GHA Board report July 2017 to December 2017

Transcription

1 GHA BOARD MEETING AGENDA Venue: John Mackintosh Hall, Charles Hunt Room Friday 16 th February 2018 at 11am 1. Apologies for absence 2. Minutes of the meeting held on Wednesday 26 th July 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 5.12 Complaints 6. Date and time of next meeting 7. In Camera session 1 P a g e

2 Minutes of the meeting held on Friday 20 October 2017 GIBRALTAR HEALTH AUTHORITY Minutes of the meeting held on Friday 20 October 2017, at 2:00 in the afternoon in the Charles Hunt Room, John Mackintosh Hall. Present: Dr D. Cassaglia (DG) Mr J. Zammit (JZ) Mr E. Gomez (EG) Mr E. Lima (EL) Mr E. Baglietto (EB) Acting Chairman Medical Member Chief Secretary Non-Executive Member GTC Member Apologies: The Hon. N.F. Costa (MH) Chairman Mr C. Lavarello Non-Executive Member Mrs P. Galliano Non-Executive Member Mr A. Mena (AM) Financial Secretary In Attendance: Mrs J. Montado Mr H. Watson Ms L. Louise Mr C. Chipolina Dr K. Rawal Mrs E. Cervan Mr D. Figueredo Mr T. Dolding Director of Finance & Procurement (Ag) Director IM&T Head of Public Service HR General Manager Mental Health Deputy Medical Director Principal Secretary SBH Operations Manager Head of Estates and Clinical Engineering Secretary: Mr S.C. Galliano 1. Apologies for absence: The Hon. N.F. Costa (MH) Chairman Mr C. Lavarello Non-Executive Member Mrs P. Galliano Non-Executive Member Mr A. Mena (AM) Financial Secretary Welcome from Chairman: The Acting Chairman opened the meeting. 2. Minutes: The minutes of the meeting held on Friday 2 June 2017, were approved as a true record. 2 P a g e

3 3. Matters arising: No matters arising 4. Statement by the Minister: The Minister had excused himself from the meeting, in the circumstances there was no Ministerial Statement. 5. Matters for Report: The Medical Director guided the Board through the Executive Summary for the second quarter (April 2017 to June 2017) It was reported that the sick note telephone line service is proving a success and, as a result, continually increasing the release of appointments presently, an average of 750 per quarter. There are now over 8,000 medical notes in digital format. All Director s Reports were taken as read and accepted. 6. Question Time: No questions at this meeting. 7. Next Meeting The next meeting was set down for 12 January 2018, at 2:00 in the afternoon in the Charles Hunt Room. 8. Closure of Meeting Being no further business the meeting concluded. For the record, the meeting was quorate throughout. 3 P a g e

4 5.1 Executive Summary - Medical Director Mr Chairman, Board Members, this Executive Summary Report covers the 3 rd and 4 th Quarters of I will summarise the report highlights according to our GHA Strategic Objectives 1. Sustained bed availability, effective Bed Management and improved patient access. Bed availability has been excellent over the winter months and on average there are approximately available beds on any given day. This has been achieved by having a proactive bed management system involving the weekly multi-agency bed management meetings - Care Agency (Hospital Social Worker, domiciliary care packages), Housing and Elderly Residential Service. During this period, there have been no surgery cancellations due to unavailability of beds. The last cancellation due to unavailability of beds was January Captain Murchison Ward has been designated as a rehabilitation ward to improve our discharge rate for patients with complex medical needs. A similar system has been established at Ocean Views offering potential for discharge of patients who previously would have been unable to return home safely. Dr Gracia s appointment as Associate Specialist has been pivotal in providing medical support to the rehabilitation team on Captain Murchison Ward and in ensuring early identification of patients requiring more assistance to facilitate discharge home at the end of their episode of care.. In order to improve patient access at the PCC, additional resources were diverted in the last week in December to help deal with the winter demand. three doctors were allocated walk-in style/book on the day appointments to ensure that patients are not turned away. This was the first of a series of measures to improve patient access to the PCC. 1 Improvement and expansion of services available at the GHA including Repatriation of Services Critical Care Unit: Services provided by the St Bernard s Hospital Critical care Unit have increased to provide the latest technology in Renal replacement therapy now being administered mostly by GHA nursing staff. Four GHA registered nurses are currently undertaking a full time MSc in 4 P a g e

5 Intensive Care Nursing at Salford University with a clinical attachment at the Salford Royal NHS Foundation Trust. 5 P a g e

6 Haematology Oncology Chemotherapy Treatments: The GHA Ayling- Buttigieg Chemotherapy Unit has extended it s opening timetable to include Fridays (previously Tuesday to Thursday) in order to cater for Haematology patients under the care of Dr Pepe Duran who require chemotherapy. As from 24 th November 2017 these patient can have their Chemotherapy in Gibraltar instead of travelling to a centre outside Gibraltar. Orthopaedic Department reforms :. In addition to the Musculoskeletal Specialist GP Dr Elaine Flores we have recruited two new Consultant Orthopaedic Surgeons. Mr Marius Negru, specialist in Upper limb orthopaedic surgery who started in September Mr George Chami, specialist in foot and Ankle orthopaedic surgery started in December Mr Thomas Boerger will continue to provide a specialist Knee and Hip orthopaedic service. Our substantive consultant team is now complete and will each provide specialist orthopaedic services. This reconfiguration will result in reduced waiting times and more specialist orthopaedic surgery taking place in Gibraltar. Junior Anaesthetists: The GHA has employed a new tier of Junior Doctors to be resident in hospital 24hours a day 7 days per week to cover Anaesthesia and Intensive Care. This means there will now always be two intensive care/anaesthetic doctors available at all times to look after our sickest patients and facilitate emergency surgery out of hours. General Surgery: Mr Antequera, Upper GI and Bariatric Surgeon now provides a specialist Bariatric Surgery service in Gibraltar (previously provided in UK). Mr Mansour, Colorectal Surgeon is now providing major colorectal procedures and other specialist colorectal surgery. Both Mr Antequera and Mr Mansour use the latest keyhole surgery techniques resulting in enhanced recovery time for most patients and shorter hospital stays. 2 Establish and embed Clinical Governance structures and systems Clinical Risk Management: The Datix Clinical Incident reporting system has been officially rolled out together with the establishment of the Clinical Incident Grading Group (CIGG). 6 P a g e

