Wednesday, June 29, 2005

Government will deliver Health Service Gibraltar deserves

Government remains committed to seeing through a complete overhaul of Gibraltar’s Health Services and, with the New Hospital now commissioned, part of that project has been achieved.

That was the message from Ernest Britto, Health Minister, in his Budget speech. He told the House that that much progress has been made.

Mr Britto spoke fully sensitive to the fact that theGSLP/Liberals Opposition has targeted health and housing at the frontline of their political strategy. But the minister declared that the Government had recently passed three major milestones:

- The introduction of new expertise and the restructure of the Senior Management Executive Team.

- The start of the implementation of the measures of improvement arising from the work of the Healthcare Development Review, and

- The once in a lifetime opening of a new hospital.

Mr Britto said that the new Chief Executive for GHA (Gibraltar Health Authority) Dr David McCutcheon, formerly the Assistant Deputy Minister in the Ministry of Health and Long Term Care in Toronto, Canada, is now firmly in the driving seat with a team including experts brought over and the local GHA team.

The New Hopsital

Commenting on the success of the complicated transfer from the old St Bernard’s, Mr Britto said that it was now “an indisputable fact that Gibraltar can now boast of an excellent secondary care facility, within an environment, which is welcoming for the user, spacious and well equipped for the benefit of patients and staff.”

He highlighted the “Front of House Staff” at the reception which uses volunteers from Community Care helping hospital visitors, providing assistance to patients and befriending patients with no visitors as well as comforting and helping families when extra hands are required.

Substantial increase in the amount of space allocated to the new hospital and the complexity of its new systems has required an increase in staffing levels of domestics, clinical, administrative and ancillary staff means that over 80 additional staff are employed.


Arrangements are in hand for the GHA to participate in a collaborative study with a London Teaching Hospital on standards and methods used for cleaning. Patients, visitors and staff will be consulted in a cleaning satisfaction survey that we intend to introduce in due course.

Renal Dialysis

The new renal dialysis unit is now close to completion and is expected to be fully operational this summer, said Mr Britto who said that the Authority has entered into a contractual arrangement with the Directors of the same unit that are contracted to run the services in La Linea.

The scope of radiology services has increased significantly, new CT scanner and mammography equipment and when a third full time radiologist arrives this will be operating.

“The new hospital has been a tremendous and unqualified success,” Mr Britto declared adding that the vast majority of Gibraltarians and other local residents have recognised this by their unstinting praise and favourable comments.


“It is only a very small minority, made up by those who have political or other ulterior motives, who have insisted with petty minded or malicious criticisms.

The opening of a new hospital is a major undertaking and it is the experience of those who have done so in other parts of the world that there are always teething troubles and new challenges which emerge as all concerned, including Management Staff and patients, adapt to the new working environment and conditions. These periods of adjustment are usually at least six months in duration,” he said.

No Private Practice

Mr Britto invited any person to report to him incidents of private practice carried out on the hospital premises or in contracted hours. “Action will be taken,” he said adding that the abolition of private practice within GHA premises has been carried out successfully and “with the co-operation of those concerned”. “There has been a historical link between private practice and waiting lists and this Government is committed to ensuring that patients do not need to seek private care to ensure rapid treatment of their medical condition,” he said.

Mr Britto also stressed the importance attached to the new statue backed complaints procedure now under Complaints Co-ordinator Marisa Desoiza and that also includes possible reference to the Ombudsman.

Government has made provision within the new hospital to ensure that facilities exist to cater for the reduction in waiting lists, Mr Britto said pointing to staff increases and a strategy of scheduling admission and discharge processes in combination with effective bed management.

Primary Care

Changes within Primary Care include the review of all aspects of GP working arrangements and practices.

In the next few weeks a revised Healthcare entitlement card in the format of the familiar plastic credit cards will be gradually issued to replace the cardboard ones currently in use. It is to be issued in tandem with the E111 card devised by the European Commission.

Mr Britto also recognised that there remains more GHA to do to provide the quality and level of service that patients are entitled to and deserve. Something which is “easy to say but hard to do”. He made clear that this will need some time. He nonetheless pointed to recruitment of new specialists including a Gibraltarian paediatrician Dr Daniel Cassaglia.

Over the next year all the doctors in the GHA, the consultants, the general practitioners and the hospital-based doctors will all be on a continuing professional development path following a performance appraisal. “For the first time in the history of the GHA the Government will be assured that a system is in place to assess and manage the competence of its clinicians,” he said. This involves ensuring doctors and nurses are kept up to date with professional developments.

Mr Britto recognised complaints about access to primary care and increasing frustration because people sometimes cannot see the same doctor or go to the same team of doctors. This was becoming more difficult because of the large number of persons going to the Primary Care Centre only because they were seeking certificates of sickness or seeking repeat prescriptions, he said.

“We need to use our resources more wisely, provide better service to our patients and provide a better quality of working life for our staff,” he said, announcing that a new plan will be implemented over the next year.

Mental Health

Mr Britto also told the House that Government will honour its commitment to “review and modernise mental health legislation and facilities”.

The GHA also plans to carry out a public health needs assessment into childhood obesity, smoking rates and the burden of illness presented by chronic diseases and access rates to primary care.

Mr Britto told the House that the attitudes in the GHA are slowly but surely changing and that an effective and robust complaint’s process has commenced and the feedback is already having its effect. Management, he said, is focusing on improving performance in the key department areas of nursing, laboratory, health records, radiology, information systems, finance and human resource management.

“The Government’s overall aim is for the GHA to get you into hospital more quickly, treat you better and discharge you as planned,” said Mr Britto.


Laboratory management systems and procedures are being altered to create a standard comparable with all the major laboratories in the world, said Mr Britto.

He however admitted that the state of the health records has always left a lot to be desired. The functions of medical librarianship and that of appointment scheduling have now been separated and a file tracking system is currently being introduced, and health records access has already improved from 60% to 97% since the opening of the new hospital.

“The centralisation of all waiting lists, the introduction of appointment scheduling and a front of desk appointment system, together with the appointment of further Consultant Staff, will see marked improvements in the reduction of waiting times,” he said.

Meanwhile Mr Britto said that Government would like to make GHA fully autonomous, if separation from the civil service can be negotiated and agreement reached on terms acceptable to GHA staff and government. He claimed that this will help management and staff achieve best human resources practices in the principal areas of attendance improvement, discipline management, performance management and leadership development.


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