GHA Board report July 2016 to March 2017

Transcription

1 GHA BOARD MEETING AGENDA Venue: Charles Hunt Room, John Mackintosh Hall at 2.30pm Friday 02 June Apologies for absence 2. Minutes of the meeting held on Wednesday 21 September Matters arising 4. Statement by Minister 5. Matters for report 5.1 Report: Chief Executive 5.2 Report: Director of Public Health 5.3 Report: Medical Director 5.4 Report: Director Estates and Clinical Engineering 5.5 Report: Director of Nursing 5.6 Report: Director of Human Resources 5.7 Report: UGM Hospital Services 5.8 Report: UGM Primary Care Services 5.9 Report: UGM Mental Services 5.10 Report: Director of Information Management and Technology 5.11 Report: School of Health Studies 5.12 Report: Complaints 6. Date and time of next meeting 7. In Camera session 1 P a g e

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3 Minutes of the meeting held on Wednesday 21 September 20 GIBRALTAR HEALTH AUTHORITY Minutes of Meeting held on Wednesday 21 September 20 at 2.30 pm in the Charles Hunt Room, John Mackintosh Hall. Present: The Hon. J Cortes (MH) - Chairman Mr F Pitto (FP) - Chief Executive Mr C Lavarello (CL) - Non-Executive Member Dr K Rawal (KR) - Medical Member Dr D Cassaglia (DC) - Medical Member Apologies: Mr E Gomez (EG) - Chief Secretary Mr A Mena (AM) - Financial Secretary Mr E Lima (EL) - Non-Executive Member Mrs P Galliano (PG) - Non-Executive Member Mr M Netto (MN) - GTC Member In Attendance: Mr G Teuma (GT) - Director of Finance & Procurement Mr A Wink (AW) - General Manager Primary Care Centre Mr H Watson (HW) - Director IM&T Mr P Linares (PL) - Director of Human Resources Mr C Chipolina (CC) - General Manager Mental Health Mr D Alman (DA) - Director of Estates and Clinical Engineering Mr K Pizarro (KP) - Clinical Information Officer Secretary: Ms E Fa (EF) 1. Apologies for absence: Mr E Gomez (EG) - Chief Secretary Mr A Mena (AM) - Financial Secretary Mr E Lima (EL) - Non-Executive Member Mrs P Galliano (PG) - Non-Executive Member Mr M Netto (MN) - GTC Member Welcome from Chairman: The GHA Chairman opened meeting. 3 P a g e

4 2. Minutes: Minutes of meeting held Wednesday 20 April 20 approved as a true record. 3. Matters arising: No matters arising. 4. Statement by the Minister: Another meeting will be held at the end of November to catch up and get the meetings back on track. This is the last meeting as a board member for DC as he has been appointed as Medical Director. Welcomes DC to management. Medical Advisory Committee will need to nominate a consultant DC to do this before next meeting. 5. Matters for Discussion: 5.1 Long service and good conduct medal policy PL This policy replaces the current scheme. Design of the medal not yet finalised. The first medals will presented in the next awards ceremony October 20. MH Long service policy approved by the Board. 5.3 Confidentiality policy NHS gave approval for GHA to adopt their policy. This policy was started in February 20 and has gone to the GRA and to the Executive. Point needs to include amended copy to be included in the Board report. The major risk is currently between patient information sent to tertiary centres. GHA working on this. MH Confidentiality policy approved by the Board. 5.2 GHA Information Governance Strategy FP Development of the strategy is not easy. Refers to resources this has a big impact on how KP is going to deliver the plan. Some of these posts are new to the GHA and have resource implications. KP some roles will be taken on by staff. The Strategy is not resource free. MH - GHA Information Governance Strategy accepted by the Board. Implication of resources to be taken by GHA. 4 P a g e