7 GHA staff are being trained in the new reporting system and are now reporting all clinical incidents and near misses electronically on Datix. These incidents are then reviewed by the Clinical Incident Grading Group and appropriate management actions instituted. This system will allow us to measure the number and types of incidents that occur in the organisation and enable management to work to minimise risk and improve the quality of care. 3 Return GHA into financial balance, ensure value for money In-Camera update 4 Improve the patient experience and increase community participation in formal GHA structures. Cardiac Rehabilitation: The new Lionel Perez Cardiac Rehabilitation Centre was opened on 20 th December Establishing this new facility followed extensive consultation with patient advocacy groups working with the Minister for Health and GHA staff to bring this project to fruition. PALS: The GHA Patient Advocacy & Liaison Service (PALS) launched over a year ago has now amalgamated with the Office of the Ombudsman Complaints Handling Scheme to provide a single point of contact for patients seeking advice or giving feedback. This will provide an improved service to the general public. GHA Medical Liaison Doctor in Spain: The GHA employed the services of Dr Ernest Guillem, a Gibraltarian doctor with over 30 years experience working in Spain to provide a liaison service with our Spanish tertiary providers. His role is to ensure that the medical needs of GHA patients are met whilst admitted in hospital in Spain and this will be achieved by regular visits and coordination with the Spanish medical teams. Dialysis: The GHA Dialysis Unit has reached full capacity in its current configuration. A review of the service in consultation with the Gibraltar Dialysis Patients and Friends Association Group has taken place to plan for future needs. This has resulted in a reorganisation of the service, which should be completed in early The service currently runs on 3 days per week and opens for 14 hours to cater for 3 dialysis sessions per day (9 dialysis sessions in total per week). 7 P a g e

8 The plan is to recruit more staff to be able to open the unit for 6 days per week for 2 sessions per day (12 dialysis sessions in total per week). This represents a 33% increase in capacity and more flexibility with dialysis session availability. It will also allow the unit to increase capacity more easily in future if necessary. These changes will also be supported by upgrading of some of our dialysis machines the introduction of new computer software and integration with the laboratory results service. Dr Danny Cassaglia Medical Director 8 P a g e

9 5.2 Director of Public Health July 2017 to September 2017 Screening Programmes Colorectal Cancer During the period spanning the months of July to September, a total of 671 invitations were mailed to eligible participants inviting them to take part in the Colorectal Cancer Screening Programme. During this same period 703 testkits were prepared and mailed to the participants and 286 samples were returned to the hospital laboratory for analysis. The breakdown of the results is as follows: 228 Negative for occult blood results 39 Inconclusive for occult blood results 19 Positive for occult blood results Of those participants invited to participate, 3 categorically refused to participate in the screening programme. In accordance with the protocol, the persons will be re-invited to participate in two years. Of the 15 invitations extended to eligible participants residing in Spain, 0 individuals expressed interest in participating in the screening programme. During this time frame, 2 individuals who were aged over 74 and therefore not routinely invited group, approached the screening office requesting to be included electively in the CRCS programme. During these months the Surgical Out-Patient Department notified the Screening Office of the following results: 2 Cancer diagnosed 6 Adenomas diagnosed (placed in surveillance programme) 25 Adenomas diagnosed (returned to screening programme) The reasons why participants visit the screening office appears to have changed. Following the introduction of the new Fact Sheet, which answers many frequently asked questions and dispels some myths, enquiries related to aspirins and anti-inflammatory medication have disappeared. The bulk of visits now relate to the requesting of replacement test-kits or seeking clarification on the method. In addition, following a public survey which had suggested that the emotive fear of cancer and negative perception might be deterring the uptake of the programme, it was decided to have the Colorectal Cancer Screening programme renamed as the Bowel Screening programme. The programme literature is being amended in a phased manner so as to avoid wastage of stationery and instructional leaflets / media. It is hoped that these changes might be more acceptable to the target audience and in so doing raise the current participation rate. The current Response Rate of the programme continues to be at 42.6% for this quarter, which is par for Gibraltar but much less than that of the UK, which is around 60%. 9 P a g e

10 Abdominal Aortic Aneurysm During the period of June - September, 38 invitation letters were mailed to eligible participants and 24 accepted their invitations. In addition 14 gentlemen accepted their invitation after receiving reminder correspondence over a 6 month period (The addition of both figures provides a 100% response for this quarter). All these participants were issued with ultrasound appointments. A total of 2 reconsider letters were issued to participants who did not reply. No expressed refusals were recorded during this period. However, 62 invitees, who did not respond to either the invitation letter or the reconsider letter were marked as Inactive and notified. Requests were received from 0 individuals aged years (outside the invitation range) to take part in this initiative as elective cases. During this period, 50 men were screened and 2 small aneurysms were newly diagnosed. Two men who were previously diagnosed with small abdominal aortic aneurysms were rescreened during this quarter. Health Improvement Public Events The Health Promotion Officers led or participated in the following events: The Officers prepared a presentation titled Healthy Eating for Healthy Living, based on the activities organised for the Gibraltar Sports and Leisure Association (GSLA )Summer Sports Programme in 2016 in Jersey- this was presented on July 6 th at the Public Health Inter Island Conference in Jersey. The Officers organised a campaign on Noise-Induced Hearing Loss in conjunction with the Department of Equality and with the Gibraltar Hearing Impairment and Tinnitus Association (GHITA) on August 22nd. Posters were designed for the event and leaflets, bookmarks and ear plugs were distributed to the public. The event was extensively covered by the media. The Officers attended sessions of the Men s Health initiative at the Leisure Centre on 20th July (Mental Health) and on 21st September (Healthy Lifestyle). The events were well attended with active participation from the audience. The Officers supported the Big Latch On on Saturday August 5th organised by Gibraltar Breastfeeding Association at Café Solo. Minister Samantha Sacramento was present at the event. The Officers commenced a new series of activities for the GSLA Summer Sports schedule on 1 st August to run every Tuesday from 11:30-12:30 for 3 weeks. Crucial aspects of healthy eating were covered through a power point presentation and a number of activities were carried out. These included: o Setting out a well-balanced plate of food using models of food and laminates 10 P a g e

