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GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 1

GHA BOARD MEETING AGENDA

Venue: University of Gibraltar, Seminar Room 05

Wednesday 26th July 2017 at 2pm

1. Apologies for absence

2. Minutes of the meeting held on Friday 2nd June 2017

3. Matters arising

4. Statement by Minister

5. Matters for report

5.1 Report: Executive Summary - Medical Director 5.2 Report: Director of Public Health 5.3 Report: Medical Director 5.4 Report: Head of Estates and Clinical Engineering 5.5 Report: Director of Nursing 5.6 Report: Director of Human Resources 5.7 Report: SBH – Operations Manager 5.8 Report: Primary Care Services – Deputy Medical Director 5.9 Report: Mental Health – General Manager 5.10 Report: Director of Information Management and Technology 5.11 Report: School of Health Studies

6. Date and time of next meeting

7. In Camera session



Minutes of the meeting held on Friday 2nd June 2017

GIBRALTAR HEALTH AUTHORITY Minutes of Meeting held on Friday 2nd June 2017 at 2.30 pm in the Charles Hunt Room, John Mackintosh Hall. Present: The Hon. N F. Costa (MH) - Chairman

Dr F Morillo (FM) - Medical Member Mr J Zammit (JZ) - Medical Member Mr E Gomez (EG) - Chief Secretary Mrs P Galliano (PG) - Non-Executive Member Mr E Lima (EL) - Non-Executive Member

Apologies: Mr C Lavarello (CL) - Non-Executive Member Mr A Mena (AM) - Financial Secretary

Mr L Gonzalez (LG) - GTC Member In Attendance:

Mrs Jessica Montado - Director of Finance & Procurement (Ag)

Mr A Wink - General Manager Primary Care Centre Mr H Watson - Director IM&T

Mr Christian Sanchez - Director of Human Resources

Mr C Chipolina - General Manager Mental Health

Dr Krish Rawal – Deputy Medical Director Mrs Evelyn Cervan – Principal Secretary

Dr Danny Cassaglia – Medical Director Mr Darion Figueredo - SBH – Operations Manager Mr Tony Dolding - Head of Estates and Clinical Engineering Secretary: Miss N Alvarez (NA) and Mr David Santos (DS) 1. Apologies for absence:

Mr C Lavarello (CL) - Non-Executive Member

Mr A Mena (AM) - Financial Secretary Mr L Gonzalez (LG) - GTC Member

Welcome from Chairman: The GHA Chairman opened meeting.


2. Minutes:

Minutes of meeting held Wednesday 21 September 2016 approved as a true record. 3. Matters arising:

No matters arising. 4. Statement by the Minister:

Welcomed new board members to the team – Mr Fabian Morillo and Mr Jonathan

Zammitt.

Apologies given for the absence of meetings since September 16 so the reports

cover July 16 to March 17. Apologies also given to Board members for the late

submissions of the GHA board papers.

The next meeting will take place on Wednesday 26th July 2017 at the University of

Gibraltar.

5. Matters for Report:

Chief Executive’s Report: (As per published in Board Report)

The Medical Director went through the July 2016 to September 2016 executive summary report that had been devised by the previous CEO. Emails sent to Minister Costa with respect to new services mentioned how staff were doing an excellent job on this. With respect to the Early Pregnancy Unit, there is a UK trainer who will be delivering training for this. Bed Management – weekly bed management meetings are taking place and there has been a great improvement throughout. There is a need to use resources as effectively and efficiently as possible and meet the clinical demands to reduce waiting lists. Day Surgery is seeing huge success rates with 90% of all surgeries completed via Day Surgery with a very high satisfaction rate. Early Warning Signs (EWS) – this has been implemented resulting in the improvement of patient safety. Increasing repertoire of detecting problems in pregnancy. WIFI system – up and running.


The Medical Director went through the October 16 to March 17 executive summary report. There has been significant improvements with respect to Primary Care, including a repeat prescription service and a telephone service for sick notes. The Patient Advocacy and Liaison Service (PALS) was launched on 30 th November 2016, which provides advice, support and information to patients, service users and the public. Chemotherapy Unit – became fully operational during October 2016 providing local, in-house treatment and support for cancer patients. Elderly Residential Services – three part time doctors were appointed to work in the elderly residential service to provide personalised care to all residents of Mount Alvernia, John Macintosh Wing, Hillside Dementia Residential centre and Bella Vista Day Centre. All Directors’ Reports were taken as accepted. Question Time: None this meeting Meeting ended with agreement to reconvene on Wednesday 26 July 2017 at 2pm.

With no further business, the meeting closed.


5.1 Executive Summary - Medical Director

April to June 2017 Mr Chairman, Board members, this report refers to the 2nd quarter of 2017 (April to

June) and the 1st quarter for financial year 2017/2018.

The following is a summary of the Director’s reports, which are enclosed in the main

body of this document.

1) GHA Management

A Bill was published on 18th May 2017 to amend the Medical (Gibraltar Health Authority) Act 1987 in line with the Government policy to abolish the post of Chief Executive of the GHA. This change will lead to significant restructuring of the GHA management team. The Bill will be read and debated in parliament on 12 th July 2017.

2) Primary Care Centre

The improvements in Primary care continue with consolidation of the repeat

prescription and sick note telephone line service. This initiative is releasing on

average 443+215= 658 extra GP appointments per month.

The scanning of all paper notes in primary care is continuing with over 2000 notes

now in digital format and accessible to the GPs on the Electronic record system.

3) New GHA Website

The new look GHA website was launched on 13th June 2017. Redesigned and

developed in-house, it provides information on all aspects of healthcare available at

the GHA. It was developed using the latest website technology available. This

includes a news feed on GHA related matters, availability of useful information (e.g.

contact information, guides, information leaflets). A new careers section will publish

GHA job vacancies and will allow applicants to interact with the HR department on-

line.

4) Medical Regulation

From 1st April 2017, all doctors in Gibraltar are required to have up to date

registration with the General Medical Council UK (GMC) with a licence to practise.

GMC registered doctors are required to revalidate every 5 years, this requires proof

that the doctors are up to date and fit to practise.


5) Sponsored Patients

All sponsored patient referrals now need to be processed through a new IT system

when the decision is made to refer a patient out of the GHA.

As from 4th May 2017, all new referrals are reviewed by the Tertiary Referrals Board

(composed of a group of senior medical & nursing clinicians) before the referral is

allowed to proceed.

This process ensures that patients are referred appropriately and to the best

possible partner hospital/centre.

6) Bed Management

This quarter marked the consolidation of the active bed management process and weekly bed management meetings. Bed occupancy decreased significantly with the transfer of over 40 elderly, long-stay patients to the Hillside Dementia residential unit.

Ward bed numbers have returned to normal levels and the temporary 7-bedded unit will be converted back to a Gym.

There have been no operations cancelled due to lack of beds this quarter and the numbers of patients admitted for major surgery have approximately doubled compared to the same period last year indicating greater patient throughput and more efficient use of theatres.

7) School of Health Studies An awards ceremony was held in May for a wide range of staff across the GHA. They received a range of vocational awards. The GHA is committed to on-going education and training for all its staff. I would like to personally congratulate all those members of staff who received an award and also encourage all staff actively engaged in education and training to continue with their personal and professional development.

8) Repatriation of Services Work continues to expand our locally available clinical services to enable as many patients as possible to receive the care they require close to home and avoid the need to travel abroad. This is particularly important in the light of Brexit and the need to modernise our clinical services in order to become as self-sufficient as possible in the coming years. Respectfully Submitted - Dr D Cassaglia, Medical Director, July 2017


5.2 Director of Public Health

April to June 2017

Screening Programmes

Colorectal Cancer

During the period spanning the months of April to June, a total of 806 invitations were mailed to eligible participants inviting them to take part in the Colorectal Cancer Screening Programme. In addition, 5 persons over the screening age limit (75+ years) requested to participate in the programme as a result of the bowel health awareness campaign. During this same period, 866 test-kits were prepared and mailed to the participants and 393 samples were returned to the hospital laboratory for analysis. The breakdown of the results is as follows:

309 Negative for occult blood

59 Inconclusive for occult blood

25 Positive for occult blood

Of those who underwent endoscopy, 11 Adenomas were found in this period. Of those participants invited to participate, 5 categorically refused to participate in the screening programme. In accordance with the protocol, the person will be re-invited to participate in two years if they are still within the eligible age range. A small number of participants continue to visit the screening office seeking replacement test-kits or clarification on the method. Bowel health Awareness day was held on 23rd May 2017 and the Screening Administrator was available to explain the different aspects of the Colorectal Cancer Screening Programme to the visitors and to answer questions. Following on from this experience, the Public Health directorate has produced a Frequently Asked Questions leaflet to dispel the many myths and misunderstandings that people have about the programme. This leaflet is now included with the test-kits and it is hoped that it will help increase the uptake of participation in the programme. The Uptake of the programme since its inception in Gibraltar is overall around 42.9%, which is disappointing when compared to that of the UK, which is around 60%. However, the uptake for this quarter was around 48.5% and this hopefully marks an improving trend.


Abdominal Aortic Aneurysm

During the period of April – June 2017, a total of 96 invitation letters were mailed to eligible participants and 49 accepted their invitations, an uptake of 51%. All these participants were issued with ultrasound appointments. No expressed refusals were recorded during this period. However, 58 invitees, who did not respond to either the invitation letter or the reconsider letter were marked as ‘Inactive’ and notified. One individual, whose age was above the upper limit, requested screening and was admitted to the programme. During this period, 59 men were screened. No new aneurysms were found, but one case was listed as undecided and a repeat appointment has been arranged. Persons with previously diagnosed small and medium aneurysm continue to be monitored. Health Improvement

Public Events The Health Promotion Officers led or participated in the following events:

A multi-disciplinary campaign for World Health Day on Friday 7th April,

focusing on the campaign theme depression. Professionals from several departments were present on the day, and provided several articles that formed a series in the Chronicle, covering concerns of depression across the lifespan.

A Skin Cancer Screening Day held on Saturday 22th April 2017. The event

was covered by the Chronicle and GBC TV.

The ‘Yellow Walk’ on Saturday May 14th in continued support of Clubhouse.

The Stay Safe campaign for senior citizens of the South District, organised

by the Citizen’s Advice Bureau covering healthy living considerations for the elderly (Tuesday 30th May).