5 5.4 Dementia Strategy MH This strategy is Government wide. The GHA has to consider it and give approval. AW This is an initial attempt to harmonise all services. The strategy will need to be modified progressively. There is a necessity to create a National Dementia Committee with the heads of various services. MH This was published to the public as a consultation draft and there has been good response from the public. AW The Dementia group asked to make some changes, this needs to be amended accordingly. DC Asks if the scale of the problem and issue was 328 in total. 50% community patients and 50% residential patients. Does this tally with our records? AW There are 2 new referrals per week in the memory clinic, not all patients are dementia patients. MH Asks the Board to support the draft strategy and AW to take on board the comments made by the Board. Dementia strategy accepted by the Board. 6. Matters for Report: Chief Executive s Report: (As per published in Board Report) FP Invites Board members to the Nursing Conference. Thanks Human Resources and the sponsors for the Staff awards. MH Normally the Director of Finance report is included in in the Agenda, however if a board meeting occurs before Estimates are published these cannot be made public until it is discussed in Parliament. The new appointment system for the blood department has received positive reviews from Hospital users, however there have been some complaints from PCC users. AW The issue is with users who are accustomed to walk in to the clinic and with users that do not turn up to their appointment. Patients that require the service urgently are done there and then. There has been a reduction in the number of complaints. AW is currently looking into this. MH The GP s appointment system seems to have settled down. 5 P a g e

6 AW There are some challenges with the review appointments. KR The capacity is better but the reviews need to be looked at. MH Has had positive feedback from patients using the acupuncture service. VK All Board members will get a copy of the Health and Lifestyle survey before the next meeting. The IVF policy will be reviewed in the next meeting. All Directors Reports were taken as accepted. Question Time: None this meeting Meeting ended with agreement to reconvene on Wednesday 23 November 20. With no further business the meeting closed. 6 P a g e

7 July to September Chief Executive Mr Chairman, Board members, this report refers to the 3 rd quarter of 20 (July to September) and the 2 nd quarter for financial year 20/2017. The following is a summary of the Director s reports which are enclosed in the main body of this document. It also includes the report and data of the Complaints Handling Scheme. 1. Medical Recruitment This period has experienced increased activity in the recruitment of medical staff. Adverts have been brought out and interview undertaken in the following areas; General Surgery Obstetrics and Gynaecology Paediatrics Ophthalmology Pathology 2. Medical Appraisals As part of the revalidation process with the GMC, medical staff are required to undertake yearly appraisals. These appraisals are provided by Health Education England Wessex Appraisal Service. The second annual report, covering the year 2015/20 was presented to the GHA. A total of 78 doctors (out of 78 eligible) were appraised over the year. This represented an uptake of 100%. The feedback from GHA doctors has been very positive with the majority saying that their appraisal was useful for improving patient care and promoting quality improvement. GHA doctors also felt that the process was very useful in their preparation for revalidation with the GMC. During this period the GHA also contracted the services of Professor Derek Burke to act as the second Suitable Person which is a legal requirement. 3. New Chemotherapy Unit September saw the opening of the new Chemotherapy Unit which will focus on the treatment of solid tumours. The unit includes five chemotherapy stations and is open three days a week. This is another example of the GHA s objective to repatriate services. The unit is already benefiting many patients and their families who can now receive their treatment at home. 7 P a g e

8 4. Dementia Day Facility September also saw the completion and handing over of the Dementia Day Facility building to the GHA. Furnishing the facility and recruitment of staff is on-going with the aim of opening the memory clinic in October 20. The GHA is still working towards having the Day Centre fully operational by early On-going Projects The Directorate of Estates and Clinical Engineering together with the Minor Works Department have been engaged in a variety of projects during this quarter. Projects completed and on-going during this quarter have included; Chemotherapy Unit Accident and Emergency Development Programme Maternity Early Pregnancy Room New temporary facility for the Ambulance Service New Primary Care Reception Area New Clinic space for Primary Care 6. Bed Management This quarter has continued to see high bed occupancy for adult patients at St Bernard s Hospital with extra beds constantly being used during this period. During this period, 14 non-urgent elective surgical procedures had to be cancelled due to high bed occupancy in order to maintain emergency bed capacity. However during this same period, 758 surgical procedures were done. This has only been possible through the excellent work undertaken by the multidisciplinary bed management team. 7. Day Surgery Unit An important factor in the success of maintaining theatre activity and minimising disruptions to services has been the Day Surgery Unit. The Unit continues to expand its services by undertaking Cardiac procedures such as Cardio versions, Urology, Dermatology and expanded general surgery sessions. 8. Introduction of the National Early Warning System (NEWS) The implementation of the NEWS programme will replace the current (MEWS) Modified Early Warning System. This new programme will enable standardisation, leading to safer and more timely and effective medical and 8 P a g e