11 o Choosing whether a given activity contributes to making your heart healthy or unhealthy o Dodge-ball style game with cut-outs of foods (healthy/unhealthy)- the aim being to try and hit healthy foods on the opponents side to gain a point The beach ashtrays (as in photo) designed by the Environmental Agency were distributed at Eastern beach on Friday 4 th August. The Officers worked with UNITE the Union during the music festival Gibraltar Calling on 2nd and 3rd September and offered free sunscreen to all attending the concert. This event has been held annually for the last 3 years and is very well-received by the public. The Officers supported the Gibraltar Alzheimer s and Dementia Society at their Dementia Awareness day on Saturday 16 th September. They also attended a drop in session on dementia held at King s Bastion on 20 th September and participated in a series of mini workshops. The Officers joined with the Cardiac Rehabilitation department, other GHA professionals and members of the Cardiac Association to organise the Heart Health campaign on September 29 th. The event was held at Casemates with representation from several other organisations including Diabetes care, Pharmacy, Dietetics and GSLA. To raise community awareness for this year s event, the Health Promotion Team asked departments, friends and families to take and send Heart Selfies. A Wall of Selfies was created (as in photo) and put on display on the day. The event was well attended and received extensive media coverage. Networking activities The Officers met with the Department of Equality to discuss strategies to highlight drug awareness in the community- production of infomercials featured on the agenda. The Officers met with the Alameda Wildlife Conservation Park and Janine Galliano to discuss progress of the healthy meat free initiative and future actions. A number of leaflets highlighting the health, environmental and economic benefits of reducing dietary consumption 11 P a g e

12 of meat have been designed and distributed to several restaurants in Gibraltar. The Officers met with representatives from the Police at their request to discuss collaborative working and regular presentations at their premises on health issues that affect the workforce. GHITA was provided with several posters designed for the noiseinduced hearing loss campaign. The newly formed Cardiac Association was provided with posters and leaflets for their new premises. Teaching and Training The Officers attended the following personal development events: Publicity and the Media o mentorship update session at the school of Health Studies. o seminar on Autism Health topics covered on GBC Radio health file included: o Noise-induced hearing loss o Healthy eating o Contraception awareness o World Heart Day Articles for the Gibraltar Chronicle included: o World Hepatitis Day 28 th July 2017 o Don t burn in the Sun o Your vision matters o Noise induced hearing loss o Contraception Awareness Day 26 th September 2017 o World Heart Day 29 th September 2017 Article for Insight Magazine (August issue) in conjunction with the GHA Dietetics Department on Nutrition, the brain and mental health 12 P a g e

13 New Resources A new leaflet on Fever was designed for the Child Health Department and printed in-house. A new banner was created for the Public Health Department (as in photo). New infomercials were produced: 1) Stroke was completed and broadcast on TV in August 2) Change4Life-Salt Two new pop-up banners on healthy eating were procured from Comic Company, UK for use at different campaignsthese were customised with the Public Health and GHA logos. Policy development A rolling programme to review Infection Control Policies is on-going. Policies currently being reviewed MRSA policy-ic (in progress), Operating theatre policy IC-0115 (completed uploaded) & Disposal of cadaver-ic-0120 (completed and up loaded). An inter-agency project involving all the emergency services, to update the Gibraltar plan for dealing with white-powder incidents and suspect packages contaminated with biological agents, is reaching completion. Significant Points of Action 1. Total Room Decontamination: Given the recent increase in the incidence of infection and/or contamination with serious organisms like Clostridium difficile and CRE, it has been agreed to implement a process of total room decontamination using up-to-date Hydrogen Peroxide Fogging technology. This is in the process of being procured. October to December 2017 Screening Programmes Colorectal Cancer Screening Programme During the period spanning the months of October to December, a total of 1002 invitations were mailed to eligible participants inviting them to take part in the Colorectal Cancer Screening Programme. During this same period 1013 test-kits were prepared and mailed to the participants and 485 samples were returned to the hospital laboratory for analysis. The breakdown of the results is as follows: 404 Negative for occult blood results 43 Inconclusive for occult blood results 38 Positive for occult blood results 13 P a g e

14 Of those participants invited to participate, 4 categorically refused to participate in the screening programme. In accordance with the protocol, the persons will be re-invited to participate in two years. Of the 48 invitations extended to eligible participants residing in Spain, 6 individuals expressed interest in participating in the screening programme. During this time frame, one individual who was aged over 74 and therefore not routinely invited group, approached the screening office requesting to be included electively in the CRCS programme. During these months the Surgical Out-Patient Department notified the Screening Office of the following results. 1 Cancer diagnosed 8 Adenomas diagnosed (placed in surveillance programme) 12 Adenomas diagnosed (returned to screening programme) It was announced in the last Report that a decision had been taken to have rename the programme from the Colorectal Cancer Screening to the Bowel Screening programme, in view of the apparently negative response to the former name by the public. The programme literature is being amended in a phased manner so as to avoid wastage of stationary and instructional leaflets / media. Over a period of time all materials related to the programme will reflect the new name and emphasise bowel health as opposed to emphasising the detection of bowel cancer. It is hoped that the altered language might be more acceptable to the target audience and in so doing improve the participation rate. The FAQ sheet that accompanies each test-kit has also been extensively amended. This leaflet answers many common questions and dispels some myths potential participants had as to whether they should perform the FOB test. A possible consequence of the new FAQ sheet may be reflected in the fact that the bulk of visitors to the Screening Office now come to request replacement test-kits or seek clarification on the method rather than to seek basic information. The Response Rate of the programme continues to be disappointing at 47.9%, for this quarter when compared to that of the UK, which is around 60%, but this is slightly better than the response figure of 43% in the first year of the programme. Abdominal Aortic Aneurysm Screening Programme During the period of October - December 86 invitation letters were mailed to eligible participants and 32 accepted their invitations. In addition 16 men accepted their invitation after receiving reminder correspondence over a 6 month period (The addition of both figures amounts to a 55.8% response for this quarter). All these participants were given ultrasound appointments. 14 P a g e