The World Environment Day (5th June) event in the commonwealth park,

this year’s focus being ‘connection with nature,’ liaising with the Environmental Agency and the Alameda wildlife park, both of whom are involved in the conscious eating initiative.

The Conscious Eating stall at Calentita (10th June), providing several

posters highlighting the health benefits of eating a diet full of vegetables.


The Cervical Screening Awareness week (12-16th June) in the Primary

Care Centre, providing posters and leaflets for the event.

The Breastfeeding Awareness day 22nd June at the ICC, alongside the

Health Visitors, Midwives and the Gibraltar Breastfeeding Association.

The Mental Health week 12th May presenting a stand in Westside school.

The pitch was well received and many girls were interested in information on stress and depression.

The Med Step Challenge event organised by Cancer Relief Gibraltar

supporting with sun awareness leaflets.

The World No Tobacco Day (31st May), which was well received and had

coverage from GBC TV.

Networking activities

The Health Promotion Officers met with the following agencies as part of their networking initiatives:

The Youth Service, to discuss potential collaborative projects such as

producing infomercials using youth that attend the service.

The Alameda Wildlife Conservation Park, to discuss the healthy meat free

initiatives, providing resources on improved heart health, mood, reduction of cancer and sustainable farming.

Cancer Relief, to discuss collaborative projects.

The Department of Environment, to discuss the beach ashtrays initiative.

The School of Health Studies, to launch a new men’s health initiative,

commencing with a publicity event at the Piazza.

The newly established charity the Gibraltar Cardiac Association 31st May.

St Paul’s and St Bernard’s First Schools on 26th June, to explore health

promotion in diet, exercise, dental health, sun awareness and personal hygiene.


The Ministry of Environment and MeteoGib to discuss collaborative working

with a focus on environmental pollutants.

Teaching and Learning

The Health Promotion Officers attended the following training:

‘Safeguarding Children’ on 28th June, in preparation for the summer sports

program provided by the GSLA.

Presentation on Air Quality on 6th June delivered by Ricardo Energy and

Environment for the Ministry of Environment.

The Health Promotion Officers delivered the following teaching:

For the Diploma in Life Skills course at the Gibraltar College on the 26th May, 30th May and 2nd June, sessions on Healthy Lifestyle, Hygiene and Mental Health.

For the Inter-Island Public Health Conference in Jersey, a PowerPoint

presentation ‘Health Eating for Healthy Living’.


Media

Health topics covered on Radio Gibraltar’s Health File included

o Sun awareness o World immunization week o Osteoporosis o Bowel health o Water o World no tobacco day o Cervical screening.

Articles for the Gibraltar Chronicle included:

o World Allergy Week (4th-10th April 2017) with focus on Pollen Allergy o World Health Day (7th April 2017) featuring a series of releases

focused on depression in adolescents and depression in older people. o Workplace Stress Awareness Day o World Immunisation Week o Bowel Health Awareness o World Meat free day and Meat Free Mondays o Cervical Screening Awareness Week (12th-16th June 2017) o Osteoporosis

Article for Insight Magazine on Diet and Mental Health, jointly with Dietetics.

New Resources

The following new resources were produced for use in Gibraltar:

A new leaflet on ‘Water’ was designed and printed.

A new leaflet on ‘Hand-washing’ was designed and printed.

A new leaflet on ‘Diabetes’ was designed and printed.

Two new bowel health posters were designed, printed and used for the awareness event (looking at bowel health in adults and children respectively).

Six new boards (3 large, 3 small) were purchased for the PCC, the large boards replaced the older ones and the 3 smaller ones are yet to be installed.

Discussions are underway to produce two new infomercials

o stroke o cancer prevention o sun awareness

Information Analyst

The Information Analyst is currently working on a number of areas:

Immunisation uptake in Gibraltar. As the GHA does not collect computerised data on immunisation, an attempt is being made to do this manually.


Bowel Health Awareness Day: at the event, Cancer Relief and GHA Public Health staff distributed questionnaires to the public, which were returned for analysis to the Information Analyst.

The Information Analyst has continued to service the Monthly Reporting of Government statistics. Infection Control

This section of the Department consists of two Infection Control Practitioners, who oversee the functions of infection prevention, control and preparedness. They also provide training to health-care staff, advise other government and non-government staff and participate in public education programmes on matters of infection prevention and control. The following are some of the activities undertaken by them during this quarter:

Public campaign

World Hand hygiene 5th May: A general campaign was undertaken to

educate the public on the importance of washing hands. Within the organisation, the Handwashing practices of nurses, doctors and allied health professionals were audited on the general wards and further training given where errors were identified.

Surveillance

Daily surveillance of high risk bacterial groups like MRSA, CRE & ESBL. All patients are returning from tertiary hospitals are screened for MRSA and CRE.

Sexually Transmitted Diseases: 25 cases seen in this quarter.

Clostridium difficile: 8 cases seen in this quarter.

An alert system was introduced in the Symphony A&E system to identify known colonisers of the above pathogens, allowing for early precautions for admission.

Monthly meetings of the Infection Control Committee and occasional meetings of Clinical Governance committee and Antimicrobial Stewardship group.

Environmental audits were carried out on six wards / locations in St Bernard's Hospital and reports of findings discussed with ward managers.

Clinics

The Infection Control Practitioners also support the Bi-monthly Blood Borne Virus Infections clinic held by the visiting specialist to review patients with chronic infections like HIV and Hepatitis C.


Training

Mandatory Training sessions for GHA staff on 11th, 17th and 19th May

Dr Giraldi Home staff training on 27th April and 26th May at Bleak House.

Manning Work station for BSc intake.

ANTT training for Enrolled Nurse intake 31st May & 7th June

Outbreaks and Events There were no significant infection control events with public health implications during this quarter.


5.3 Medical Director

April to June 2017 Education & Training

Regular Continuous Professional Development sessions for all medical staff continue on the first Friday of each month. Friday 7th April 2017: Session led by Prof Derek Burke, Responsible Officer for the GHA and GMC Suitable Person. All available GHA doctors attended this session (repeated in the afternoon) to ensure maximum attendance. Three key areas covered Revalidation, Reflection and Patient Safety. Doctors had the opportunity to meet their Responsible Officer. Friday 2nd June 2017: “The Health of Doctors” led By Professor Clare Gerada, previous president of the Royal College of GPs. Professor Gerada is currently the Medical Director of the Practitioner Health Programme (PHP), a service based in London for doctors and dentists with mental health and substance misuse problems. The session explored why doctors become unwell and why they find it so difficult to seek help. Professor Gerada was supported by Dr Shivanthi Sathanandan,

General Adult Psychiatry fellow at PHP. The session was repeated at the primary Care Centre at lunchtime for the GP team. Tuesday 20th June 2017: Neonatal Life Support Course (UK Resuscitation Council

accredited): The annual NLS course was held at St Bernard’s. Experienced neonatal teaching faculty came from the UK to deliver the course. This regular course ensures new borns receive the highest quality care possible at birth. Medical Regulation

From 1st April 2017, all doctors in Gibraltar are required to have up to date GMC registration with a licence to practise. Transitional arrangements were put in place for those doctors who were in the process of applying and had yet been unable to obtain their GMC registration (for administrative reasons). These transitional arrangements will last until April 2018 at which point it is expected that all doctors will be GMC registered with a licence to practise. Quality Improvement An i-stat machine was presented to Rainbow Ward by the Gibraltar Lifesaving Association. This machine will allow immediate bedside testing for basic blood tests including blood gases which will help in the medical care of the most critically ill babies and children. The Gibraltar Prostate Cancer Support Group has donated a new Nexam Pro urodynamics machine to the GHA. This machine will enhance the service delivered by the Urology team and more importantly will repatriate a service that has


previously been provided at Xanit Hospital in Spain. This will allow approximately 115 patients per year to have the necessary testing and treatment in Gibraltar. Tertiary Referrals

The GHA Sponsored Patients programme allows for referral of patients outside of Gibraltar for treatments and tests not available locally. All referrals now need to be processed through a new IT system when the decision is made to refer a patient out of the GHA. As from 4th May 2017, all new referrals are then vetted by the Tertiary Referrals Board (composed of a group of senior medical & nursing clinicians) on a weekly basis before the referral is allowed to proceed. This process ensures that patients are referred appropriately and to the best possible partner hospital/centre. All emergency referrals proceed as normal to avoid any unnecessary delay and are reviewed retrospectively by the Board. This process will ensure that the GHA is able to closely monitor all external referrals and ensure patients access the care they need in a timely manner.

The Ayling-Buttigieg Chemotherapy Day Unit This unit has now been open and active for nine months. In that time, 47 adult patients have been treated/are being treated with Chemotherapy infusions for solid tumours. Additionally, cancer patients requiring intra-venous antibiotics, zometa treatments, blood transfusions, blood taking and portacath flushes are also being accommodated. The specialist Pharmacist has also accommodated some Chemotherapy mixing for patients being looked in other areas of the GHA. Most of the patients treated have been discussed and referred through the GHA’s new Oncology MDT, which meets on a weekly basis. In nine months, 240 patients have been discussed in the Oncology MDT meetings. Patients have been repatriated from tertiary centres outside of Gibraltar, e.g. the Royal Marsden Hospital has diagnosed, provided surgery and recommended specific adjuvant Chemotherapy to patients, which is now being administered at the GHA Chemotherapy Unit. Some current Clinica Radon patients have also asked for their Chemotherapy treatment to be transferred to our Unit. There have been over 700 patient contacts: treated in the unit, seen in clinic by the Oncologists, seen on a drop-in basis or visits to patients on the wards. The A&E Department has access to updated clinic information of all patients attending the Chemotherapy unit. This information is updated by the Cancer Services Coordinator. Additionally, A&E’s ‘Symphony’ programme has all Chemotherapy/Immunotherapy and Palliative patients flagged, enabling clinical staff to identify oncology issues and deal with them accordingly.


5.4 Head of Estates and Clinical Engineering

April to June 2017

1. Department Strategic Plan work-streams

Over the last 15 months, the department has been developing our quality manual

based on ISO9001:2008 requirements. In conjunction to this, we have also been

updating our core procedures, which will underpin this.

2. Medical Devices

Based on the asset registers formulated within our CAFM system, a bespoke 10 year

Lifecycle plan is in place. This is a live working document, which will clearly identify

and track each assets lifecycle plan and prioritise replacement based on age, risk

and cost. It is therefore a significant step forward to have reformulated the Medical

Devices Committee.