9 nursing interventions of acutely ill patients. A steering group has been formed to assist with the implementation and awareness programme. 9. Screening for Sickle Cell Disease and Thalassaemia in Pregnancy The Department of Pathology, Obstetric team and Haematologist have worked together to introduce a new screening programme for Sickle Cell Disease and Thalassaemia in pregnancy. The aim of the screening programme is to support people in making informed choices before conception and during pregnancy, to improve infant health through prompt identification of affected babies, to provide high quality and accessible care to our patients and to promote a greater understanding and awareness of the disorder. In line with UK guidelines, all pregnant women will be offered the tests in early pregnancy. In cases where women are identified as carriers, screening will also be offered to the father. 10. Hospital WiFi After a successful pilot, the patient WiFi network has been rolled out to all hospital patient areas. The initial feedback is that the system is working well and being utilised by a large number of patients. 11. Fire Prevention In line with the GHA s Fire Prevention Strategy, the commissioning of the Fire Safety Management Plan was completed in September 20 for final review and implementation by the GHA s Fire Safety Group before the end of GHA Expenditure The financial performance report presented covers the period 1 st April to 30 th September 20. Target spend for this period is 50% of the approved budget of million, with actual recorded expenditure to end of September representing 54.4% of the overall approved budget. The main factors contributing to this forecast overspend is increased pressure on some of the patient demand led budgets, in particular; GPMS Drugs and Pharmaceuticals Sponsored Patients Visiting Consultant Programme The details of this are explained in the report provided by the Director of Finance. 9 P a g e

10 13. Staff Awards The new Staff Awards Committee has been set up with the aim of planning and organising the GHA s 9 th Staff Awards Ceremony. The next awards ceremony will take place in October 2017 and will see the presentation of the newly formed GHA Long Service and Good Conduct Medal. 14. Health & Lifestyle Survey Following on from the first ever Health & Lifestyle Survey which was undertaken in 2008 (published in 2013), the Health Promotion Department has completed the 2 nd survey. The report has been printed and delivered and is ready for distribution. This represents an important investment and initiative in order to understand better the health of our community. 15. GHA Annual Report 2014/2015 The report is now in its final stages of completion with a target date for publication early in To conclude, I would like to thank all of the Directors, contributors and their staff who have assisted in providing these reports, without whom the achievements outlined would not have been possible. Respectfully Submitted Mr Fred Pitto CEO, GHA 10 P a g e

11 Executive Summary by the Medical Director (Public) October to March 2017 Mr Chairman, Board members, this report refers to the period October 20 to March The following is a summary of the Director s reports highlighting some of the main points which are enclosed in the main body of this document. 1) Health and Lifestyle Survey The Report of the Health & Lifestyle Survey was formally published in December 20. It contains a wealth of information about the health and lifestyle of the Gibraltar adult population. Over 24,000 separate pieces of data have been captured and analysed. 2) Medical Education & Training Regular monthly Medical Education CPD sessions continue. The highlight in this period was the ATLS (Advanced Trauma Life Support) Course and ATNC (Advanced Trauma Nursing) Course that took place in October 20 and February Approximately 60 local medical, nursing and paramedic GHA staff were trained. The course was provided by a team from St George s Hospital in London. The GHA Trauma team are now fully qualified in the provision of Gold Standard care to Trauma patients. A four day training course was provided to GHA Psychiatrists, GPs, A&E Doctors, and mental health workers on the new Mental Health Act. This training was crucial in preparing our front line mental health staff for the implementation of the new Mental Health Act. 3) Quality Improvement & Service Development The development of maternity services includes the establishment of an early pregnancy assessment unit and a visiting perinatal pathology service. Work is on-going to repatriate as many clinical services as possible to the GHA. As from October 20, patients requiring treatment for Hepatitis C will now be seen and treated at St Bernard s Hospital. Recruitment is on-going for an Accident & Emergency Consultant and two Sister/Charge nurses to lead in the development of A&E. 11 P a g e