15 A total of 27 reconsider letters were issued to participants who did not reply. 2 expressed refusals were recorded during this period. However, 14 invitees, who did not respond to either the invitation letter or the reconsider letter were marked as Inactive and notified. Requests were received from 1 individual aged years (outside the invitation range) to take part in this initiative as elective cases. During this period, 39 men were screened and 1 small aneurysm was newly diagnosed. 2 men who were previously diagnosed with small abdominal aortic aneurysms were rescreened during this quarter. Health Improvement Public Events The Health Promotion Officers led or participated in the following events: The Officers ran a campaign outside the ICC building for World Mental Health day (10 th October) with the support of the Gibraltar Welfare Society, students from the Gibraltar College, the Psychological Support group and Ocean Views. The topic this year was mental health in the workplace. Several visitors sought information on GHA counselling services. The Officers ran a campaign for World Diabetes Day (14 th November) supported by the adult and paediatric diabetic nurses. The focus this year was on Women and diabetes. The event was well attended. The Public Health website was launched on 8 th December at the No. 6 Press Office by Minister for Public Health Dr Cortes. The Officers developed posters for Conscious Eating to support World Vegetarian Day and an online competition with prizes donated by local restaurants such as Kasbar and Pizza Express. The Officers met with dentists to discuss an initiative by the Gibraltar Dental Association to distribute 20 Save-A-Tooth pots to the ambulance service, local schools and the Sports and the Department of Education. These are devices designed for saving knocked-out teeth and can keep the tooth alive for 24 hours until replanted by a dentist. The Officers attended the fifth and final session of the Men s Health Initiative at the Leisure Centre on 25 th October. The Men s Health Passport was distributed to attendees on the day. Networking activities The Officers met with the Alameda Wildlife Conservation Park and the Environment department to review a new leaflet for local restaurants on health and environment issues related to meat and dairy produce. 15 P a g e

16 The Officers met with the Nurse practitioners to discuss Sexual Health program for secondary schools in The Officers participated in the CHAMPs initiative to promote healthy lifestyles in children. The Officers provided the newly formed Cardiac Association with posters and leaflets for their new premises. The Officers supported the Breathe Easy charity on the World COPD day (15 th November) campaign, providing them with No Smoking literature and posters for their premises. The Officers supported the GHA physiotherapy and OT departments in their campaign covering Stroke Awareness (18 th November). The Officers met with the Antibiotic Stewardship team on raising public awareness regarding antibiotic resistance. The Officers provided GHITA with several posters designed for the noise-induced hearing loss campaign. Teaching and Training The Officers delivered a health promotion talk in St Paul s First School on 6 th October (covering healthy eating, exercise, hygiene, head lice and dental health). The Officers delivered the first two talks (out of planned four) to the Year 8 groups in Bayside School discussing healthy eating, portion sizes, and food swap ideas. The talks were well received and involved active discussion. 16 P a g e

17 Publicity and the media Health topics covered on Radio Gibraltar Health File included: o Hand hygiene and Flu o Women and Diabetes o Healthy Lung Awareness Article for Insight Magazine (January issue) included: o World Obesity Week Articles for the Gibraltar Chronicle included: o World Vegetarian Day 1 st October o Importance of hand hygiene o World Mental Health Day o Health concerns for Cocaine use and addiction o International Stress Awareness Day o Save that tooth (Dental Pots) o Diabetes o COPD o International Men s Day o Antibiotic Awareness week 13 th - 19 th November o Surviving the Winter Blues o World Aids Day Short infomercials were aired on GBC-TV on WHO Antibiotic awareness during November and December. The Health Promotion website was updated with new posts on Understanding Autism, WHO antibiotic awareness, Stroke awareness, Diabetes, COPD and AIDS. The Officers carried out updates of St Bernard s display boards and all of the poster boards across the Primary Care Centre. New Resources Several new posters have been developed and printed in-house, including o Stop the spread of Flu, o Flu Vaccination Clinic, o Protect our patients, o Role of the OT, o Cardiovascular diseases, o A child s guide to tooth-brushing, and o Use of alcohol gel in hospital. A new leaflet Is your child too sick for school? was procured. Two new pop-up banners on healthy eating, customised with the Gibraltar Public Health Logo were procured and are used for display at campaigns and other initiatives.(e.g. Healthy lunchbox at the Bayside talks for year 8 pupils). 17 P a g e

18 Infection Control GHA Board report July 2017 to December 2017 This section of the Department consists of the Director of Public Health and two Infection Control Practitioners, who oversee the functions of infection prevention, control and preparedness. They also provide training to healthcare staff, advise other government and non-government staff and participate in public education programmes on matters of infection prevention and control. Surveillance Daily surveillance of highly resistant organisms like MRSA, CRE & ESBL continues. All patients returning from tertiary Hospitals are screened for MRSA and CRE. Blood-Borne Virus (BBV) prevention A new alerting function was introduced in the Emergency Department s Symphony information system, which will help in flagging up known colonisers of ESBL, MRSA, CRE and Clostridium difficile, so that precautions can be taken in good time. Significant actions World Aids Day Campaign (1 st December): The Infection Control Practitioners collaborated with Health Promotion team and Friends for Life by raising awareness in the stall set up in Casemates and a newspapers article. Hydrogen Peroxide decontamination: Following a collective evaluation by GHA stakeholders, a hydrogen peroxide decontamination system has been selected and will shortly be procured Influenza Vaccination programme: All GHA staff and long stay patients were offered Influenza immunisation and to date, a total of 461 vaccines have been administered. These included St Bernard's Hospital staff (day and night), Ocean Views staff, Ocean Views residents, HMS prison staff and HMS prison inmates. Respectfully submitted Dr. V. Kumar Director of Public Health 18 P a g e

19 5.3 Medical Director Mr Chairman, Board Members, this Report covers the 3 rd and 4 th Quarters of ) Repatriation of Haematology Oncology Chemotherapy Treatments The GHA Ayling-Buttigieg Chemotherapy Unit has extended it s opening timetable to include Fridays (previously Tuesday to Thursday) in order to cater for Haematology patients under the care of Dr Pepe Duran. As from 24 th November 2017 these patient can have their Chemotherapy in Gibraltar instead of travelling to a centre in Spain. This is part of the strategy to repatriate clinical services to the GHA. 2) Clinical Governance The project to introduce a formal clinical governance structure to the GHA continues with the rolling out of the Datix Clinical Incident reporting system and the formation of the Clinical Incident Grading Group(CIGG). GHA staff will be reporting all clinical incidents and near misses electronically, these incidents are then reviewed by the CIGG and appropriate management actions instituted. This system will allow us to measure the number and types of incidents that occur in the organisation and enable management to work to minimise risk and improve the quality of care. 3) Junior Anaesthetists The GHA has employed a new tier of Junior Doctors to be resident in hospital 24 hours a day 7 days per week to cover Anaesthesia and Intensive Care. This means there will now always be two intensive care/anaesthetic doctors available at all times to look after our sickest patients and facilitate emergency surgery out of hours. The positive effects have already been felt by staff and patients with fewer delays in scheduling of emergency surgery and much better resilience in the Critical Care Unit over the busy winter months. 4) GHA Medical Liaison Doctor in Spain The GHA employed the services of Dr Ernest Guillem, a Gibraltarian doctor with over 30 years experience working in Spain to provide a liaison service with our Spanish tertiary providers. Dr Guillem started in September His role is to ensure that the medical needs of GHA patients are met whilst admitted in hospital in Spain and this will be achieved by regular visits and coordination with the Spanish medical teams. He will also provide valuable feedback to the GHA medical teams and ensure a smooth transition of care to the GHA once patient care discharged. 19 P a g e