The 3 main types of medical devices and their associated directives are:

• active implantable medical devices: The Active Implantable Medical Devices

Directive 90/385/EEC

• in vitro diagnostic medical devices (IVDs): The In Vitro Diagnostic Medical

Devices Directive 98/79/EC

• general medical devices: The Medical Devices Directive 93/42/EEC

3. Clinical Engineering

Training

• Two members of the team are attending management courses

• A training course on profiling beds and wheelchairs has been arranged

Medical Device Alerts and Recalls Attended in the last 3 Months

• Completed: 5 • In-Progress: 6


In-House Scheduled Maintenance

PPM Status Completion Date

Medical Gases completed April

Fluid Warmers completed May

Electrosurgical Units In-Progress June

Patient Beds In-Progress June

Reactive works attended over the period covered by this report

% Difference

from Previous Quarter

Ticketing System

Phone Jobs

Emails Jobs

Call-Outs

Total Breakdown

Completed Jobs

Pending Jobs

Not Captured 348 18 28 43 391 352 39

Commissioning of Medical Equipment

Qty Equipment Date

2 Powered Wheelchair April

Qty Equipment Date

2 Philips Monitors

1 Digital Clock & Stopwatch Display

1 Ophthalmic Tonometer

2 Heraeus Benchtop Centrifuge

1 Portable Headlight

30 Sleepcube CPAP May

1 ISTAT 1 Analyser & Printer

1 Philips Image Intensifier

1 UPD-3 Scope Guide and Monitor

1 Embedding Station

4 Wheelchair

1 Baby Weighing Scale May


5 Portable Suction Units

1 Patient Bed Low Profile June

2 Air Purifier

3 Patient Trolleys

Corrective Maintenance under Contract -

Service Provider Equipment Repairs Month

Philips Medical Radiology Equipment 2 April

Olympus Endoscopes 2

Philips Medical Radiology Equipment 1 May

GE Healthcare

Ultrasound and Radiology Equip. 2

GE Healthcare

Ultrasound and Radiology Equip. 2 June

4. Electrical Engineering

The following items have been the main focus this quarter:

Planned and reactive maintenance works;

2nd QUARTER 2017 TICKET CALLOUTS

April 39 15

May 45 17

June 46 16

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

Continue the upgrade of lighting to LED technology as required and under

lifecycle replacement;

Project support; installation of LED lighting, bedhead trunking services and

nurse call for the new A+E Infusion Room;

The refurbishment of the old A+E Minors - support for these works, including

the installation of new LED lighting;


Support for the on-going upgrade of the access control system;

Electrical auditing and control of Solar HWS project electrical installation.

5. Mechanical Engineering

Progress for the reporting period is as follows is as follows:

Reactive works - All service and maintenance requirements

Continued routine sampling of the dialysis treatment plant water has

taken place with remedial works carried out as required

Air handling units remedial works are on-going – this is picking up

defects raised within the annual verification reports carried out by

AirisQ last year

Major repair on the west wing cooling cool in February, resulted in

the precautionary purchase of spare coils for our critical AHU’s

Decommissioning of the temporary ward

Install refurbished A/C System for mental welfare offices PCC.

Install new A/C in Dental clinic, 4th Floor Block 2

Supply Drugs refrigerator for Home care patient along with

uninterrupted power supply

Mechanical General Reactive Calls

2nd QUARTER 2017 Mechanical Section

TICKET CALLOUTS

April 5 8

May 10 9

June 19 12

Planned Preventative Maintenance

Major Air Handling units Service completed in this quarter; April = 7; May = 3; June = 4 Extra works repairs due to failures for this quarter; April = 67; May = 23; June = 38


External Specialist Maintenance – completed in the last 3 months:

Month Due Equipment Service Provider

April Lifts Otis

Escalators Otis

BMS Systems Emblem

Theatre Equipment and Wards Draeger

WP9 Water Purifier Abatron

May Lifts Otis

Escalators Otis

Emergency Lighting Thomas & Betts

Emergency Generators Versetec

Roof Man-Safe Systems PTSG

GE Ultrasound - Radiology GE

CPR Training Mannequins Laerdal

June UPS systems Upsmeir

Main LV Elect - Air circuit breakers In House

6. Projects Completed and On-Going

Solar PV – Installation of Photo Voltaic panels on the roof of link block 2. These will

drive heat pumps, which will in turn supply LTHW to the hospital existing Hot Water

calorifiers.

This should help to reduce the hospitals fuel bills and

add to the Governments commitments to CO2

reduction/management. This will also improve further

the hospital DEC energy performance in buildings

score, and contribute to our obligations under the EU

Energy Efficiency Directive (2012/27/EU known as

ESOS). This project is in the final stages of snagging and commissioning.

However, we are already getting the benefit of solar energy being fed directly into

our electrical infrastructure.


Temporary Ward – This has now be decommissioned and has been reverted into the Physio Gym. Server Room A/C – install fit for purpose A/C and UPS resilience into block 1.


5.5 Director of Nursing Services

April to June 2017 Child Health The child health team was introduced to the signs of safety protection practise framework in accordance with UK policies. The signs and safety is an innovative strength based, safety organised approach to child protection casework. From the month of April to June, the child health clinic staff nurses administered the Diphtheria, Tetanus and Polio booster vaccine to year 9 Westside and Bayside school in the school premises. The process was well organised. The child health clinic team provided extra clinics at the PCC to administer the Diphtheria, Tetanus and Polio vaccine to year 9 Prior Park and Hebrew school. The process was well organised. The child health care team has re-introduced education talks for all parents whose children will be commencing the reception year in September 2017. The talks were about the role of the child health care team and how to seek advice and support if any matter of concern arises concerning the health of their children and how to prevent, treat and manage head lice spread in schools. Head lice Patient information packages were distributed to all parents who attended the talks. Influenza vaccination programme The influenza vaccine campaign is now finished however there are still patients who are referred from a consultant or GP. EHR Improvements continue to be made to the working processes and templates that have been incorporated within the electronic health system. As of recent, we are now working with the appointment reporting system to be able to audit all our statistics as appropriate. Dermatology

April was the commencement of the sun awareness campaign and commenced with

its Bi-annual visit to the Cancer Relief Centre. A talk was given by the Clinic Nurse

Specialist on the importance of sun protection especially for those people who have

suffered from cancer and who may have had chemotherapy or radiotherapy. It was

followed by a short clinic to check the skin of those who may have had any concerns.

On Saturday 22nd April 2017, the dermatology department held its 4th skin cancer

screening day. The outcomes are listed below


Breakdown

Urgent Biopsies – *those sent to Surgeons o Facial Maxilla Surgery – 1 o General Surgery – 3 o Plastic surgery – 0

Referred to dermatology services o CNS – 0 o Dr Ferrera – 1 o Cryotherapy – 14 o Hyfrecation – 1 o PCC Minor ops – 4 o Punch biopsy – 0 o Dermoscopy/Photography – 16 o Derm Clinic (Consultants) – 2 o Patch test – 0

Advised to get an appointment with their GP – 0

Reassurance: o Patients who were reassured that the lesion(s) presented were benign

and that no further action(s) were required – 99 o Unregistered patient – 1

Diabetic Service

Progress of the Diabetes Team in PCC from March 2017 to June 2017 Two part time qualified nurses, one Enrolled Nurse and one Registered Nurse joined the Diabetes team in the Primary Care Centre to undertake Annual Diabetic Review Clinics (ADRC). A pilot for carrying out annual reviews to members of the elderly community took place on the 20th and 23rd June at Albert Risso and Bishop Canilla House for those patients with impaired mobility. In total, 26 patients were reviewed. The feedback was extremely positive and the team are looking forward to repeating this exercise again next year to include Albert Bruzon House and Sea Masters Lodge. Both nurses spent one month each working with the Diabetes Nurse Specialist learning about Diabetes Pathophysiology, diet and exercise in the management of diabetes. They looked at biochemical parameters to assess diabetes control, identifying factors, which enhance the cardiovascular risk, which complications associated with diabetes. In April 2017, the Diabetes Nurse Specialist provided a one-day teaching session for year 2 students in the School of Health studies on the management of diabetes and diabetic emergencies. On the 11th May 2017, the Diabetic team carried out Diabetes education for members of the Moroccan community at the Europa Point Mosque whereby 28 people attended.


Second year student nurses undertook a placement with the diabetes team at the PCC to have first-hand experience of diabetes and its complications, as well as having a real life scenario of what it is like for people to live with diabetes. The DESMOND course took place in May with an attendance of 7 participants. There was a GP CPD session on insulin pump therapy, which took place on 21st June. The Diabetes Nurse Specialist circulated the information materials to all GP’s and Nurse Practitioners in the PCC and offered to repeat the session if there is an interest. Nurse Practitioners Cervical Screening Awareness Day Outcomes for week June 12th 2017

The first Cervical Screening Awareness week was held at the Primary Care Centre from the 12th of June to the 16th of June. Clinics were held daily from 1.30pm-3.30pm and were carried out by two Nurse Practitioners. In the main waiting area, a counter was staffed specifically for the purpose of information sharing and appointment facilitation by 2 Administrators. This is the first time this screening week has been held in Gibraltar.

The outcomes were as follows:

Attendees: 75

First time cervical screening (25-30) years of age: 5

First time cervical screening (31-65) years of age: 10

Cervical screening carried out over 3 years ago: 13



Cervical screening due during this period: 13

Patient concerns advance cervical screening appointment given: 2

Patient concerns GP/NP appointment given: 3

Advise that a recall appointment will be sent: 15

Recall appointment given for within 3 months: 3

Appointment given for routine women’s Health issues: 2

In total, 34 patients received cervical screening and there are 13 pending to be done

by the end of June.

The patient satisfaction survey showed that there was only one patient that felt not all of their questions had been answered. All said they would encourage others to attend this screening.

Although not covered in the questionnaire, it was expressed by many women that not enough media coverage had been available prior to the commencement of the Awareness week.

A Nurse Practitioner attended a one-day Primary Respiratory Academy road show on Friday 16th of June in UK.

The topics covered included:


Fundamentals in getting the diagnosis right

Spyrometry

Hot topics in asthma

Smoking cessation and the role of the e-cigarette

Inhaled medication- safety and practice

Hot topics in COPD

District Department

The district team are currently undertaking the annual mandatory course in basic life

support. In addition to this, they are also undertaking their annual review training

programme in managing the care of porta-cath lines.