12 An automated system that s blood results to the requesting clinicians was rolled out in March These innovations represent a significant clinical quality and safety improvement. 4) Bed Management Increasing pressure on beds towards the end of 20 resulted in plans to further enhance the bed management system. These improvements resulted in an increased average daily bed availability, no cancellations due to lack of beds since 10 th January 2017 and the number of major surgical operations has doubled between January and March 2017 compared to the same period in 20. 5) Primary Care Centre Significant improvements including a repeat prescription service and a telephone service for sick notes have released up to 500 extra GP appointments every month. Specialist services in Primary Care have been boosted by a significant increase in dermatology clinics on the establishment of a new musculoskeletal service to bridge the gap between primary and secondary care. 6) Elderly Residential Care Three part time doctors were appointed to work in the elderly residential service to provide personalised care to all residents of Mount Alvernia, John Mackintosh Wing, Hillside Dementia Residential centre and Bella Vista Day Centre. This will no doubt improve the care provided to our elderly residents. 7) Estates and Clinical Engineering The first phase of the Redevelopment Plan for Accident & Emergency is virtually complete resulting in a new and more spacious facilities for Accident & Emergency patients and staff. 8) Day Surgery The Day Surgery unit continues to expand, undertaking over 90% of all patients requiring surgery. The Day Surgery team won the Rotary Club Extra Mile award in recognition of the service they provide to the community. 9) Human Resources The GHA has commissioned a comprehensive review of the Human Resources department, which is being undertaken by the Public Sector HR Business Support Unit. 12 P a g e

13 10) Patient Advocacy and Liaison Service (PALS) Launched on 30 th November 20, PALS will provide advice, support and information to patients, service users and the general public to ensure optimum delivery of health care and services. 11) Chemotherapy unit The new Ayling-Buttigieg Chemotherapy Day Unit became fully operational during October 20, providing local, in-house treatment and support for cancer patients. 12) Complaints Handling scheme There were 399 Complaints/Enquiries in 20 out of which 244 (61%) were speedily resolved. A total of 98 complaints (25%) were investigated more thoroughly by the complaints handling scheme. Only 17 complaints (4%) were passed on to the ombudsman for further detailed investigation. I would like to thank all of the Directors, contributors and their staff who have assisted in providing these reports. Respectfully Submitted Dr Danny Cassaglia Medical Director 31 st May P a g e

14 5.2 Director of Public Health July to September Colorectal Cancer Screening Programme During the period spanning the months of June to September, a total of 1244 invitations were mailed to eligible participants inviting them to take part in the Colorectal Cancer Screening Programme. During this same period 1293 testkits were prepared and mailed to the participants and 586 samples were returned to the hospital laboratory for analysis. The breakdown of the test outcomes is as follows: 492 Negative for occult blood results 60 Inconclusive for occult blood results 34 Positive for occult blood results Of those participants invited to participate, 12 refused at the outset to participate in the screening programme. In accordance with the protocol, the persons will be re-invited to participate in two years. Of the 30 invitations extended to eligible participants residing in Spain, 9 individuals expressed interest in participating in the screening programme. During this time frame, 3 individuals who were aged over 74 and therefore not routinely invited, 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 colonoscopy results. 0 Cancer diagnosed 8 Adenomas diagnosed (placed in surveillance programme) 11 Adenomas diagnosed (returned to screening programme) It should be noted that the above figures for colonoscopy results do not directly match those for invitations or test outcomes because they take place at different times. Participants continue to visit the screening office for guidance, but the nature of the visits has changed significantly. In particular, the number of enquiries related to aspirins and anti-inflammatory drugs has dramatically reduced. Now, most of the visits are about replacement test-kits or seeking clarification on the method. A possible explanation for this change may be in the new instructional DVD and leaflet, which now accompany each test-kit and provide much clearer instructions on taking medication concurrently or medical conditions such as piles. The Response Rate of the programme continues to be disappointing at 47.0%, when compared to that of the UK, which is around 60%. Abdominal Aortic Aneurysm Screening Programme During the period of June - September, 84 invitation letters were mailed to eligible participants and 29 accepted their invitations (35% response). All these participants were issued with ultrasound appointments. A total of 28 Reconsider letters were issued to participants who did not reply. 14 P a g e