20 5) Dialysis The GHA Renal Dialysis Unit led by Dr Simon Lines has reached full capacity in its current configuration. A review of the service to take into account future needs has results in a reorganisation of the service which should be complete in early The service currently runs on 3 days per week and opens for 14 hours to cater for 3 patient groups (9 dialysis sessions in total per week), the plan is to recruit more staff to be able to open the unit for 6 days per week for 2 sessions per day (12 dialysis sessions in total per week). This represents a 33% increase in capacity and more flexibility with dialysis session availability. It will also allow the unit to increase capacity more easily in future if necessary. These changes will also be supported by upgrading of some of our dialysis machines the introduction of new computer software and integration with the laboratory results service. 6) Orthopaedic Department reforms Reorganisation of the Orthopaedic Department is proceeding well. In addition to the introduction of the Musculoskeletal Specialist GP Dr Elaine Flores we have recruited two new Consultant Orthopaedic Surgeons. Mr Marius Negru, specialist in Upper limb orthopaedic surgery started in September Mr George Chami, specialist in foot and Ankle orthopaedic surgery started in December Mr Thomas Boerger will continue to provide a specialist Knee and Hip orthopaedic service. Our substantive consultant team is now complete and will each provide specialist orthopaedic services. This reconfiguration will result in more specialist surgery taking place in Gibraltar. 7) A&E Consultant The GHA appointed an A&E Consultant to lead the A&E department. Dr Francis Heyes started in November A senior medical clinical presence in the department will lead to service improvements and better clinical oversight and supervision. 8) General Surgery Mr Antequera, Upper GI and Bariatric Surgeon now provides a specialist Bariatric Surgery service in Gibraltar (previously provided in UK). Mr Mansour, Colorectal Surgeon is now providing major colorectal procedures and other specialist colorectal surgery. Both Mr Antequera and Mr Mansour use the latest key-hole surgery techniques resulting in enhanced recovery time for most patients and shorter hospital stays. 20 P a g e

21 9) Neurology, Stroke Frailty and Rehabilitation Services The GHA has reconfigured it service for Neurology/Stroke, Frail/Elderly with the addition of an Associate Specialist to consolidate the services provided at St Bernard s Hospital. This new service will complement the new medical service provided in the Elderly Residential Service, the Dementia day care and residential services and the increase in community packages for care for frail elderly and vulnerable patients. Dr Keith Gracia has been appointed to this post in August Dr Gracia s appointment has been pivotal in providing medical support to the rehabilitation team on Captain Murchison Ward. This ward is now tasked with rehabilitation frail elderly patients and works with the multidisciplinary clinical team to enable patients to return home safely as soon as possible. This approach has without doubt been an essential part of the bed management strategy. Since October 2017 we have engaged Dr Dominic Heaney, Visiting Consultant Neurologist from the National Hospital for Neurology and Neurosurgery(UCLH), Queens Square in London. Dr Heaney has strong ties to Gibraltar and will visit approximately every 6 weeks (previous visiting clinics were held every 3 months). Work is on-going to establish a specialist Stroke Unit on Captain Murchison Ward and enable the GHA to provide specialist emergency treatment for stroke in appropriate cases. Dr Danny Cassaglia Medical Director 21 P a g e

22 5.4 Director of Nursing Services Nursing Directorate s Board Report July 2017 September 2017 Surgical Directorate Operating Theatres With Mr Antequera as our Upper GI specialist there have been further developments to this service. Bariatric surgery has now become a high quality service delivered locally. With a blend of disciplines (Dieticians, Diabetic Nurse Specialist, Pre-assessment and Surgical Out-Patients), the bariatric patient s journey through the organisation is of a high standard. Mr Mansour, our newly appointed Colo-Rectal Surgeon, performs most major cases laparoscopically. With this approach technique the benefits include: Minimal risk of bleeding during surgery Smaller incisions with less post-operative Minimal scarring after surgery Less risk of infection Shorter length of stay in hospital Patients return to their normal everyday lives sooner quicker The Gibraltar Health Authority in collaboration with Edge Hill University are once again delivering Surgical First Assistant Training (HEA 3055) A further five members of staff from both Main Theatres and Day Surgery will become competent practitioners by February 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 July 2017 September 2017, a total of 644 patients have been admitted through Day surgery with 540 surgical procedures undertaken within the Day Surgery Theatres its self. Endoscopy We now have a third appointed endoscopy technician, (Enrolled Nurse Mark Brooks. Staff Nurse Aidan Lane has completed his training from the JAG/GETS programme for endoscopy at St Georges and is gaining further knowledge and experience with the help of Mr Mansour as his preceptor. 22 P a g e

23 Surgical The surgical out-patient department has taken lead in the Vac Pump wound care management of the outpatient. S/N Suzanne McGarvey is 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). Victoria Mackintosh Ward Victoria ward continues to cater for the elderly, long stay patients of our hospital. There are now two side rooms that are dedicated for the care of end of life patients. This includes an en-suite bathroom and a common area with a beverage bay for the comfort of the patient s family. Medical Directorate Captain Murchison Ward: The 22 nd July saw the staff & patients of Victoria Ward relocated to their new location Captain Murchison Ward. 24 patients transferred to CMW. Ward Activity: July September 2017 inaugurated the new idea for a stroke /elderly frail acute unit. Staff and departmental reviews have commenced since the two new sisters were appointed in post, such areas being developed are: Introduction of Staff and Patient Initiatives, Sickness Policy, New Documentation for patient records, Hourly Comfort Checks, Change in Observation times & the NEWS. Other Training completed by the team between July & September: Stroke Rehabilitation Development Dysphagia Training Dementia Training Course. PICC line training In house training by Dr Keith Gracia in the management of Stroke / Rehab John Mackintosh Ward: JMW continued to exhibit a high admission rate of the summer. Monthly Admissions:- Month Total Admissions July 48 August 30 September 41 New Initiatives: The team in JMW endeavours to ensure all patients obtain optimal care during their stay on the ward. The introduction of a colour coded 23 P a g e