Primary Care Clinics The department has initiated a new point of care testing service (POCT) for patients who are currently on the warfarin anticoagulant medication. POCT is a medical diagnostic testing done in the phlebotomy clinic where results are available relatively quickly so that they can be acted upon without delay. The purpose is to transfer all the patients currently attending the hospital laboratory for testing to be done in the PCC and community.

However, there is a need to implement a CDSS system (computerised decision

support software for anticoagulation). This system will facilitate a standardized

dosing recommendation and will help the workflow processes for this service and will

facilitate patient’s journey through the service.

A Primary Care Sister participated in the men’s health awareness events in combination with the School of Health Studies on the 22nd May at the leisure centre. This was the first session on Male Health initiative where the speaker and public raised concerns about the lack of screening processes for men’s health. The sick note line service continues to be used widely by the community of Gibraltar and since its introduction we have provided a total of approximately 599 medical certificates. The Hypertension Screening Clinic

Hypertension is the most commonly diagnosed condition at the GP’S practice in

Gibraltar.

We currently have approximately 5,000 patient diagnosed with hypertension.

We are managing clinics to screen and advice as appropriate, however the number

of patients attending is growing.


The modern western diet and lifestyle is one of the most important and potentially modifiable risk factors that most patients and many doctors ignore. For this reason it is easier to accept medication other than adopt healthy life style changes. Although it takes a lot of work to change our lifestyle, the potential rewards are great; therefore as health professionals we must raise awareness and make this our goal and objective.

In the Primary care, we have set out objectives to promote health education and prevent secondary effects

Objectives of the hypertension clinic

To promote the primary prevention of hypertension and cardiovascular

disease by changes in the diet and lifestyle of the whole population

To increase the detection and treatment of undiagnosed hypertension by

routine screening and increase awareness of hypertension among the public

To ensure that patients taking antihypertensive drugs are controlled to optimal

blood pressure levels

To reduce the risk of cardiovascular disease of treated hypertensive patients

by non-pharmacological measures, and by appropriate use of statin and

aspirin treatment

To increase the identification and treatment of patients with mild hypertension

who are at high risk of cardiovascular disease—for example, elderly patients,

patients with ischemic heart disease, people with diabetes, people with target

organ damage, or people with multiple risk factors

To promote continued adherence to drug treatment, by optimizing the choice

and use of drugs, minimizing side effects, and increasing information and

choice for patients.

Cardiac rehab Cardiac rehabilitation is defined by the World Health Organization (1993) as ‘activities that favorably influence the underlying cause of the disease and provision of the best possible, physical, mental, and social conditions, so that patients may, by their own efforts, resume as normal a place as possible in the community’. WHO suggests rehabilitation must be integrated within secondary services, of which it is only one facet. The cardiac rehab services are divided into four phases. Phase 1: identify patients who may benefit from the cardiac rehab services who may be in CCU or the medical wards, referred from Xanit or UK hospitals or patients visiting the cardiologist who may be eligible to join the CRS programme.


Discuss issues of importance with the patient and allow patients to raise concerns and views and advice as appropriate. Phase 2: Expediting patient discharge. In this phase, the cardiac rehab nurse should be undertaking risk stratification. A platform to identify which patients need to be prioritized according to presentation and risks involved. A holistic patient assessment will be undertaken during a face-to-face consultation where the nurse will determine whether the patient qualifies to be in the programme or whether they require other form of rehab within a home environment, which can be organized by the community physiotherapists. The patients will need to sign a contract to be able to be part of the programme. This will ascertain compliance during the eight-week programme. The CRS nurse should be planning and organizing all the CRS educational talks to be delivered to the patients. One of the subjects to introduce into the talks will be smoking cessation. Phase 3: the patient will now be ready to start the programme and will be booked for his first joint assessment in the gymnasium The CRS physio and cardiac rehab nurse will work together to ascertain level of fitness. A plan of care according to policy will then be discussed with the patient. That same day the patient will also be assessed by the dietician and information provided as required. Phase IV: Community based assessments should be carried out by a phase 4 instructor.

Operating Theatres

With Mr Antequera as an Upper GI specialist, there have been new surgical interventions offered for our patients. Three members of staff from main theatres, visited Mr Antequera’s previous place of employment to identify specific requirements to cater for the Upper GI interventions. Specific surgical instruments and items have been procured for this speciality. This has resulted in surgeries being performed for the first time in Gibraltar (Gasterectomies, Gastric bypass, Fundoplication (Anti-Reflux Surgery). 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. All four candidates have successfully passed 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

Surgical Directorate


professional issues associated with surgery and have received their Surgical First Assistant (HEA 3055) part 1. A further five members of staff from both Main Theatres and Day Surgery will undertake (HEA 3055) in September 2017. One of the mentors in Theatres has now extended her role to become a sign-off mentor. As a result, third year nursing students can now carry out their management placement within the perioperative environment. The Gibraltar Health Authority, Nurse Management and the School of Health studies are still exploring the possibility of introducing the Operating Department Practitioner (ODP) training locally. Day Surgery

The Day Surgery Unit continues to undertake on average 90% – 95% of all elective patients requiring surgical procedures of all sub specialities with even more complex surgical procedures. With the Day Surgery Theatres performing more extensive surgeries, the team are gradually enhancing their intraoperative skill in collaboration with team members for main theatres. During the period of January 2017– March 2017 a total of 709 patients have been admitted through Day surgery with 611 surgical procedures undertaken within the Day Surgery Theatres its self. DSU Monthly Statistics 2017:- Total DSU % April 205 182 88.78 May 274 240 87.59 June 230 189 82.17

Out Patients Department There will be a bespoke training focused on transforming the way that outpatient services are delivered. This will be tailored to meet the need of the organisation and will consist of a three session course scheduled for 1st September, 3rd November and 1st December. This will be directed for:

Endoscopy (MIU)

Urology

Cardiology

Respiratory

Ophthalmics

ENT


The plan for the three days is to base the three sessions on Kotter`s Eight Step Process of Creating Change. Each session would build on the last session so; Session 1 - 1- 3 stages Session 2 - 4-6 stages Session 3 - 7-8 stages

Urology

Two nurses will be carrying out competency based learning in the field of urology. This will cover tasks such as assisting with supra-pubic catheterisation, urodynamics, obtaining biopsies. This training is due to take place in October 17. This training will allow for the urology nurse to:

Provide clinical management and independent care for Urodynamics, Uroflows, reporting of results to consultants for interpretation.

Perform Prostate TRUSS biopsies

Provide clinical care and education for the patient with catheter changes, self-catheterisation, and trial without catheter.


Orthopaedics

An Enrolled Nurse will be a full time plaster technician as from mid-July. A further two members of staff (one Enrolled nurse from Orthopaedics and one Staff nurse from A/E) will be undertaking this module accredited by the British Association of Plaster Technician in February 2018 enabling them to become plaster technicians. Once they become qualified, there would be a total of three plaster technicians within the organisation. Endoscopy

We now have a third appointed endoscopy technician and another Staff Nurse has completed his training from the JAG/GETS programme for endoscopy at St Georges. Surgical Out-Patient Department The surgical outpatient department will be taking lead in the Vac Pump wound care management of the outpatient. A Staff Nurse will be leading with the responsibility of the Mini pumps whilst CCU will keep the large pumps. We are communicating with KCI (Vac Pump Company) to provide further pumps and training sessions on dressing application). TSSU Department With the increase of elective Day Surgery Procedures and provision / utilisation of Theatre 3, TSSU / CSSD has had to undergo modification and development of its services at many levels. Educationally, three members of the team have undergone SSD Manager / Supervisors (DTM HTM) training at Eastwood park hospital in the UK as part of the natural progression in CFPP practices and E.U requirements. The Department has recently undergone refurbishment and updating of its Steris automated washers and decontaminations units to enable to continue to provide a streamlined service to its users, which include:

Operating Theatres

Day Surgery Unit

Maternity

Accident & Emergency Department

Ambulance Services

Radiology Department

Dialysis

All Wards & Clinics in SBH

PCC

ECA

Ocean Views

HMS Prison


RGP & City Fire Brigade

St Johns Ambulance

Dudley Toomey Ward All registered nurses have carried out the NEWS training session in order to update their knowledge on the use of using the NEWS observation charts, which went live on the 21st May. Members of staff attended a Gynaecology Module provided by Salford University. This focused on the management of early pregnancy loss. Due to improvements in bed capacity, the ward has returned to becoming a solely substantial surgical ward. It has since been divided into a purely ortho-trauma wing in an effort to minimise potential risks of surgical site infections. The remaining half of the ward caters for all other surgical patients.

Victoria Ward Ward Activity: April & May continued to see a continued high inpatient capacity catering for 36 complex/long stay patients. 10th & 11th June saw the successful transfer of 14 Patients to Hillside Dementia Unit, thus by the end of June inpatient capacity dropped to 27. These last 3 months has also seen 2 nursing staff successfully qualify and take up posts as Enrolled Nurses.

Current Inpatient status: Total

Long stay patients/ Palliative 2

Rehabilitation 7

Long stay 18

Training:

Mandatory Training with 10 staff members completed this in-house training which included Infection Control updates, Introduction to NEWS, BLS & Manual handling

2 Staff Nurses completed a 2 day Triage Course

3 Enrolled Nurses completed a 5 Day Dementia Course

2 Staff Nurses completed the Immediate Life Support (ILS)

Adult Safeguarding Training a total of 2 staff members attended John Mackintosh Ward Staff are working hard to make patient safety a top priority on John Ward. Everyone is becoming much more conscious in areas such as pressure area care and skin inspection on admission and daily thereafter.

Medical Directorate


Ward Activity: April – June showed a high inpatient capacity. Environmental safety checks are being accomplished. JMW Monthly Statistics 2017:-

Month Total Admissions:

April 31

May 23

June 32

Critical Care Unit Ward Activity - This period has seen a reduction in admissions to the unit. During the period of April 2017–June 2017, 195 patients have been admitted via A&E. The department has developed the NEWS implementation for patients transferred out of CCU. In June 2017, the Hon Minister for Health gave approval for CCU’s development plan. Training Five staff members completed a Bespoke training programme in April, subjects covered:

Ventilation and Respiratory care.

Care needs surrounding the cardiovascular system / ECG Interpretation.

The Renal system & Hemofiltration.

Trauma/ Head injury.