15 No expressed refusals were recorded during this period. However, 44 invitees, who did not respond to either the invitation letter or the reconsider letter were marked as Inactive and notified. Requests were received from 3 individuals aged years (outside the invitation range) to take part in this initiative as elective cases. During this period, 37 men were screened and no aneurysms were newly diagnosed. 1 gentleman who was previously diagnosed with a medium abdominal aortic aneurysm continued to be rescreened during this quarter in accordance with policy. Health and Lifestyle Survey The Report of the Health & Lifestyle Survey is now being printed and is expected to be delivered in mid-october. Health Improvement The two Health Promotion Officers continue to have a busy schedule of work. The following are some of the activities undertaken by them during this quarter: The Health Promotion Officer supported the Child Health team at St Bernard s First School during a parent open day at the end of June, offering advice on wet combing and the management of Head Lice Infestation The Health Promotion Officers met with the Youth Service to discuss potential ways to deliver important health education to the youth, placing special emphasis on sexual health issues. One idea is to pilot the proposed sexual health education program with the smaller numbers of the Youth Service before launching it in the schools. The Health Promotion Officer met with the Practice Development Nurse to design and procure public information materials on safety in hospital, pressure ulcers and fall prevention. The Health Promotion Officer met with the Manager of the Alameda Wildlife Park at the request of the Minister to discuss the promotion of a meat-free initiative in local schools and restaurants. The Health Promotion Officers supported Gibraltar Breastfeeding Support Group at the annual Big Latch On at Café Solo in Casemates Square on Saturday 6th August. The Health Promotion Officers supported the Gibraltar Alzheimer s and Dementia Society at their awareness day on Saturday 17th September. The Health Promotion Officers helped to provide summer job experience for a university student who had not been placed in the department but expressed a wish to work in it. The Health Promotion Officers delivered a teaching session on Health Promotion to the Third Year student nurses. The following articles were written for the Gibraltar Chronicle: 15 P a g e

16 Healthy Eating GHA Board report July 20 to March 2017 o Breastfeeding o Balancing Life and Work o Enjoy summer, stay well (4-part series) o Look after your mouth and teeth this summer o Food Safety o World Hepatitis Day o Mind Full or Mindful o Know your numbers (World Blood Pressure Week) o Top Tips for Good Eye Health o World Mental Health Day The Health Promotion Officers ran a series of Healthy Eating workshops for children over July and August (four sessions) at the Summer Sports programme organised by the GSLA. This was an innovative initiative, conceived, planned and developed by the two officers. Presentations on healthy eating were given to the attending children, alongside which a number of fun activities were conducted to augment and consolidate the teaching sessions. Sports leaders assisted with the games, guiding the children as the event progressed, which added to its value. One game involved a class of 7-9 year-olds, taking part as team apples and team bananas, in a relay aimed at filling of a blank Eat Well plate, based on foods they liked and believed to be healthy. This was followed by a talk on healthy eating and guidance on how the Eat Well plate might be optimally filled. The game was well received by the children, all excited in their teams to show off their plates and compare amongst themselves. Another game called Lollies and Ladders, based on the snakes and ladders concept, used triggers based on health. The game was very interactive, with the children responding well to the questions asked and thinking about the answers. P a g e