24 service to identify those patients who will need nursing assistance at meal times has been developed and currently is in its pilot phase. CCU Statistics July September 2017:- Total Admissions 113 Total Discharges 118 Deaths 2 Patients requiring 4 RRT Ventilated patients 15 Non Invasive 14 ventilation Accident & Emergency Department: Department Activity: July September continued with the building works in A&E, as well as the inauguration of the new minors area. The department continues in its development of senior staff through the continuation of the team rotating into the role of department lead, thus allowing the team to experience managing the department. New Initiatives: Acting Sisters: Elaine Ferro - has established a protocol for the Use of Inhalers with Spacers in asthmatic/copd patients. Nerea Asensio - is currently devising an Expiry Date Policy for Medications in A&E. A&E statistics for the period 1 st July - 30th September 2017: New Attendances 6493 Planned Return Attendances 350 Unplanned Return Attendances 327 Clinic Attendances (Arrived) 969 Total Attendances 8139 Injury at Work Attendances 47 Visitor Attendances 512 Attendances for Children 15> (non 1219 MOD) Attendances for MOD 16< 9 Attendances for MOD 15> 54 Total Attendances 1841 Ape/Monkey Bite 43 Dog Bite 29 Insect Bite 75 Human Bite 2 Cat Bite 2 24 P a g e

25 Total Attendances 169 Sting Fish 0 Sting Jelly Fish 4 Total Attendances 4 Chest Pain / Palpitations 259 Intoxication Alcohol 5 Cardiac/Respiratory Arrest 4 Overdose 15 Road Traffic Collision 19 Referral 98 Total Attendances 400 Ambulance Non Urgent Ambulance 40 Total Attendances 1089 Surgical 161 Medical 338 Paediatric 57 Gynaecology 9 Orthopaedic 68 Total Admissions 633 Mental Health 16 Anaesthetics 4 ENT 6 Ophthalmology 0 Total Admissions 26 Referral to Trauma Clinic 233 Dressing or Wound Cleaned or 97 Wound Closure Plaster of Paris 92 Dress/Bandage or Splint 384 Total Referrals P a g e

26 Maternity: GHA Board report July 2017 to December 2017 Maternity statistics July 2017-September 2017 Total births 104 Male 56 Female 48 Premature <37 4 IOL 24 EM LSCS 5 URG LSCS 8 SCH LSCS 1 EL LSCS 10 Total LSCS 24 Ventouse 7 Forceps 4 Twins LSCS 4 sets 2 Midwives Deliveries 70 Transfer to Spain in Utero 0 Transfer to Spain Neonates 0 SCBU Admissions 4 Ward Attenders 494 Total Nº Practice Development 1. Mental Health Policies Review. In partnership with UGM Mental Health Mr Chris Chipolina and CNM Kay Rajkumar, a review of all policies is on-going. These have been categorised (1-3) in order of priority. The impact of the new Mental Health and Capacity Acts on SBH, have been discussed at length during regular meetings with Dr Lillywhite from a staff awareness and development perspective. These exchanges are envisaged to intensify once amendments to existing legislation are made. A draft Aidememoire has been developed to familiarise staff with new terminology and relevant components of sections. 26 P a g e

27 2. Porta-cath Training. Initial discussions with the Palliative/Breast Team and Dialysis Unit have occurred to develop an in-house training programme for ward staff regarding the management of patients with a porta-cath. Initial plans are for Dialysis to support JMW while the Palliative/Breast Team focuses on DTW. Areas such as A&E and long stay wards will follow. Inclusion in future CPD training as a regular item is envisaged for Westside School/Colleague of further Education- Career Presentations. Building on presentations delivered in Westside and Bayside Schools promoting both the BSc in Adult Nursing and specialist roles, mental health will be featuring in future months. Nursing Directorate s Board Report October 2017 December 2017 Primary Care Clinical Nurse Manager Vacancy post: Mrs Suzanne Romero was successfully appointed as the Primary Care Clinical Nurse Manager as from 14 th December Child Health: Miss Daniella Hernandez was successfully appointed as a Health Visitor in the month of December. HV Louise Mauro and HV Daniella Hernandez attended a Child protection tier 3 course organised by the ministry of tourism, housing, social services and equality. Influenza vaccination programme: The seasonal influenza vaccination programme commenced on Monday 9 th of October. Over 1,105 patients have been vaccinated since we commenced, the number of attendees has increased by 0.6 per cent over the previous year. Diabetic Services: The Diabetic team strives to improve and expand additional services delivery for patients. In November the Diabetes Gibraltar association printed 750 booklets of low carbohydrate recipe ideas for patient distribution. This donation was sponsored by Piranha designs BMI group estate agents. The association has also sponsored pedometers for the education sessions on walking away from diabetes, which is a structured educational programme aimed at people at risk of developing diabetes. This programme also raises awareness of how to slow the progression of the condition. 27 P a g e

28 In the New Year we will be planning towards implementing a foot care clinic that will be led by SN Mifsud who is a trained foot care nurse. Additionally we may recruit a podiatrist trained to assess, diagnose and treat foot and lower limb problems including skin and nail problem and foot and ankle. Primary Care Clinics: The Minister for Health and Justice the Hon Mr Neil Costa officially inaugurated the Primary Care Lymphoedema Clinic on the 19 th December 2017, which will be a nurse led service. The funding for the new Lymphoedema clinic was kindly donated by Mrs Hilda and Mr James Levy and was named Issac and Rachel Levy Lymphoedema Clinic. Cardiac rehab update: The inauguration of the new Lionel Perez cardiac rehab centre took place on the 19 th December. This marks a historic event for our cardiac patients. Cardiac users continue to be one of the top two largest patient groups, not just locally but worldwide. Cardiac Rehab is a nurse led, multidisciplinary service bringing together the skills of Nurses, Physiotherapists, Occupational Therapy, Pharmacists, Health Promotion Officers, Hospital Doctors, GPs, Dieticians and Patient Representatives; In May 2017 a full internal review of the service was carried out following patient feedback from the Gibraltar Cardiac Association; Following the review, we now have more comprehensive inpatient and outpatient cardiac rehab programmes, a cardiac information helpline and a Self Help Group formed from patients who had completed CR programme to enable them to continue maintaining the benefits of continued group exercise under their own organisation and lead; The improvements include a newly refurbished gym and exercise equipment, a second Clinical Nurse Specialist post (currently advertised), improved referral pathways, better initial assessments, more efficient working practices and an overall GP clinical supervisor; Surgical Directorate Day Surgery: The Day Surgery Unit continues to undertake on average 90% 95% of all elective surgery. 28 P a g e