Other training completed by the team between April – June:

CRIPA

Bariatric Training Session

Alert

Transfer of the critically ill patient

ILS

Mentorship

Sign-off mentor

CCU Statistics April – June 2017:-

Total Admissions 195

Deaths 10

Patients requiring Renal Replacement Therapy

4


Ventilated patients 13

Non Invasive ventilation

15

Accident & Emergency Department

Department Activity: April saw the Minister of Health announce the commencement of 2 New Department managers. April also saw the reorganisation of 2 areas within the department:

1. The Minor Injury Unit (protocols, guidelines, stock) 2. Ordering, procurement and store room

Throughout April to June, Department works continue allowing for improved patient care. Training: The team have continued to keep updated and have attended Mandatory Training, which include:

Work Based Learning Module

ALERT Course

Advance Life Support Instructor

ILS

Gynae study day

Suturing course completed by all staff in A+E department.

Advance Trauma Instructor Course A& E stats for the period 01/04/2017 to 30/06/2017:

New Attendances 6146

Planned Return Attendances 403

Unplanned Return Attendances 357

Clinic Attendances (Arrived) 807

Total Attendances 7713

Injury at Work Attendances 54

Visitor Attendances 438

Attendances for Children 15< (non MOD)

1174

Attendances for MOD 16> 13

Attendances for MOD 15< 51


Ape/Monkey Bite 23

Dog Bite 28

Insect Bite 77


Human Bite 2

Cat Bite 5


Sting Fish 1

Sting Jelly Fish 2

Total Attendances 3

Chest Pain / Palpitations 250

Intoxication Alcohol 7

Cardiac/Respiratory Arrest 6

Overdose 12

Road Traffic Collision 26

Referral 115


Ambulance 190

1012

Non Urgent Ambulance 40


Surgical Admissions 118

Medical Admissions 316

Paediatric Admissions 50

Gynaecology Admissions 10

Orthopaedic Admissions 46

Total Admissions 540

Mental Health Admissions 9

Anaesthetics Admissions 5

ENT Admissions 6

Ophthalmology Admissions 2

Total Admissions 22

Referral to Trauma Clinic 256

Total Referrals 256

Phlebotomy & Blood Donation Department

Department activity: The department continues benefiting from the implementation of an appointment system, with the system proving to be a success.


Training: Staff Nurse continues to train all grades within the GHA in the theory and practical competences in two main areas: Venepuncture & Phlebotomy i.e. drawing blood & its storage & transport it for testing. Rainbow Ward Ward Activity: There has been a steady flow of children admitted and seen in Rainbow. Training: In-house training continued with 5 staff completed the Paediatric Intermediate Life Support (PILS). Mandatory training was also attended by 5 staff. In May 2017, the Care Agency inducted the Signs of Safety. To enable clear communication between the agencies, 2 of the Paediatric team completed Child protection training at tier 2. Paediatric Statistics April – June 2017

Maternity

Ward Activity: Following training in early June, the Early Pregnancy service commenced. The Hon Minister for Health introduced the new Early Pregnancy Assessment Service for expectant mothers to staff from A&E, Dudley Toomey Ward, & Day surgery. This initiative has been supported by the School of Health Studies. Training: A bespoke Gynaecology module was designed to instruct staff nurses from A&E, Dudley Toomey and Day Surgery as well as the midwives in the hospital, to enhance and update vital skills in this key area of healthcare in Gibraltar. Anna Sherliker, BSc (Hons) Midwifery from the University of Salford, Manchester will be leading the programme. The objective was to empower staff when dealing with pregnancy loss, and explained that the training has been tailor made to give staff the proficiency to deal clinically with all aspects of such a difficult experience, including psychological and emotional care.

2017 Paed HDU ENT Dental

Ortho Eye Surg Total Ward Attender

Clinic

Total activity

April 18+1 2 3 18 4 0 5 55 38 126 219

May 41 1 9 19 7 1 5 83 51 224 358

June 31 2 7 19 8 0 5 72 69 89 230


Maternity statistics April 2017-May 2017

Total Nº

Total births 100

Male 46

Female 54

Premature <37 4

IOL 17

EM LSCS 3

URG LSCS 8

SCH LSCS 3

EL LSCS 17

Total LSCS 31

Ventouse 4

Forceps 0

Twins LSCS 4 sets 8

Midwives Deliveries 65

Transfer to Spain in Utero 6

Transfer to Spain Neonates 0

SCBU Admissions 4

Ward Attenders 416

Dementia Training Week for Enrolled Nurses

This took place between 3rd – 7th April in the School of Health Studies with 9 Enrolled Nurses attending the weeks training plus 3 Enrolled Nurses and other MDT staff who became Dementia Friends following a session given by GADS (Gibraltar Alzheimer and Dementia Society). Relative’s stories about family experiences of dementia care were particularly moving and made a big impact. Practice Development from GHA and ERS delivered sessions on the Programme with input from Medical Staff, Physiotherapy, Occupational Therapy, Pharmacy, Mental Health and Palliative Care. Feedback for the programme was generally excellent with the visits to the Bella Vista Day Centre, John Mac Wing and Ocean Views giving a great insight into more Dementia Friendly environments and highlighting the need for St Bernard’s to become more Dementia Friendly as there are so many people living with dementia and receiving care in St Bernard’s Hospital.

Practice Development


World Health Week – Depression Awareness Day This awareness event took place in the lobby area of the ICC on April 7 th and was well supported by Multi-Disciplinary/ Agency staff including health promotion, practice development, nursing and midwifery staff from St Bernard’s Hospital, community & voluntary workers. The media/ GBC interviewed staff regarding stress and depression and highlighted the need to speak out, get support and reduce stigma. Mandatory Training This took place on 11th, 17th & 18th May in the School of Health Studies – 36 staff members completed their up-dates in Basic Life Support, Moving & Handling, Infection Control and National Early warning Scores (NEWS). Further provisional dates have been pencilled in for 30th and 31st August & 28th and 29th September – these will need to be confirmed with Instructors and organised through Practice Development. NEWS Launch

Practice Development and other members of the NEWS Steering Group have participated in training staff, raising awareness and the implementation of the National Early Warning Scores within St Bernard’s Hospital – the launch took place on 21st May. The introduction of the National Early Warning Score (NEWS) to clinical areas throughout the GHA in a stepwise fashion is an important milestone as for the first time there is a common language and approach to assessment of a patient’s condition. Application of this common approach should eradicate variation in practice and reduce harm to patients. (Dr Richard Roberts, NEWS steering group 16.05.17). NEWS resource files have been placed in wards with information about NEWS including the policy being made available to all staff. Dignity in Care Training

This took place week beginning 5th June in the School of Health Studies and Bleak House and was attended by 23 nursing staff members including the new Pupil Nurses who are carrying out their Enrolled Nurse training. This focused on providing safe, compassionate, person-centred care, exploring ways to support staff and enhance practice. Suturing in A&E

This course was delivered during 3 one day workshops in the Multi-Skills Room in the School of Health Studies for 21 A&E staff members.


Safeguarding Adults at Risk - Training for Managers

This training was delivered for 8 senior nursing staff and 3 medical staff on 20 th June in the School of Health Studies. Bed Management Report for period April 2017

The month of April 2017 has demonstrated a slight decrease in bed occupancy for adult patients at SBH. Extra beds have still been used during the month. CMW and VMW continue with the increased bed capacity as per Bed Management Escalation Policy. A positive approach was undertaken on the 22nd April whereby 14 patients from SBH were transferred to the new Hillside Dementia Home. Bed management meetings continue to be held weekly with a proactive team approach.

Total admissions for April 2017 for SBH are as follows:

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

101.5%. There has been a slight decrease from March (109%)

Bed Management Report for period May 2017 The month of May 2017 has demonstrated a very slight increase in bed occupancy for adult patients at SBH. Extra beds have still been used during the month. CMW and VMW continue with the increased bed capacity as per Bed Management Escalation Policy. Bed management meetings continue to be held weekly with a proactive team approach.

Total admissions for May 2017 for SBH are as follows:

Admissions all areas

243 Admissions via A&E 183

Admissions Adult & CCU


Paediatrics

51 Admission via A&E 17

Maternity

55 Non elective 12

Admissions all areas


Admissions Adult & CCU


Paediatrics

74 Admission via A&E 41

Maternity

67 Non elective 10


May continued to see high bed occupancy with the average adult occupancy at

102.5%. There has been a very slight increase from April (101.5%)

The following efforts successfully continue throughout the hospital:

MDT working both on acute & long stay wards (rehab) improving patient flow

Proactive approach to the discharge process with dedicated hospital social

worker and escalation of bed management meetings with closely followed up

action points.

Domiciliary hours availability to support discharge.

Close integration with the ERS (availability of long-term beds in order to

expedite patient flow).

Transfer of patients to the temporary ward (interim measure)

Transfer of patients to Hillside

It was unfortunate that the number of beds were reduced when the old St Bernard’s Hospital was moved to the new St Bernard’s Hospital back in 2004. This had a grave effect on bed occupancy rates, which caused pressure on bed availability and patient flow. If the same level of beds had been kept as per clinician’s advice at the time, the average bed occupancy rates would have been far better.

However, I am happy to announce that during this quarter, the bed occupancy audits

have shown a tremendous increase of available beds at St Bernard’s Hospital. A

snapshot in April showed a recording of 26 beds available that day, in May, a

recording of 28 beds available that day and in June, a recording of 44 beds available

that day.


Fig 1: Occupancy levels (adult wards & CCU calculated @ 30 & 10 beds respectively) Jan 2015- May 2017.

85.00%

90.00%

95.00%

100.00%

105.00%

110.00%

115.00%

Average Occupancy Adults 2013 96. 99. 10 10 96. 10 10 10 10 11 10 11 10 10 10 10 10 10 10 10 10 10 10 10 11 10 10 10 10

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Note: 85% ceiling for occupancy as per DOH 2001 recommendations

Fig 2 Distribution of elderly long stay/dementia/complex by ward-snapshot @ 05/6/2017


Fig 3 Distribution of elderly long stay/dementia long stay/complex & Palliative by cohort-snapshot @ 05/6/2017

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

27

Elderly Long-Stay

28 Average age 85 years

Dementia Long-Stay

24

Palliative 5

Total Beds Held 84 130 adult beds SBH – 84= 46 acute beds available (plus 19 extra beds)= 65

Fig 5: Total Cancellations elective inpatient surgery January 2015 to May 2017 due

to bed shortage

Total cancellations due to beds 2015-2017

.

