months in January and February 2016. This allowed a dysphagia service to be given across all of the Elderly Care premises. In addition, dysphagia training sessions were carried out for nursing staff and carers in Mount Alvernia. Once an ECA Speech & Language therapist is in post, it is envisaged that dysphagia training will be extended into a rolling programme across all ECA sites. Locum cover for the ECA also served to release 18 hours back into Paediatric Special Needs thus converting the latter into 1 WTE. Locum Maternity cover for the Paediatric service ended in February 2016 when the therapist in post returned to full-time duties.


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The DEPARTMENT IS SET TO EXPAND FURTHER VIA THE RECRUITING OF 2 FURTHER THERAPISTS THESE WILL COVER THE dementia centre and the other though strictly speaking not a GHA POST, WILL PROVIDE COVER FOR THE ELDERLY RESIDENTIAL SERVICES Training

The programme of presentations to First Schools ended with the last school

receiving their presentation on 29th February. All schools now have updated

referral information and will be able to explain the process of referral to parents.

A 3rd NAS Early Bird Training workshop for parents run weekly throughout this

trimester. This is run co-jointly with Occupational Therapy and three families

enrolled and benefitted from learning valuable strategies towards coping with

autism.

In January 2016 Clinical Lead Mainstream therapist started recruitment for

phase 2 of a PhD research project. She then went on to give a poster

presentation on the results of the pilot study at an AHP conference in Sheffield in

March 2016.

The Clinical Lead in Paediatric Special Needs gave a presentation to staff at St

Martin’s Special School on Intensive Interaction, an evidence-based approach

towards optimising communication in children with autism and other profound

and multiple learning difficulties.

On-going Initiatives.

In 2015, the Paediatric service has had an unusually high number of referrals

which meant starting the year with a particularly long waiting list. Children had

to wait around 4 months for therapy programmes. As a response to this lag, the

paediatric service embarked on a focused waiting list initiative and has

successfully managed to reduce the waiting list back down to a target 2-month

wait.

Work on the GHA Autism pathway is on-going with regular meetings scheduled

throughout this period. On 18th March the pathway was presented to an inter-

agency forum at the Department of Equality. This will now contribute towards a

wider Autism Strategy for Gibraltar.

Occupational Therapy

1. 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 continued into February and the

service remained working hard on the waiting list.


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Number of referrals received in Jan 2016 = 19

Bathing related referrals: 4

Total waiting = 17 (reduced) Number of referrals received in Feb 2016 = 29


Total waiting= 15 (reduced) Number of referrals received in March 2016 = 38


At end of March 2016: Total waiting = 27(increased)Approx.15 weeks wait but now increasing.

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.

2. ROVI SERVICE:

ROVI provides assessment, advice, and emotional support, training in mobility, communication, and daily living. Provide equipment, advice on adaptations to the environment both indoors and outdoors. Support family and carers with understanding the patient’s condition and techniques to assist people with a visual impairment. In addition to this the ROVI can provide Visual Impairment awareness sessions to organisations, and environmental audits. Currently 11 Referred Clients waiting to be seen. ROVI referrals received: Total for 2014 50 Total for 2015 52 Jan - March 2016 22

3. MENTAL HEALTH SERVICE:

Attendance to OT Groups, 1:1 and Community sessions remains high and residents enjoy the variety of therapeutic activities offered. Patients from Horizon, Dawn and Sunshine Ward attend the ARC every week.

Urgent 5 Mediums 8 Routine referrals 6




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Numbers of patient contacts / attendance to groups from the Ocean Views wards:

4. PAEDIATRIC SERVICE:

The Early Bird Course for Parents of children with Autism was again well received and will run again in the autumn. OT referrals for children both pre and post a diagnosis of Autism (0-18yrs) are increasing. They have also received a higher number of referrals from mainstream schools and learning support facilities; this combination has placed additional demands on the services offered Number of Children open to the team = 234

Approx. 79 children with ASD

Approx. 63 children have not as yet been given a formal diagnosis.

Number of Children currently waiting to be seen = 24

Approx.19 children have not as yet to be given a formal diagnosis.