29 During the period of July 2017 September 2017 a total of 644 patients have been admitted through Day surgery with 540 surgical procedures undertaken within the Day Surgery Theatres DSU Monthly Statistics 2017:- TOTAL DSU % OCTOBER NOVEMBER DECEMBER New developments in Day Surgery: New Urology lists with Mr Takacs Shoulder surgery with Mr Negru Halo & RAR surgery with Mr Mansour Extensive Plastic surgery procedures done within Day Surgery Theatre with Mr Offer. Operating Theatres: With Mr Mansour as our Colo-rectal surgeon, there has been a significant improvement to the service. Performing Colo-rectal cases laparoscopically has resulted in quicker and less painful post-operative recoveries. Minimally invasive bowel resection reduces risks of infections and pain amongst other complications. With this approach technique the benefits include: Enhanced Recovery Programme Minimal risk of bleeding during surgery Smaller incisions with less post-operative Minimal scarring after surgery Less risk of infection Shorter length of stay in hospital Patients return to their normal everyday lives sooner quicker. Out Patients Department: Bespoke training is currently under way. The name of this programme was changed to meet our needs. Titled "Working as an Autonomous Practitioner" Urology: A new Urodynamics machine has been kindly donated to the GHA by the Prostate Cancer Support Group. Commissioning and training took place in November. 29 P a g e

30 Orthopaedics: 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 become plaster technicians. This will eventually increase the complement of qualified plaster technicians to three. A plastering workshop was carried out between 3 rd 5 th October. Medical Directorate Captain Murchison Ward: CMW has come long way from being, in essence, a Long Stay Ward, to progressing to an effective Rehabilitation Ward for Stroke and Elderly Frail patients with the aim of returning those to their own homes. At this point in CMW s development, there have seen many changes; an acute bay has been established and a Physio/Occupational Therapy Gym within the ward in order that rehabilitation of patients is on-going. Regular MDT meetings with Dr Gracia to discuss patient progress and Nursing staff work alongside Physio s and OTs to provide constant improvement. Close liaison with the Hospital Social workers to enable seamless transition back into the Community for our patients has developed enhancing a streamline discharge process. Dr Gracia has introduced an Activities Coordinator to promote mental and physical stimulation, which reduces the risk of patients becoming institutionalised and depressed. Accident & Emergency: The months of October December saw a total 6385 attendances to the department, resulting in a total of 771 admissions. Paediatric services 90 Medical 410 Surgical 169 Gynae 11 ENT 6 Orthopaedics 70 Mental Health - 15 Matrons Update Outreach working really well. Ward staff supported and potential deteriorating patients are identified and overlooked by the ICM team. Matrons have conducted 3 NEWS audits on John and Toomey ward. Wards have increased compliance from 60% to 88%. 30 P a g e

31 GHA Board report July 2017 to December 2017 The DNS has introduced monthly meetings with the matrons and ward sister/charge nurses to implement continued Standards of Clinical Excellence Ongoing projects: Stroke unit Cath lab Organ donation Respectfully submitted Sandra Gracia Director of Nursing Services (Ag) 31 P a g e

32 5.5 Human Resources GHA BOARD REPORT 1 st July to 30 th September EXECUTIVE SUMMARY Throughout this quarter, the department has made significant progress in areas of recruitment and selection, holding successful interviews for clinical vacancies within Medicine and Nursing, as well as non-clinical vacancies within administrative, domestic and support grades. The successful appointment of the Matrons has further reinforced the GHA s Nurse Management structure. Also notable, are the new Associate Specialist appointments, which form a pivotal part of the strategic development of our Neurology and Urology patient services. The department also continues to build on the momentum of recent medical staff appointments, having held 4 successful interviews for Consultant positions. In close collaboration with the Medical Director, the department has managed to successfully negotiate additional short term contracts, which have further reduced prolonged locum requirements, whilst both maximising public funds and promoting continuity of patient care. Our positive industrial relations with Trade Unions have proved instrumental in successfully regularising 81 nursing and industrial positions. These regularizations include longstanding supply and bank employees, who had been on continuous supply employment; domestic supervisors who had been successfully performing the role in an acting capacity, and finally, opportunities for career progression were presented to supply and part-time domestic staff, by way of competitive interviews. Similarly, and also in consultation with Trade Unions, 12 agency based temporary staff where appointed as Junior GHA Clerks, following successful interviews, resulting in further career progression opportunities. The department continues to look forward to its integration with the Public Service HR and to their relocation to office premises located within proximity to St Bernard s Hospital, as this will generate opportunities for further HR practice and service development, as well as provide additional spatial capacity for the GHA. GHA BOARD REPORT 1 st October to 31 st December EXECUTIVE SUMMARY Throughout this quarter, the department has made progress in recruitment and selection, holding successful interviews across the majority of professional groups. In addition, the department has continued to maximise 32 P a g e

33 public funds by successfully negotiating pro-rata short term contracts for the provision of emergent cover. Within Medical Grades, the department has held successful interviews for Consultant positions within the departments of Obstetrics and Gynaecology, Paediatrics and Radiology. The successful recruitment of Clinical Fellows/Registrars in Anaesthesia & Intensive Care has enabled the restructure of the Department of Anaesthesia. Successful interviews within Nursing have also resulted in appointing nurses in specialist areas such as Palliative Care, Child Health, Dialysis Services, Dermatology, Mental Health, Critical Care Unit and Accident and Emergency. Successful interviews have also been held within the departments of Pathology, Speech and Language Therapy and Occupational Therapy. The department has renewed its approach to managing employee conduct and performance by supporting line managers across the organisation. This consultative and collaborative approach has resulted in the resolution and deescalation of numerous professional concerns and sensitive matters, generating a win-win culture amongst HR, line-managers and GHA staff. We also look forward to working together with a new Occupational Health Specialist service provider that will complement our sickness and absenteeism management practices and provide expert employee wellbeing and occupational health support to GHA staff. The department continues to look forward to its integration with Public Service HR. Our much anticipated relocation to office premises located within proximity to St Bernard s Hospital is due to take place during the first quarter of Respectfully submitted Mr Christian Sanchez Human Resources Manager (Ag) December P a g e