-2

8

18

To

tal N

um

be

r o

f P

atie

nt's

Cancellation due to unavailability of bed 0 0 10 0 0 3 0 0 0 0 4 5 6 2 12 13 3 7 7 3 2 0 0 6 2 0 0 0 0

Jan-Feb- Ma Apr- Ma Jun- Jul- Aug- Se Oct- No De Jan-Feb- Ma Apr- Ma Jun- Jul- Aug- Se Oct- No De Jan-Feb- Ma Apr Ma

There have been 0 cancellations of elective inpatient surgery specifically due to bed unavailability in May 2017.


5.6 Human Resources

April to June 2017

1. EXECUTIVE SUMMARY

The department’s new focus and direction continues to be guided by principles of helping others, whilst contributing to the strategic HR objectives of the GHA. This is helped by supporting line managers and building strong working relationships with the range of professional groups; alignment with the business and service needs of the organisation and developing the HR experience and perceptions of our ultimate customers, our GHA staff. Throughout this second quarter, the department has made progress in significant areas of our recruitment and selection, advertising and holding successful interviews, including the use of technology for remote interviewing, for clinical vacancies within Medicine, Nursing and Allied Health Professionals. The use of conferencing technology in interviewing brings about both cost and time savings to the process, ensuring a more efficient service to our customer base. The successful recruitment of Medical grades has signified a reduction in prolonged locum requirements. In addition, we have successfully negotiated short term contracts for 5 locum staff members, where we have anticipated a minimum of 3 months of continuous employment requirements. The department has been working in close collaboration with the trade unions, developing positive Industrial Relations. Together, we have managed to regularise longstanding supply positions for our General Operative Labourers, as well as resolved numerous longstanding professional claims from staff that have promoted employee wellbeing. Professional relationships and communication with clinical and non-clinical heads of departments continues to develop. This is resulting in improved integration and a partnership approach towards the operational management of core HR functions such as recruitment planning, contract renewals, conduct and behaviour and employee wellbeing. In addition, the department’s renewed commitment to providing HR support to line managers has been evident, where HR Managers visited our Mental Health facility, to offer line managers HR advice on policies and practices relating to the preventative management of disciplinary proceedings, sickness management, employee wellbeing and occupational health. Our HR staff continues to be fully engaged with the ongoing review of the department and value the direction and support provided by the Public Sector HR Business Support Unit. Their HR expertise has been a welcomed addition and a noticeable resource, utilised by both HR staff and GHA line managers, especially when managing complex HR matters. Our department has also welcomed three new members of staff.


To conclude, I would like to add that there is a noticeable rise in the gratifying feedback and praise from line managers and GHA staff alike, received by HR staff. This, although intangible, gives the department increased motivation and a sense of purpose and reassurance that our collective efforts make a positive difference to the wellbeing of GHA employees and to our healthcare service delivery.


5.7 SBH Operations Manager

April to June 2017

Introduction The “New Look” GHA website was launched on the 13th June 2017 www.gha.gi. The new website has been re-designed and developed completely in-house and provides information on all aspects of the healthcare services available to visitors, patients and health professionals in Gibraltar. The revamped website also contains general contact information, guides, forms, information leaflets and other up to date health related news that patients, visitors and service users will find both useful and informative. The website is further designed to work on multiple platforms, web browsers & mobile devices and now includes a new careers section where vacancies will be published and applicants can interact online with the Department of Human Resources http://careers.gha.gi/. There is an automated news feed on GHA related matters and departments can now administer the content of their sections individually. The original website launched in July 2013 has served well for the past three years, but it needed to be refreshed and built using the latest software and technology available. Since the launch in 2013, the website has generated 289,392 Unique User Visits, 860,582 Page Views and the GHA has received 992 Cancellations of Appointments, 2483 HR Enquiries and 1356 General Enquires via the online forms. The Estates and Clinical Engineering team have also completed the installation of the first Photo Voltaic panels on the roof of link block 2. These will drive heat pumps which will in turn supply LTHW to the hospital existing Hot Water calorifiers. This should help to reduce the hospitals fuel bills and add to the Governments commitments to CO2 reduction/management Facilities Management Fire Prevention

The GHA Health and Safety at Work Policy was approved by the GHA Board on 2nd June 2017. The new committee, terms of reference, risk assessments and training programme will be reviewed in line with the new policy.

http://www.gha.gi/


Patient Advocacy & Liaison Service

The service was created during October 2016 and is managed by the Medical

Records Manager together with a full time GHA Clerk.

Case Activity for PALS for 2017

JANUARY 35 CASES

FEBRUARY 33 CASES

MARCH 73 CASES

APRIL 43 CASES

MAY 56 CASES

JUNE 55 CASES

Medical Release of Records Office

STATISTICS 2017

APRIL

Patients: 93

Lawyers: 9

RGP: 2

D.S.S: 0

Insurance Company: 5

MAY

Patients: 99

Lawyers: 11

RGP: 7

D.S.S: 0


JUNE

Patients: 75

Lawyers: 10

RGP: 4

D.S.S: 4



Minor Works

A total of 487 work tickets excluding those arising from department/ward inspections

have been received this period, 1st January 2017 to 30th June 2017.

The figure for this quarter has again increased to 75.6 requisitions/defects per

month, which shows the system is now being used by most departments. Compared

to the previous reporting system were the average was 28 requisitions/defects per

month. This quarter we have managed to again analyse the TMV system as the hot

water pumps are fully operational. This has amounted to an excess in works carried

out as the whole hospital has been re-checked in order to safely commence the

routine programme of maintenance.

Shower flexi and heads together with the inspection of all ward gullies continue to be

done as part of the maintenance regime.

Dudley Toomey ward, CSSD and Calpe Ward together with other common areas

have been inspected and completed during this period.

The Estates Manager 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 St Bernard’s, CMHT and the PCC.

The section was heavily involved in the creation of a new temporary ward in the

rehabilitation department which was required as a result of bed management issues.

These works have now been dismantled and the ward removed allowing for the gym

to be in use again.

Routine repairs and maintenance continues throughout the estates.

Catering Services The Catering Unit is generally performing well.

A new cook was employed last month of May through the services or MEDDOC and

the Assistant Associate Director is now undertaking his role.

Quality and service improvements

A deep clean of the facility was carried out during June 2017.


Red trays – Patients that require assistance to eat have had red trays allocated and

this has been piloted with great success and the aim is to commence this initiative

with all words, the cost is insignificant.

Offer sandwiches to patients waiting outside A&E twice a day, some patients suffer

from diabetes or other ailment and cannot be long periods of time without any food.

We already provide sandwiches for A&E, but now we will off to patients outside

waiting as well as patients inside.

Meals Provided during April and June 2017

Ambulance Service New Ambulance Recruits

On 8th May, new Ambulance Care Assistants commenced employment and are

currently undergoing induction training. They have completed their ACA course and

are currently competing blue light driving instruction and C1 Driving license.

Government Agencies Training

The GHA Ambulance Service continues to develop strong links with different

Government Agencies. As a result Emergency Medical Responder Courses were

delivered by our instructors to the following agencies:

Gibraltar Fire and Rescue Service

Airport Fire and Rescue Service

New Emergency Ambulance

Two new Emergency Ambulance vehicles are expected to be commissioned this

year. The first unit is due to arrive in July 2017 with the second unit in December

2017. This is part of the transfer of the 3rd ambulance responsibilities from the


Gibraltar Fire and Rescue Services to the GHA planned to take place with the 3rd

Quarter of 2017.

AMBULANCE SERVICE OPERATIONS

Emergency Ambulance Deployments

Main Zone Deployments

Month Total Average

per day

Apr 430 14

May 446 14

Jun 380 12

Month Apr May Jun Total

Gib Port 7 14 8 29

North Area 61 53 35 149

Eastside Area 10 6 10 26

Westside Area 150 157 139 446

South District 86 83 76 245

Upper Town 23 30 22 75

Town Area 87 88 83 258

Frontier/Airport 5 9 4 18

Nature Reserve 1 5 3 9

Gib Dock 0 0 0 0

Maritime 1 1 0 2


AMBULANCE ROUTINE TRANSFERS OPERATIONS

Summary of Patient taken for Scans and or Transfers to Spain

Summary of Local Patient Transfers

Destination Apr May Jun

Algeciras 25 34 39

Benalmadena (Xanit) 23 32 27

Cadiz 0 3 0

Gibraltar 14 27 11

La Linea 0 0 0

Malaga 1 1 1

Seville 0 1 0

Jerez 2 1 4

Marbella 0 0 0

Totals 65 99 82

Month Total Average per day

Apr 338 11

May 317 10

Jun 273 8


Pathology Services

During this quarter, the Department of Pathology, in collaboration with A&E

clinicians, has introduced the parameter, Lactate, to its repertoire of parameters

available on its main biochemistry analyzers.

Lactate is of value as a parameter in various settings. Two major ones are: (1)

conditions associated with hypoxia, e.g. shock, congestive heart failure, myocardial

infarction, blood loss and pulmonary oedema, and, (2) Metabolic or drug/toxin

related disorders. Examples of metabolic disorders include diabetes mellitus, hepatic

disease, and neoplasia.

Sponsored Patients Services

The Sponsored Patients Department actively responds to the demand for tertiary services.

This quarter, the Sponsored Patients team has also been involved in the review of tertiary referrals and service arrangements in UK and Spain together with the Medical Directorate team and a new referral software application developed by the IMT Dept. has already been implemented. The application will assist in the capturing of information and requests for referrals from Consultants which are then reviewed by the newly formed Tertiary Services Review Board.