OT Advice / Assistance for Outside Projects continue to be requested which is additional to the clinical caseload. Currently working to complete Mons Calpe Mews / working with Gib-Elec with plans for their refurbishment of the customer services area / Highways – improving access routes around Gibraltar and the Waterport Day Centre Bus. Dementia day care centre The second draft of the Dementia strategy has been finished and re-circulated for general consultation. This Draft has included points raised in the previous draft . The point did not alter the strategy but consisted mainly of clarifying points and rectifying omissions. Respectfully submitted, Adam Wink UGM Primary Care Services

Wards Community Jan 440 111 Feb 373 101 March 323 84


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6.8 UGM – Mental Health Services

Introduction The following board report represents the first 5.5 months (Jan – June) of 2016; many changes have been implemented and further are expected as we settle in our new environment one year on.

This report concentrates on the developments of departments as part of the mental health services growth in general. Although patient’s mental health is our primary aim, central to this wellbeing is an understanding of patients physical health and the link physical and mental health have on one another. With this in mind the MDT made a conscious decision to concentrate and focus on our patient’s wellbeing and physical needs in conjunction to their mental health with the aim of recovery at the beginning of 2016. This has meant developing further links with other care services (PCC and SBH) in order to facilitate further the philosophy of patient recovery. What has this meant for the service and more importantly the patients and families who use the service, is a concerted emphasis on organising patient appointments with chiropody, eye department and dental services. This board report concentrates on this and provides not only the usual data around admissions, risk and general day to day activities but more importantly focuses on the physical care needs of our patients, including dignity in death.

The 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.

0

50

100

150

200

250

Dr Segovia Dr Lillywhite Dr Diaz Dr Ruiz Dr Marin Patientsseen inClinics

CommunityVisits

Jan-16 44 61 20 65 11 228 95

Feb-16 66 68 27 78 21 167 85

Mar-16 48 78 23 48 9 190 90

Apr-16 42 50 25 68 29 231 142

May-16 62 78 23 55 23 211 139

Axi

s Ti

tle

CMHT - Patient Contact/ Staff Activity table


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Psychology therapy offered with the mental health services. The tables (1+2) below provide an overview of the number of referrals received per month and the source of referrals to the psychology and counselling services.

As in previous months Table 2 (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/counselling intervention provided, some patients will continue to need admission to Ocean views for periods of time. The mental health teams have continued to provide an ever improving service to those who need it, when they need it and how they need it. In order to continue in the development of the service and in response to patient need we have during this period of time focused on not only the mental wellbeing but also on the physical needs of patients. The charts below capture a number of demographic details, such as; admissions, diagnosis, 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.

Table one Month Number of

referrals received

January 53 February 70 March 77 April 58 May 81

Table two Source of referrals Number of referrals

received Primary Care 247 Community Mental Health Team 24 Secondary Care 42 Paediatrics 14 Other 12


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In-patient quarterly data – Horizon / Sky

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

Section appeals / outcomes Jan – June 2016 Month Number of appeals

/ Section Gender Outcome

Jan 2016 0 NA NA Feb 2016 1- Sec 6 Male Mar 2016 2 – Sec 5 Femal e 1 – patient withdrew

appeal before hearing 1 – section upheld by tribunal

1 – Sec 6 Male Tribunal recinded section.

April 1- Sec6 Male Upheld.

May 0

June 1 – sec 5 Female Awaiting date


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X1 patient meeting

Ladies pamper groups

Relaxation groups

Rehabilitation in-patient services - Dawn Ward Data As previously described the rehabilitation services (Dawn ward) provides an environment of both double and single rooms, enabling patients to both independence and social interaction. Following a period of settling down into our new environment patients, families and the multi-disciplinary team are now seeing the benefits from the new environment. Recovery and reduction in stigma has been noted, patients physical wellbeing high on the agenda for all concerned. Ward based activities and community outings have also been part of this recovery and stigma reduction, with a number of patients attending the ‘walk on mental health day’ in May. 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 falls, aggression or self-neglect). 13 male and 6 female

Elderly care services - Sunshine ward As described above, this report and the data within it represents not only the demographic details of patients but also the focus for this period of physical health needs for patients. The data below provides information risks identified as well as contacts patients may have at any time services to mental health. As mentioned at the beginning of this report, dignity in dying is also high on the agenda for the MDT here and across the GHA, with this in mind the team set about to explore


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how we could ensure patient dignity and respect when patients come to end of life care. Therefore, a number of discussions have taken place in order to address this With the current patient acuity on Sunshine ward the level of dependency and risk over the 6 month period presented in this report has not changed. As a result patients contact with other services across the GHA is monitored and recorded (as per charts below).

Specialist clinics held and Elder care patients seen by colleagues within ocean views.