17 Around 30 children attended each class, reaching over 110 children. The classes proved to be enormously popular with both children and parents. One child told the Chronicle We have loads of fun and at the end of the day I don t want to leave. Another said, I learnt that you have to eat healthy and that you can have a little bit of sugar. Out of a score of 10, this is a nine. It has been lots of fun. Overall, this is a good example of innovation within the GHA that adds to the health of our community, particularly its younger residents. Norovirus outbreaks During a two week period in July-August, an outbreak of gastro-intestinal disease occurred in Mount Alvernia, Calpe and Cochrane wards, affecting 28 residents and 8 staff. Norovirus was isolated from samples analysed. All those affected recovered rapidly after a brief illness, but such events can be seriously disruptive for the wards, residents and staff. On the 27th July the Nurse in Charge of the 2nd Floor of Mount Alvernia made the on call infection Control Practitioner aware of one resident with gastro-intestinal illness. The Nurse was instructed to implement transmission based precautions, use personal protective equipment, intensify hand hygiene, isolate affected persons, restrict the mixing of patients, maintain logs of essential data and limit visiting. Despite precautions, a total of 12 residents and 5 staff were affected. Two specimens were positive for Norovirus. Three days after the onset in Mount Alvernia, on the 30th July the Nurse in charge of Calpe ward alerted the Infection Control Practitioner to multiple residents having gastro-intestinal symptoms simultaneously. Similar advice was given. In total, 11 residents were affected and 3 staff. On the 8th August, after the outbreak had ended in the two locations above, five cases of gastro-intestinal disease were reported on one day in John Cochrane ward. A search was carried out for possible links between the affected sites. Although it was noted that no staff had been rotated from Mount Alvernia to Calpe, it is possible that visitors and voluntary workers could have mingled. Carbapenem Resistant Enterobacteria In late July, the GHA had its first encounter with a Carbapenem Resistant Enterobacter (CRE), which was isolated in St Bernard's Hospital laboratory from a patient who had returned from Xanit hospital. CRE is a group of superbugs resistant to third line antibiotics and a matter for global concern. It is important to emphasise that the bacteria were discovered as colonisers (not causing infection) in the patient and the discovery was more a triumph of the intensive surveillance protocol that the Public Health department introduced in late Although this person was not infectious, all potential contacts were also screened, a process that was undertaken over several weeks. CRE carriage is currently believed to be lifelong and carriers will need to be treated with precautionary measures in future healthcare episodes. In late August, a further two patients, also returning from Xanit hospital were found to be carrying CRE, although not infected with it. The Infection Control Practitioners have alerted the staff at Xanit hospital to ensure that the necessary precautions and screening are conducted there. 17 P a g e

18 The serious nature of CRE necessitates that the efforts to eradicate these bacteria are more intense. These discoveries have prompted the need for investing in specialised technology for Terminal Cleansing of rooms vacated by persons with CRE, in accordance with best practice protocols. Current GHA CRE Policy recommends the use of Hydrogen Peroxide fogging machines for this purpose and it is planned to procure this technology in the next financial year. These terminal cleansing machines are useful against other difficult to eradicate organisms as well, such as Clostridium difficile. Information Analyst As part of the training required under her contract of employment, the Information Analyst completed two distance-learning Diploma Courses, in Statistics and Epidemiology at the London School of Tropical Medicine and Hygiene, which she passed with grades of 3/5 and 4/5. In August 20 she also visited Public Health England in London for bespoke three-day training for the Cancer Registry. She received guidelines and instructions on the technically demanding tasks of quality assuring and cleaning the cancer registry data in Gibraltar. October to December 20 Colorectal Cancer Screening Programme During the period spanning the months of October to December, a total of 782 invitations were mailed to eligible participants inviting them to take part in the Colorectal Cancer Screening Programme. During this same period 741 testkits were prepared and mailed to the participants and 292 samples were returned to the hospital laboratory for analysis. The breakdown of the results is as follows: 241 Negative for occult blood results 29 Inconclusive for occult blood results 22 Positive for occult blood results Of those participants invited to participate, 9 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 78 invitations extended to eligible participants residing in Spain, 12 individuals expressed interest in participating in the screening programme. During these months the Surgical Out-Patient Department notified the Screening Office of the following results. 1 Cancer diagnosed 3 Adenomas diagnosed (placed in surveillance programme) 8 Adenomas diagnosed (returned to screening programme) The nature of participant visits to the screening office has changed during this period. There were no more enquiries related to participant suitability to take part in the programme whilst taking aspirin or anti-inflammatory drugs. The bulk of visits have related to the requesting of replacement test-kits or seeking clarification on the method. 18 P a g e