34 GHA Board Report 3rd Quarter 2017 For the period July to September SBH Operations Manager This board report covers the 3 rd Quarter period of the 2017 from 1 st July to 30 th September 2017 and the 2 nd Quarter of the Financial Year During this term, we have been actively engaged with the regularisation of the Domestics Department engaging staff, management and Unite the Union in order to complete a pending restructure. This has also included the creation of a new evening shift to begin towards the end of Similarly we have been discussing a proposal to restructure the Ambulance Service to enable us to provide a long term succession plan and career path for staff and deliver the appropriate level of pre-hospital clinical care under a cohesive and structured Clinical Governance programme. Ambulance Care Assistant vacancies have already been filled. In terms of facilities management we are close to finalising the Door Access project with the card readers and access points being commissioned. New Access Cards will be issued to staff members by October 2017 once testing is complete. Works continue on major and minor projects including the new treatment and storage room in Day Surgery, the Early Pregnancy Assessment Unit, Cardiac Rehabilitation Refurbishment, Radiologist Office expansion, Domestics Mess Room and the new Lymphedema Clinic amongst others. There will also be a major programme to upgrade the fire prevention and detection systems within St. Bernard s Hospital with completion by end of Estates & Clinical Engineering 1. Medical Devices. It is a significant step forward to have reformulated the Medical Devices Committee which has met on two occasions in the quarter. 2. Electrical Engineering Project works over the quarter - These include: PCC Lymphedema Clinic; 34 P a g e

35 PCC Registration staff moves; SBH Assisting G4S with the smooth change out of peripheral fire alarm devices; SBH Radiology Offices; SBH UPS changes and A/C installation for the main server room SBH Overseeing the installation of Solar PV SBH completion of the A+E extension phase 2 - minors SBH and PCC various office and clinic moves Mount Alvernia monitoring of electrical load in order to size a larger generator that could support 100% of the load. 3. Projects Completed and On-Going (main projects this does not include strategic reactive works) St. Bernard s Hospital: Redevelopment Plan for A&E Phase two expansion/refurbishment of minors is complete and operational; all of the works have been completed largely in-house by our very capable team. We were pleased to see that our hard work was recognised in the press. The link between the new and refurbished minors department in A+E. 35 P a g e

36 St. Bernard s Hospital - Maternity Early Pregnancy Room (EPR) This unit is now complete and in service. Part of this process was also to create a memorial garden; this will be opening in early October. GHA Board Report 4th Quarter 2017 For the period October to December 2017 Introduction This board report covers the 4th Quarter period of the 2017 from 1 st October to 30 th December 2017 During this final quarter of 2017 we have finally completed the Domestics Section restructure and begun the evening shifts at St. Bernard s Hospital, although still in early stages of adjustment, the benefits are already beginning to show in clinical areas. The Ambulance Service received two new frontline Emergency Ambulance vehicles in December 2017 which will serve to enable the EAS to absorb the 3 rd emergency ambulance service currently being provided by the GFRS. Plans for a new Ambulance Service facility have also begun and site feasibility studies are being conducted. In terms of facilities management the Door Access project with the card readers and access points has been commissioned. New Access Cards have been issued to staff and the system is being monitored. 36 P a g e

37 Works continue on major and minor projects with some having been completed this quarter including the new treatment and storage room in Day Surgery, the Early Pregnancy Assessment Unit, the Lionel Perez Cardiac Rehabilitation Centre, Radiologist Office expansion, Domestics Mess Room Ambulance Crew Room refurbishments, New Funeral Directors Office and the new The Isaac and Rachel Levy Lymphedema Clinic at the Primary Care Centre amongst others. The Patient Advocacy & Liaison Unit launched over a year ago will amalgamate with the Office of the Ombudsman Complaints Handling Scheme over the next quarter to provide one point of contact but with distinct responsibilities for formal and informal complaint procedures. This will create a more efficient and effective use of resources and provide an improved service to the general public who wish to make enquiries, obtain information or raise matters of concerns. Sponsored Patients Services The Sponsored Patients Department is also actively supporting the new Calpe House project in London in providing advice and feedback to the Trustees. Following a tender process, the Gibraltar Health Authority formally engaged in contractual agreements with two UK transport companies, to provide services to sponsored patients and their appointed escorts, when travelling to London for treatment or, to attend medical appointments. Seven established transport service providers were invited to tender, of which two were successful, namely, Raj Car Services and Greyhound Cars. The contracts were signed on Friday, 11th of November, at Gibraltar House in London. Both contracts will run for a minimum of 12 months. The two service providers will offer transport to sponsored patients and their escorts, from Gatwick and Heathrow airports, to their accommodation. Upon arrival at the airport, patients and their escorts will be met by their designated driver. Estates & Clinical Engineering Medical Devices. The Medical Devices Committee has met on several occasions in the last quarter. These meetings have concentrated on the development of priority list for both the 2017/18 FY spend and the 2018/19 FY estimates; for both lifecycle replacement and new equipment. Clinical Engineering We continue to work with the CAFM towards having an up-to-date medical equipment database that will provide a live database for our assets, and improve asset tracking and systems management. It will also be fundamental in providing accurate information to the Medical Devices Committee in terms of the prioritization for equipment lifecycling. 37 P a g e

38 Infection Control Projects Over the period we have also been involved with various infection prevention and control initiatives as follows: HPV fogging where we will be able to decontaminate a room or bed space quickly and effectively. This system uses Hydrogen Peroxide Vapour to evenly cover all exposed surfaces in an enclosed area, including complex shapes and hard-to-reach places with true repeatability with a success rate of % pathogen reduction for a 6-log kill over every exposed surface. We are expecting delivery of two units within the next 4 to 6 weeks. Linked to this we have been investigating the possibility of purchasing bespoke isolation pods as a solution to our lack of true isolation facilities. Over the last month the hospital has been put under extreme pressure due to a number of infectious cases, including an outbreak of influenza. These pods would be a quick and reasonably cost effective way of being able to isolate patients effectively. PCC The Isaac and Rachel Levy Lymphoedema Clinic External funding was gratefully received so that we were able to develop this much needed. This project has been completed in house by our excellent teams within Estate and Facilities. This project turned what was a poorly utilised store area into valuable and much needed clinical space. Hospital Security We have installed new roller shutter doors on the entrance to the garage, this will help to improve security to the hospital, particularly outside of normal hours and in lock down situations. Palliative Care Palliative care has been relocated to the 2 nd floor building 4, this work has been completed in house and is in the final stages of completion. Renal Dialysis within the quarter we have procured two new dialysis machines, this is the first stage of increasing the level of service to our dialysis patients. We are also looking at providing an isolation facility in which we are able to dialyse patients. Fire Alarm System we have managed to update all of the fire alarm systems peripheral devices under lifecycle (smoke detectors, heat detectors and sounders), this completes the complete upgrade of the system. 38 P a g e