Jan 2016 Clinic Professional Number of patients seen General Practitioner Dr Haider/ DR Marin 26 Podiatry John miles 14 Physiotherapist Jan Wink 6 Occupational Therapy On-going treatment 124 Catheter Clinic District Nurses 2

Specialist clinics held and Elderly care patients seen by colleagues within ocean views.

Feb 2016 Clinic Professional Number of patients seen General Practitioner Dr Haider/ DR Marin 26 Physiotherapist Jan Wink 6 Occupational Therapy On-going treatment 118 Catheter Clinic District Nurses 2 Palliative Care team SN Fawden 6


Mar 2016 Clinic Professional Number of patients seen General Practitioner Dr Haider/ DR Marin 34 Podiatry John miles 14 Palliative Care team

Dr Robles / SN Fawden District nurses

6 2

Physiotherapist Jan Wink 6 Occupational Therapy On-going treatment 120 Catheter Clinic District Nurses 1 Eye Clinic Isabella Crisp/ Zoe

Stagnetto 14


April 2016 Clinic Professional Number of patients seen General Practitioner Dr Haider/ DR Marin 28 Palliative Care team Dr Robles / SN Fawden 8


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District nurses Physiotherapist Jan Wink 3 Occupational Therapy On-going treatment 120


May 2016 Clinic Professional Number of patients seen General Practitioner Dr Haider/ DR Marin 28 Palliative Care team


2

Physiotherapist Jan Wink 3 Occupational Therapy On-going treatment 120


June 2016 Clinic Professional Number of patients seen General Practitioner Dr Haider/ DR Marin 28 Palliative Care team


2

Physiotherapist Jan Wink 3 Occupational Therapy On-going treatment 120 Monthly sessional attendance by patients to the ARC. The enclosed statistics 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 18 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. Community patient contacts have remained high in Jan/ Feb/Mar, reducing slightly in April and May. 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 Jan Feb Mar April May June (2

weeks) Horizon 20 18 11 11 14 13 Dawn 273 220 138 191 187 62 Sunshine 36 34 21 24 21 10 Community 111 101 76 64 21 30


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EDUCATIONAL DEVELOPMENTS

Training- As discussed in previous reports mental health has continued to

maintain staff CPD through training and development opportunities. This has

included a number of mandatory sessions, which have been delivered by staff in-

house.

DCRT, safeguarding children and dignity training has been continued throughout

the period (Jan- June). All of these have been attended by a cross section of the

multi-disciplinary team, again enhancing skills and experience of those working

in the unit.

Conference attendance –Following the attendance last year of a cross section of

staff at a conference held on management of violence, a number of initiatives

have already been implemented, from policy documentation to day to day

activities for patients as well as service delivery and training.

Supporting the newly qualified enrolled nurses and staff nurses in their post,

through some aspects of preceptorship – this will be particularly useful to the

recent newly appointed enrolled nurses, who had many years’ experience and

skills within their nursing assistant role, but now undertake much more. .

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 had been approached by a number of students from overseas, requesting

short term placements (4 weeks) in mental health services in Gibraltar, this has

now been organised and we have 3 such placements organised, starting in June.

CLINICAL DEVELOPMENTS

Electronic Patient Records – This is an on-going service delopemnt within

mental health. We have a number of key staff working as part of a small working

group in order to review and advised the larger team of service needs

requirements.

Rockside flats – Both flats are now in use for the 6 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.

Review and development of policies, at present we are currently looking and

reviewing the ‘falls policy’ in conjunction with the GHA as a whole.


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Plans for the next 3 months As hoped, the first part of 2016 has seen a number of positive changes to the service. We have developed more ward based activities and community outings, appointment of a richer skill mix has not only enriched what is already a very positive service of care to are most vulnerable group within Gibraltar, but brings with it a number of ideas on further service development. These are just a few:

Continuing to support 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

with of EPR, reviewing and implementation improved documentation. A

number of staff will 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; these have been identified and will be

reviewed over the coming months.

Organisation of ‘work experience’ placements following interest from staff who

would like to work within a mental health setting.

Development of ‘snoozelam ‘room. This will be a mobile unit in order that all

patients can access and benefit from the service.