19 It has been noted that since the second recall of participants started in 20 there has been a number of participants who initially did not accept their invitations during 2014 but who did decide to participate second time round. The Response Rate of the programme continues to be disappointing at 39.4%, when compared to that of the UK, which is around 60%. Abdominal Aortic Aneurysm Screening Programme During the period of October - December, 129 invitation letters were mailed to eligible participants and 46 accepted their invitations (35.7% response). All these participants were issued with ultrasound appointments. A total of 34 reconsider letters were issued to participants who did not reply. No expressed refusals were recorded during this period. However, 29 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 an elective case. During this period, 58 men were screened and the following were diagnosed. - 2 small aneurysms - 1 large aneurysm One man who was previously diagnosed with a medium abdominal aortic aneurysm was rescreened during this quarter. Health and Lifestyle Survey The Report of the Health & Lifestyle Survey was formally published in December 20 in the record time of 21 months. It contains a wealth of information about the health and lifestyle of the Gibraltar adult population, but the top four findings are: The levels of Obesity remain high. Three out of Five adults in Gibraltar are overweight or obese. Smoking levels are high. Smoking prevalence in Gibraltar is higher than in all the countries chosen for comparison. Smoking has actually increased from 2008, particularly in younger people. Alcohol consumption in the population is generally low at all ages and in comparison to the countries studied. Gibraltar people have a good awareness of the risk factors related to skin cancer and have a generally healthy attitude towards risky sunbathing behaviour. The full report includes a lot more detail, for example, it also examined what people eat, their perceptions about their health, how they exercise, their use of health services and many other aspects of health and lifestyle. All in all, over 24,000 separate pieces of data have been captured and analysed. It is intended that the Report will be widely available. A limited quantity of print copies of the full 200-page report has been produced and will be distributed to libraries, schools and other locations where the public can access it. 19 P a g e

20 A condensed -page version of the report has also been produced and will be distributed to people s homes in Gibraltar in the coming months. A PDF version of the full report will shortly be made available for download on the GHA website. The Report follows on the report of the first survey carried out in Producing two successive Health Surveys is a great achievement for our small nation. Launching the Survey Report jointly at a Press Conference on 6 th December 20, Health Minister Hon. Costa and Public Health Minister Hon. Cortes said, This Survey provides us with the information, and challenges us all to do our best to improve our health and that of our families. For we are people and not statistics, and we must do all we can to live better, live longer, and be happier. Health Improvement The two Health Promotion Officers continue to have a busy schedule of work. The following are some of the activities undertaken by them during this quarter: The Health Promotion Officers met with the Youth Service to discuss potential ways to deliver important health education to the youth with special emphasis on sexual health issues. The Youth Service suggested that the planned sexual health education program could be piloted with the Youth Service before taking it to the schools. The Health Promotion Officers have been working with the Manager of the Alameda Wildlife Park at the request of Minister Cortes to discuss promotion of a meat-free initiative on at least one day a week in local schools and restaurants. There have been previous discussions about the campaign with Vegan Gibraltar and the Department of the Environment. It is thought that Ocean Village would be a good place to start and the aim is to try and get a campaign evening together at one of the Ocean Village restaurants, inviting interested parties, even the restaurateurs themselves (perhaps with a Veggie Weekend or night to start off the campaign). In November, the Health Promotion Officer was interviewed by the Gibraltar Magazine for a project for the January issue on the above project and on the pros and cons of vegan/vegetarian lifestyle in the short and long run. The Health Promotion Officer set up an awareness campaign for World Mental Health Day an on 10th October 20 with support from several mental health professionals including Club House Gibraltar, Nurses from the Community Mental Health Unit, Health Minister Dr Cortes and Equality Minister Ms Sacramento also attended. Health Promotion Officer Daya Dewfall personally supported the event by taking part in the Southampton Solent Half-Marathon and raised over 500 for Club House Gibraltar. 20 P a g e