5.8 Deputy Medical Director - Primary Care Services

April to June 2017 This reporting period has been characterised by a consolidation of services and ensuring the new initiatives are established in to regular daily practice. This Board submission also heralds the start of a more accurate system of data collection in terms of services provided and numbers of patients seen in the different sub-departments. 1. Update from the reporting period March to June 2017

The Main Counter is working well and is allowing far better patient flow within the department as signs are clearer and clerks are more readily available. Patients now seek assistance at the Main Counter for Repeat Prescriptions, Appointments and Registration matters related to self-employment. The Repeat Prescription system continues to work well with increasing numbers of patients accessing this service daily as people become more aware of the service on offer and how to access it. The Medical Certificate Telephone Service also continues to go from strength to strength with increasing awareness of the service on offer and patients are reporting high (anecdotal) levels of satisfaction with these two services with no reported problems or complaints so far. The scanning and uploading of patient records also continues well albeit somewhat slower than originally anticipated. The GP lead Baby Clinics have now caught up with waiting times such that all babies are seen at the 6 week point for their scheduled check. 2. Administration All clerks attended a training session for CAMIS with the EPR team. Five admin officers attended the Frontline Staff Disability Awareness Training Seminar on the 24th May 2017 at the University campus. One member of the team also attended the Management Interpersonal Skills course from the 5th to the 7th of June 2017. The Last Prescription Service has helped 1329 patients over the last three months as follows, representing an average of 443 GP appointments saved per month:

Repeat Prescription Service Apr May Jun Total

Totals 328 523 478 1329


Note Scanning and Uploading

Patient Notes Scanned Apr May Jun Total

Totals 763 735 630 2128

So far since inception 2376 sets of patient notes have been scanned and uploaded and the paper record archived. 3 Registration Department

Patients seen at the Registration Counter

Apr May Jun Total

Totals 1460 2261 2532 6253

4. General Practitioners Activity Statistics The full range of clinic activities is included to demonstrate the wide range of services on offer and the numbers of patients seen. Clinic/Appointment Type Apr May Jun Total

2 Year Check (chronic disease) 38 55 30 123

Admin Repeat Prescriptions 724 1062 872 2658

Patient Administration 1814 2146 2078 6038

Advanced Appointments 1282 1795 1635 4712

Reports/Letters/Referrals 3469 4971 4164 12604

Critically Ill Patient 98 122 122 342

General Appointment 88 131 125 344

Dermatology (Review) 29 0 32 61

Dermatology New - Routine 57 61 80 198

Dermatology WSI Session 21 53 50 124

Dermoscopy 30 83 92 205

Discharged Patients 143 197 161 501

Elderly Care Agency 60 75 65 200

Emergency 1980 2031 1980 5991

Emergency Overflow 226 307 272 805

Home Visits 1109 1264 1220 3593

Last Prescription Reviews 643 954 853 2450

Medicals (Govt/LAC) 11 32 46 89

Minor Surgery 12 12 20 44

Dr Vassallo Specific 8 14 14 36

Palliative Care 112 48 40 200

Postnatal 28 47 66 141

Prison 40 50 30 120

Released On The Day 2381 2822 2769 7972

Review: To Be Booked By Clinician Only

461 688 612 1761

Women’s Health 129 164 160 453 Totals 14993 19184 17588 51765

GHA Board report – April 2017 to June 2017

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5. Nursing Services Activity Statistics

Apr May Jun Total

Child Health Department 49 51 30 130

Health Visitors/Nurse team

Newborn hearing test 30 45 34 109

Social services attendances 90 95 97 282

HV Primary visits 83 39 25 147

HV Assessments @ 8 weeks 25 45 31 101

Eneuresis Clinic 1 0 0 1

Weighing clinic, feeding advice

422 515 486 1423

Immunisation Clinic 331 1,157 380 1868

Totals 1031 1947 1083 4061

Cardiac Rehab Nurse

Inpatients visits 4 10 7 21

Pre clinics 6 3 2 11

post clinics 5 3 2 10

Cardiac rehab programme 47 77 72 196

Self-help group 82 0 0 82

Community 0 0 0 0

Drop-in 18 28 10 56

Totals 162 121 93 376

Diabetic Specialist Nurse

ADRC 150 95 239 484

Other (comment/default) 143 195 119 457

Diabetic Review 167 171 222 560

Diabetic ward patients 71 87 82 240

Diabetic ward/ antenatal patients

11 39 50 100

Glucose assessments 0 32 11 43

Clerical meetings 0 2 10 12

Unscheduled consultations 0 7 0 7

Telephone consultations 130 110 181 421

Totals 672 738 914 2324

Nurse Practitioner

Smoking Cessation clinic review

11 27 23 61

Smoking Cessation clinic new

10 36 22 68

Asthma Clinic/COPD 14 35 33 82

Driving medical 20 44 27 91

Emergency clinic 281 295 254 830


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Spirometry 8 15 21 44

Review clinic 15 43 27 85

Women’s health 21 31 20 72

Cervical Smears 364 86 124 574

Comment/admin 0 30 0 30

Totals 744 642 551 1937

Practice Nurses

Phlebotomy Clinic 1041 1346 1415 3802

Ear Syringing Clinic 51 75 78 204

ABPM Clinic 30 23 27 80

ECG Clinic 104 119 128 351

House call telephone calls 233 245 235 713

General wound 108 205 217 530

Lymphoedema clinic 29 34 53 116

Leg Ulcer Clinic 215 224 235 674

Doppler Clinic 11 21 18 50

Blood pressure check 345 477 376 1198

Hypertension clinic 94 137 168 399

Triage 38 43 54 135

Blood Glucose 268 65 28 361

Admission to A/E 18 19 14 51


Injections/ urinalysis/Nebs 400 425 475 1300

Nursing admin patient contacts

199 199

Reception nurse admin duties

0 1,913 1913

Sick note line consultations

192 244 208 644

Flu vaccines 2 0 1 3 Totals 3412 4088 6211 13711

Dermatology Nurses

Cryotherapy 154 259 236 649

Light therapy 16 13 0 29

Photos clinic 3 11 13 27

Pre- derm clinic 49 58 69 176

Ancillary see and treat 21 23 29 73


Minor-ops Hyfrecator 1 0 1 2

Patch testing 0 3 0 3

CDM 21 61 48 130

Totals 300 496 440 1236

Mental Welfare Officers 114 120 116 350


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District Nursing Team

Diabetic/Insulin 154 174 180 508

Dressings 379 431 294 1104

Injections 83 129 98 310

Baths/General Care 0 0 0 0

Visits- Support/Monitoring 111 77 115 303

Terminal Care 19 20 10 49

Catheter Care 5 4 11 20

INR and Blood Samples 88 131 94 313

Admissions 8 14 7 29

Discharges 4 9 1 14

Flu Vaccinations 0 0 0 0

Totals 851 989 810 2650

Grand Monthly Total 7286 9141 9778 26205

6. Dental Department Activity Statistics

April DNA May DNA June DNA

281 53 338 67 233 44

116 13 114 9 82 18

293 81 319 86 344 95

259 94 354 98 303 93

286 86 321 108 227 89

103 17 139 32 134 46

139 26 227 59 218 53

61 18 0 0 0 0

0 0 256 110 218 80

A Dental Officer visits HMP on a regular basis and has attended on 24 April and 23 May for this reporting period. 7. Allied Health Professionals i. Community Physiotherapy Apr May Jun Total

(PHYSIOTHERAPIST) 25 0 0 25

(PHYSIOTHERAPIST paeds) 37 120 69 226

(PHYSIOTHERAPIST paeds) 7 20 38 65

(PHYSIOTHERAPIST) 15 42 33 90

Totals 84 182 140 406


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ii. Speech and Language Apr May Jun Total

(Speech and Language Therapist) 72 156 149 377



(Speech and Language Therapist) 0 0 7 7 Totals 157 521 407 1085

The department has delivered a 4th NAS Earlybird Parent Training programme for parents of pre-school children with Autism. This 12-week Programme is run co-jointly with the Occupational Therapy Department. Service initiatives include a triage neurodevelopmental assessment clinic run by two senior therapists with the aim of identifying children with pervasive developmental disorders and the delivery of weekly neurodevelopmental therapy sessions working closely with these parents in meeting these children’s communication needs. A total of 8 children with ages ranging from 18 months to 6 years have accessed this provision during the period April to June 2017. iii. Occupational Therapy Apr May Jun Total

(Occupational Therapist) 2 3 32 37




Totals 65 75 73 213


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5.9 Mental Health – General Manager

April to June 2017 Introduction There has been a number of initiatives developed over this period, which will be extended over the coming months / years. The aim of mental health services as always is about recovery and a seamless journey through the services, during a period in one’s life, which can be very difficult at times. The focus of multi-disciplinary, multi-agency working we believe goes a long way to achieving this goal and is something we will continue to strive for. Inclusion rather exclusion must always be seen as the way forward and we believe that joint training initiatives such as we have had over the last few months will definitely aid this idea. Also presented are our plans for the coming months with respect to service delivery – the implementation of community outreach/ crisis work and phone lines will move the service forward and meet the needs of patients and carers who access our services. Section one – monthly activity Community Mental Health Team (CMHT) – Patient contact/staff activity


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Psychology therapy offered with mental health services

Primary Care

CMHT CAMHS External Secondary Care

Monthly Total

April 42 4 2 1 1 42

May 63 6 1 6 5 63 June 35 5 0 2 4 35

Totals 140 15 3 9 10 187

As in previous reports, the figures illustrate that most of the referrals made to the Department of Clinical Psychology and Counselling are from General Practitioners in Primary Care. These referrals are usually made on behalf of patients who are most appropriately allocated to the Counsellor but the excess referrals have until now been allocated to the Clinical Psychologists.

In-patient data and activities Horizon - Sky / Dawn - Flats / Sunshine / ARC

In-patient quarterly data – Horizon / Sky


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Section / appeals / outcomes April - June 2017

Month Number of patients admitted on section

Number of appeals / Section

Gender Outcome

April 2017 6 1 M Section upheld.

May 2017 5 1 M Section resinded and patient discharged.

June 2017 4 2 F One section was resinded and patient remained informal on ward One awaiting outcome of tribunal.


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Presented in boxes below are: (1) the patient admission and discharges for

Dawn ward, primarily from Horizon ward over the 3 month period covered in

this report. This movement from Horizon to Dawn clearly demonstrates the

work carried out in the in-patient settings in order that recovery and

reintegration back into community settings is happening. (2) The level of

dependency and (3) the current risks identified for patients within the

service.

Other groups / activites held on the Horizon and Sky

Arts and crafts x2 sessions every week

Interactive games x2 every week

Ladies pamper groups

Relaxation groups

Painting weekly

Commuity escorted leave, these will be for access to social events and

for collection of fortnightly benefits.