Respectfully submitted, Chris Chipolina UGM Mental Health Services


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6.9 Director of Information Management and Technology

Information Technology During the first two quarters of 2016 the increase in the number of calls to the IT Helpdesk has remained. This continues to be 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 completed. The revised Wi-Fi Policy was approved by the GHA Board on 10th February 2016. The planned pilot of the sponsored Wi-Fi access model commenced on 1st March in the children’s ward and two weeks later for the School of Health Studies area. This initial pilot uncovered a number of technical issues which the IT team worked tirelessly to resolve. I can now say that through, their diligent hard work, those technical issues have now been resolved and that the Wi-Fi access in both areas is now working well. It is now intended to continue rolling out into General Wards throughout the month of July 2016. The PCC appointments line has been reconfigured so that callers are now told their position in the queue of 60 callers. This allows patients to make an informed decision as to whether they should stay on hold or hang up and try again later when the queue is not quite as long. The planned upgrade of the Radiology Information System (RIS) took place in mid-June. As in the latter half of 2015 this required the IT department to work closely with the Radiology department to ensure that all preparatory work and pre-configurations were undertaken well in advance of the upgrade date. The upgrade took place over a weekend, to minimise disruption to clinical activity, and the main system upgrade was completed before the Monday morning. Unfortunately, a supplier issue with the physician requesting portal resulted in a delay on the availability of the portal until the Tuesday afternoon but full functionality has been available as of that day. Activation of the new door access system is now expected during the summer. The technical infrastructure has been completed for some time and the changeover is awaiting the contractor and GHA administrative staff to complete the administrative element of the project and then schedule in the works to switch systems. The department has been closely involved in the introduction of the new Chemotherapy Suite. All IT infrastructural requirements were completed in 2015. The procurement process for all necessary IT equipment has started and orders have been placed for arrival in the first week of July.


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The programmed replacement of the aging hospital CCTV system with a modern IP network based system is on-going and expected to be completed in July. All server and storage hardware has also now been consolidated into one server cabinet in one location. 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 has been completed. All GHA workstations now have full security patches installed as and when released by Microsoft. This significantly reduces the risk of these systems being compromised by malware or other security breaches. Incompatibility of legacy clinical software applications with Windows 7, and the need for the suppliers of these systems to update and test, had 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 almost complete. The remaining server is awaiting an upgrade to the latest version of the Sidexis software used for dental x-ray imaging before migration can be finalised. The GHAs e-mail system has, as reliance on e-mail communication (both within the organisation and with external partners and organisations) has grown over recent years, been steadily approaching its maximum capabilities for both storage and resources. There is now an immediate need to replace this system before catastrophic failure occurs. The necessary hardware has been ordered and the installation/configuration of this new e-mail system is expected to commence in the next quarter. The current GHA telephone system is this year reaching what is called ‘End of Life’. This essentially means that by the end of the year it will no longer be supported by the manufacturer and any failure could result in considerable down time of the entire GHA telephone systems. A replacement system has been identified and the placement of the order is awaiting funding allocation in July. If funding is made available then the order will be placed and it is expected that installation will be complete well before the end of the year when support is no longer available for our current system. A large number of the GHA servers currently operating are in urgent need of replacement due to the lack of availability of security patches and manufacturer support. This is planned for in the current financial year and is awaiting funding allocation in July before the project can go ahead. The new GHA Intranet site has been completed and was launched on 29th February 2016. A great deal of work was undertaken by the IT team on this complete overhaul and redesign of which the benefits can clearly be seen by any who access it. It now has the look and feel of the GHA external website with increased features and functionality over the previous incarnation. A substantial benefit to the new Intranet is the ability to allow individual GHA departments to add and manage the content


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pertaining to their area themselves. This ensures that information can be kept as up to date as possible and is in the full control of the area it pertains to. Phase 2 of the GHA website is almost complete. As stated in the previous board report, 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 on a technical level. 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 being planned. A request for funding was submitted in the 2016/17 estimates submission to be able to undertake this essential project. Final funding allocation is being awaited in July before any further progress can be made. The Dementia Day Care Facility is now at the stage were network infrastructure can be configured, installed and commissioned. This is now underway and is currently being finalised so that online systems within the building can be commissioned and brought online. 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, as shown in the last report, 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.


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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.


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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 current 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 this project. The planned pilot phase was carried out in February 2016. The pilot went very well with a small number of suggestions and requests for minor modifications made by the stores staff. These were implemented shortly afterwards. Statistics for the usage of pantry items are now available to management and a specific report was requested by procurement staff in order to assist with planning for the pantry budget. This has been implemented. Human Resources System Considerable work has gone into developing this system. As it stands now the team has developed a working employee database which will allow HR users to add new employees, manage manning levels, and reflect when employees join or leave the GHA, as well as when they receive promotions, transfers, etc. The system also allows a variety of HR documents to be automatically generated, such as offers of appointment, resignation and retirement letters, etc. A demonstration of the system to the HR teams received very positive feedback, with the teams stating that the document generation in particular will lead to a clear time-saving. Statistics and reports should also be much easier to generate with this system. A final demonstration to the Director of HR and his senior personnel is being planned. If feedback is again positive then an implementation plan will be devised for launching the system across the HR Directorate. It should be noted that existing employee details and manning levels information will be imported into the system by the IS team from the


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existing spread sheets just prior to launch. This will remove the necessity for HR staff to input the initial data and will ensure all data is current as of that day. Once launched the IS team will work subsequent modules and bring them online as and when they are complete. Some of these additional modules would be a Special Leave module, a Contracts database and a Locum database with many more as and when required. 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 3rd 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 ) – The pathology department has asked that we look at implementing this as an interim solution whilst a solution form the EPR programme is being developed. Discussions are on-going regarding the feasibility of this. 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. Enhancements to Screening application – 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. Vast improvements have been made to speed up the application which had been gradually getting slower. 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.


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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. Replacement of Technical Services Systems – A solution to replace the existing CAFM facilities management software and the Building Management System is currently being designed. This solution will tie into other IT service offerings, such as the ticketing system, aiming to reduce and streamline current workflow and increase functionality of currently used products. Staff Recertification Database – A module to record and maintain re-certification and qualifications of GHA staff was requested. This was completed in the 1st Quarter of 2016. Computerisation of the GHA Estimates Process – A solution is currently being discussed with the Finance Directorate to computerise the estimates submission process. This is currently a very laborious process involving multiple documents and the manual transference of figures from document to another. Computerisation of this process in a closed system would much improve the working practices for financial staff as well as those members of staff across the organisation that are involved in producing estimate submissions. Respectfully Submitted, Heath Watson Director of Information Management & Technology


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6.10 School of Health Studies

1st quarter January 2016 to March 2016 The Enrolled Nurse training programme is now into its first six months of the eighteen month programme with pupils progressing well. Two students have ‘stepped’ off the programme due to personal issues, with a view to returning at a later date. The QCF Level 2 training programme continues to run successfully in response to local need and to assist staff in developing their knowledge and skills. The SHS is preparing for a review of its BSc (Hons) provision. This is as a result of the introduction of a new nursing curriculum by Kingston University London and St George’s University of London, the review takes places June 2016. BSc (Hons) programme students (September 2015) are progressing as predicted, clinically and academically as they complete the first semester of the programme. One student has failed one element of her academic work and is being given an opportunity to retrieve this. The September 2014 cohort are embarking on the second semester of their second year, these senior students are developing clinical and academic skills supported by practitioners and academic staff. One student has failed one element of her academic work and is being given an opportunity to retrieve this. A variety of modules as part of the Continuing Personal and Professional Development (CPPD) portfolio (multidisciplinary) continues to be provided reflecting the needs of people cared for and addressing GHA strategic aspirations, assisting our healthcare professionals to develop their skills and knowledge, learning about new developments that can benefit patients. The Surgical First Assistance programme has now completed with 4 staff submitting their work for assessment. The SHS is responding to procuring a range of programmes/modules identified by senior GHA wide staff. The two year part time MSc Leadership and Healthcare is coming to an end with students submitting their final taught module assessment. Students are now working on activities to complete the dissertation element of the programme. The SHS is assisting with the Clinical Governance, teaching and learning elements of the Gibraltar Ambulance Service. We are working closely with medical staff in addressing on-going needs for revalidation activity as well as other non-nursing health care professionals (Allied Healthcare Professionals) and Midwifery colleagues. The Principal of the SHS continues to provide us with considerable structural and material resources support, investing in a range of updated clinical low fidelity simulation components that will serve our multidisciplinary audiences. We are continually adding to our electronic and hard copy library resources. All academic staff in the SHS are publishing work in a variety of health care journals as well as a range of text books. Two students have also published in international journals. A range of multidisciplinary study days have been organised by the SHS, these are in response to organisational need. Five clinically focused education/practice updates have been provided as consequence of service development, these activities are ensuring that staff are equipped with the knowledge and skills required to continue provide a service that is evidence based, safe, effective and responsive. The Mentorship in Practice Module was delivered in house with 15 students attending this.