Rehabilitation in-patient services - Dawn Ward Data (Inc flats)


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As the above data indicates, Dawn ward has seen a total of 6 patients discharged from the in-patient services back to their home environment. The ward staff have achieved this through outreach work that they are currently offering to patients that may have been in hosptial for more than 13 years. They are currently also working with 3 in-patients providing support in the community in order to promote independent living over the last few months – through Multi team working with ARC and CMHT. The outreach offered has covered aspects of overnight leave at the 2 bed Community flat whereby patients are utilising 2-3 nights leave a week in increasing days / nights in order to faciliate a smooth reintgration back to the community. This has also included outreach from 20:00 – 00:00 during the night and 08:00 – 10:00 in the mornings, in order to observe concordance with medication, support with ADLs, assess mental state and social needs (budgeting, shopping etc) and environmental checks. The nursing staff on Dawn also work very close with the ARC team to offer support with ensuring accommodation is suitable for the patient once discharged or for Rehabilitation/ Outreach requirements. This includes home visits as assessment, meeting with source providers, ie electrics, water, housing departments. The ward has continued to take seriously the physical well being of patients also with a number of health checks co-ordinating throughout the month (see below). Daily outings/ activities on and off the ward to develop social skills and community skills for the patients both in group settings and 1:1s. Our patients are now benefiting from the ward team being able to provide assistance with benefits applications and payments of bills. Due to the better liaison with housing, patients are now benefiting from home improvements that in turn lead to better living conditions and an improved pathway to recovery.


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Specialist clinics held and Rehabilitation patients seen by colleagues

within ocean views or SBH . April 2017

Clinic Professional Number of patients seen

General Practitioner Dr Haider/ DR Marin 8

Physiotherapist At SBH 6

Outpatient Appointments to SBH

Various depts. 3

Patient outings Variety of social activities

5

Chiropodist John Miles 2

Outreach work Community and Kent house

13

Psychology Appointments 2

Specialist clinics held and Rehabilitation patients seen by colleagues within ocean views or SBH .

May 2017





Various depts. 3

Patient outings Variety of social activities

9

Chiropodist 3


14



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Specialist clinics held and Rehabilitation patients seen by colleagues

within ocean views or SBH. June 2017





Various depts. 3

Patient outings Variety of social activities 9

Chiropodist John Miles 3


27


Elderly care services - Sunshine ward

During the course of the 3 months represented within this report, Sunshine ward staff have facilitated a number of ward based activities, such as art, pamper groups, reminiscence and gardening. One patient recently admitted, did so with his pet bird, enabling both the patient and fellow patients to look after the bird’s needs, which has proved a success with a number of patients. Following the opening of Hillside residential care home, we have seen four patients transferred, therefore reducing the dependency levels on the ward from an environment, which had previously seen very high physical health care needs.

Specialist clinics held and Elderly care patients seen by colleagues within ocean views.

April 2017

Clinic Number of patients seen

General Practitioner 18

Eye Department 1

Chiropodist 3

Mount Alvernia assessments 3

Dermatology 5

Sunshine wards Identified risk April – June 2017.


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Specialist clinics held and Elderly care patients seen by colleagues within ocean views.

May 2017



Physiotherapist 6

Occupational Therapy 6

Palliative Care / district care team 4

Chiropodist 4

Specialist clinics held and Elderly care patients seen by colleagues

within ocean views. June 2017



Palliative Care team

4

Occupational Therapy 2

Chiropodist 1

Monthly sessional attendance by patients to the ARC.

The Activity and Rehabilitation Centre (ARC) team consists of three Occupational Therapy staff and three Nursing staff, who work collaboratively with the MDT to provide a holistic service to the patients. The ARC has established itself into it pleasant environment, providing homely, welcoming surroundings. Patients are able to participate in the activities on offer and feel relaxed and comfortable. Referrals are accepted from all three wards (of Ocean Views Mental Health Facility) and some sessions are specifically for certain wards. Tuesday and Thursday afternoons are specifically for the needs of Horizon ward to provide a quieter environment. Sunshine ward have a session on Monday afternoons and a ‘pamper group’ is held weekly on Wednesday mornings. In order to maintain good communication and working relationships, staff provide written summaries directly into ward patient notes, therefore enabling the full team to keep up to date with patient progress etc. The ARC provides a wide range of treatment, activities and support to facilitate functioning and recovery to patients within the mental health service. In order to continue the philosophy of recovery, the staff in the ARC promotes and encourages patients independence in all activities, from making themselves a meal, to supporting time spent at home and paying bills/rent and looking after their own home. The ARC provides a wide range of groups and activities, and also offers individual sessions, for example, cooking lunch, preparing for discharge, or supporting the patient to maintain their functioning and recovery. What might seem a simple ‘outing’ actually incorporates a lot more with regards to the aims and needs of the patient. The Community skills groups provide structure and routine, a chance to socialise with others from within and outside of the hospital, and to gain confidence in using public


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transport. It encourages motivation and confidence in an everyday activity of going out for a coffee, and may include, for example, paying bills, collecting benefits, attending hairdresser/ dental appointments, or buying toiletries/ clothes. The ARC also provides relaxation sessions for the patients on the wards, the Drug and Alcohol Service (Bruce’s Farm) and the Cardiac Rehabilitation Service at St Bernard’s Hospital. Community patients are seen either in groups or individually to encourage independence and community living skills.

Activities completed per month by Arc for ward / community patients April to June 2017

April May June

Horizon 29 65 39

Dawn 135 175 148

Sunshine 26 34 26

Community 65 119 105


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5.10 Director of Information Management & Technology

April to June 2017

During the second quarter of 2017, the number of calls to the IT Helpdesk has remained high. This is despite the fact that GHA staff have been able to submit tickets directly, and avoid calling the IT helpdesk support line, for some time. This demonstrates the continued reliance an IT systems which will increase further as more systems are implemented and further computerisation is introduced. The new GHA website, with a fresh look and feel, utilising modern functionality that is now common place on most modern websites, was launched on 13th June. The new content management interface now allows departments to keep content as up-to-date as possible without having to ask for changes to be made by the GHA webmasters. In early April, the Pathology Results Mobile App was launched together with the notification by e-mail of Pathology Results being ready. This has realized huge benefits and ensures that clinicians are made aware of, and are able to view, their patient’s results as soon as they are ready. Other work in the Pathology Department continues, assisting in expanding the computerization across all pathology disciplines. The department continues to assist with the computerisation of Microbiology and the Anticoagulation clinic. Izasa continue to use the installation as an example of cutting edge implementation of their systems. The Backup/recovery system continues to function well on a technical level. IMT Helpdesk

Our helpdesk continues to be at the core and central to our department. GHA staff continue to submit support tickets directly into the system which initially reduced the number of calls received but the number is now rising and for this quarter was between 500 and 700 calls per month. This increase in calls continues to reflect the growing usage and reliance on the IT systems by GHA staff.


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It can also be seen, in the table below, that the number of support tickets created in the last quarter has dropped from the previous quarter but is still an average of 400 calls per month. This continues to be substantially higher, by at least a factor of two, than levels prior to implementation of the EPR system.

Patient Entertainment System Daily checks continue to be carried out, and a high level of availability and service is provided to patients on this system. Requests to install TVs in the Elderly Care Agencies Cochrane Ward and Calpe Ward are still received but have reduced considerably due to the fact that a large number of the beds now have the installation completed.


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General

Regular backups of our main servers and databases continue to ensure the integrity and safety of our data. 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. Information Systems Projects Below is an update of the programme of works highlighted in the previous report. Hospital Stores Inventory and Stock Control System

The online user portal for stock ordering has been completed and is being trialled by the Stores and Procurement Department for the placing of hospital pantry orders. Human Resources System

The HR system is in active use by the HR department. Sponsored Patients This module was completed and launched in April as planned. It allows clinicians to submit an electronic form when patients require treatment at a tertiary clinic. This serves to notify Sponsored Patients of the need for this patient to travel for treatment. The system also notifies GHA Consultants when a follow-up has been requested by the tertiary clinic, so that they can approve or reject this follow-up (e.g. if the follow-up could be done locally.) Further enhancements were made to the system in May at the request of the Medical Director. These included the automatic submission of all new tertiary referrals created by clinicians to the Tertiary Referral Board for consideration. The Board can view all of these referrals and approve / not approve them as appropriate. The system automatically notifies the relevant parties (consultant, secretaries, Sponsored Patients) of the decision of the Board. Enhancements to Screening application

The screening application has recently been expanded to also include the Breast Screening programme. It is now being used for Colorectal, AAA and Breast screening programmes. Further re-development of the screening application is on-going, providing additional features and functionality in a rolling programme.


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As further screening programmes are introduced, these will be incorporated as and when needed. Also, additional functionality for recall management and a general screening programme is being developed. Staff Recertification Database The module to record and maintain re-certification and qualifications of GHA staff has been completed and is now in use.


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5.11 School of Health Studies

April to June 2017 During this session, the School of Health Studies has received much good press. In May, the School enjoyed a successful awards ceremony where a range of vocational awards were made to a wide range of staff from across the GHA with the Honourable Minister of Health, Care and Justice in attendance. The External Advisor to the Enrolled Nurse Programme made her annual visit to the School of Health Studies where she met pupils, school staff and clinicians. Her annual report was most complimentary praising the work of the pupils and the School noting that programme remains current and is fit for purpose. The 4th Enrolled Nursing programme that commenced in February 2017 from across the health and social care sector is progressing well. This cohort of pupils have submitted their first written assignment, they continue to develop their QCF portfolios. The School has held the first of 5 men’s health seminars focusing on health screening. Publicity was wide ranging with much media interest. These public events are held at the King’s Bastion Cinema, the first was opened by the Honourable Minister of Health, Care and Justice. The second seminar focussed on male cancers. We continue to facilitate and offer a range of multidisciplinary study days and accredited learning modules at a number of academic levels, often these are bespoke and are provided in response to service need. We have completed a Gibraltar run and assessed 15-credit level 6 and 7 mentorship module, this is the first time we have offered the module at level 7. The Work Based Learning Module has commenced. Participants focus on local health and social care issues working with their manager/supervisor to achieve the module learning outcomes. This module adopts a practice based approach to learning. The third iteration of the CRIPA module has commenced, the module is offered at level 6 and 7 with 30 academic credits. The 2nd year BSc (Hons) Nursing programme continues. It is anticipated that this cohort of students will successfully progress to the 3rd year of the programme with regards to the theory and practice elements. The 3rd year BSc (Hons) students have now completed all academic aspects of their programme. All students seeking employment will be offered employment locally if completing successfully.


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The School ran a successful open evening with the Honourable Minister of Health, Care and Justice in attendance. Over 25 members of the public attended. The primary aim of the open evening was primarily to recruit to the September 2017 intake as well as inviting the public to meet students, staff and view our facilities. Candidates from across the GHA have been interviewed for the MSc Leadership and Management for Health Care Practice with the programme leader from the University of Salford participating in the interviews.

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