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An award ceremony was held for the QCF Level 2 Care Assistants, QCF level 3/ Enrolled Nurses and A1 Assessors with the Minister for Health, Environment, Energy and Climate Change presiding. A total of forty GHA staff received awards at this ceremony. 2nd Quarter April 2016 to June 2016 The Enrolled Nurse training, 1st year BSc (Hons) Nursing and 2nd year BSc (Hons) Nursing Programmes are all progressing well and as predicted. The QCF Level 2 training programme is running successfully, responding to local needs and assisting staff in developing their knowledge and skills. The second year of the BSc (Hons) (September 2015) will move to the recently re validated BSc (Hons) programmes. The External Advisor Enrolled Nurse training visited the GHA from the University of Salford in order to externally assess this aspect of our provision. The Advisor randomly selected a range of scripts from the current cohort, met with students, visited placement areas and met clinicians. Her verbal report concluded that the provision is fit for purpose, innovative and reputable. The Pearson/Edexcel External Verifier made an annual quality assurance visit to the SHS to consider the QCF aspect of the level 3 work; she examined portfolios, met with the pupil cohort and the A1 assessor. The External Verifier provided complimentary feedback to the team at the SHS suggesting that the programme was defendable and is being delivered in a competent and confident manner, we await the written report. Seven staff from SGULKUL visited the SHS and undertook a review of the BSc (Hons) Adult Nursing provision over two days as a result of the introduction of a new nursing curriculum. The outcome of this visit with the CEO and Minister in attendance was excellent with the Panel expressing confidence in the team delivering the programme, the quality assurance elements and the practice experiences. The SHS have received a number of requests from international health care organsisations to act as host and to support students and staff undertaking elective periods of study. Academic staff in the SHS continue to publish work in a variety of health care journals as well as a range of text books. The Head of School has been awarded an OBE in the Queen’s 90th Birthday Honours list for his services to Nursing and Nurse Education


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6.11 Complaints Handling Scheme

Volume of GHA Complaints/Enquiries

1st Quarter 2016

The Complaints Handling Scheme – Health Office has received 58 complaints and 44 enquiries in the first quarter of 2016 (1st Quarter - 1st January 2016 to 31st March 2016). The busiest month in this quarter was January 2016 with 24 Complaints. The average number of complaints for this quarter is 19.


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Table 1 - Complaints/enquiries received by department

GHA Departments Facilities 3 Surgical Unit 17 ENT 3 PCC 14 John Mac Ward 2 A & E 11 Outpatients 2 MI Unit 9 Physiotherapy 2 Orthopaedic 7 Theatres 2 Opthalmology 6 Xanit Hopsital 2 Records 4 Radiology 2 Dental 3 Others 13 TOTAL: 102


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Classification of complaints resolved through informal action


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Table 2 – Nature of Complaints

Category of Complaints/Enquiries Waiting times/appointments 30 Poor Communication 15 Clinical Issues 15 Bad attitude 8 Loss of records/test results/referrals 6 Resources 6 Poor Service 4 Poor Coordination 4 Delay in having examinations/tests done 3 External Agency 3 Bed Management 2 Cancelled Procedures/tests/appointments 1 Phone unanswered 1 Delay in obtaining results 1 No replies 1 Pt Safety 1 Pt Confidentiality 1

TOTAL: 102


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Volume of GHA Complaints/Enquiries 2nd Quarter 2016

The Complaints Handling Scheme – Health Office has received 41 complaints and 64 enquiries in the second quarter of 2016 (2nd Quarter - 1st April 2016 to 30th June 2016). The busiest month in this quarter was June 2016 with 17 Complaints and 25 Enquiries. The average number of complaints for this quarter is 14.


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Table 1 - Complaints/enquiries received by department

GHA Departments Ophthalmology 4 Medical Investigations Unit 14 John Mac Ward 3 PCC 11 Neurologist 3 Surgical 11 Radiology 3 Orthopaedic 10 Sponsored Patients 3 A & E 7 Victoria Ward 3 Dental 6 Others 22 ENT 5 TOTAL: 105


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Classification of complaints resolved through informal action


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Table 2 – Nature of Complaints

Category of Complaints/Enquiries Waiting times/appointments 31 Poor Communication 21 Clinical Issues 17 Phone unanswered 9 Poor Service 7 Policy Issues 6 Resources 3 Bad attitude 3 Services 2 Loss of records/tests 2 Delay in obtaining results 1 Delay in having procedures preformed 1 Cancelled procedure/tests 1 Pt Confidentiality/ethical issues 1

TOTAL: 105