21 A five-week programme on Sexual Health covering contraception and sexually transmitted diseases was commenced on Monday Oct 3rd and ran through to Monday Nov 7th.Professionals involved included the Infection Prevention and Control Practitioners, Nurse Practitioners and the Health Promotion Officers. The initial session was a combined session covered by the Nurse Practitioners and Infection Control team. However, it was found that there was too much subject matter to be covered and future sessions were divided into two sessions that ran concurrently in different rooms: o Contraception/Relationships and responsibility (NPs) o Sexually Transmitted Diseases and Infection prevention and control (Infection Control team) The Health Promotion Officers visited the Cancer Relief Centre to discuss future opportunities to work together in The Health Promotion Officers participated in the Antimicrobial Stewardship Team Meeting in November 20 to discuss European Antibiotic Awareness Week and ways to promote public and professional awareness of antibiotic resistance. Further actions ensuing from this meeting involved a short article and video link for uploading onto the GHA social media accounts (Facebook/Twitter) and onto the GHA website. The Health Promotion Officers, the Physiotherapists and Occupational Therapists raised awareness on Stroke and Stroke prevention on Saturday 14th November along with stroke survivor John Sheppard and other stroke patients. World Diabetes Day was observed on Monday 14th November with an awareness pitch outside the ICC Building with several professionals supporting the event (including Diabetes Nurses, professionals from the Eye department, Dieticians and Health Promotion Officers). The Health Promotion Officers supported the Practice Development Team and several other departments at St Bernard s Hospital on Thursday 17th November, to raise awareness on pressure ulcer injury. The Health Promotion Officers met with the Care Agency, Community Drugs & Alcohol Team and to discuss plans for this year s binge drinking campaign and future health promotion campaigns. Following on from this meeting, the Health Promotion Officers teamed up with the Care Agency and the Police to deliver a series of presentations on binge drinking at Westside and Bayside Schools. Multidisciplinary presentations on alcohol awareness, binge drinking and addiction were delivered from 6th-14th December. The Health Promotion Officers met with the Westside School Head teacher Mrs Barabich and Deputy Head teacher Ms Scott to discuss future joint-working to promote healthy living, positive sexual health and general well-being for students. The teachers welcomed the idea to work jointly with the GHA Public Health team and emphasized that 21 P a g e

22 there was a strongly felt need for a school nurse or similar professional to be present in the school on a regular basis. The Health Promotion Officer, Infection Prevention and Control Practitioners Sandra and Nathan and the Friends for Life group raised awareness about AIDS on Thursday 1st December (World AIDS Day) with a pitch outside the ICC building. Leaflets providing information were available, red ribbons were given to the public to raise awareness and those wishing to donate were asked to put down their thoughts about HIV into a word cloud highlighting different beliefs. The event went well with quite a few people stopping to discuss HIV Stigma (the theme of this year s campaign). The Health Promotion Officers met with the College of Further Education to discuss the delivery of sessions on personal health and wellbeing to a cohort of students in 2017 The Health Promotion Officers delivered a presentation on Health Education and Health Promotion to the 3rd year student nurses. The Health Promotion Officers gave assistance to the Breathe Easy society in raising awareness about Chronic Obstructive Pulmonary Disease on World COPD Day (November th). The advanced Nurse Practitioner was also present to answer queries about COPD and to promote the GHA Stop Smoking Service. The following articles were written for the Gibraltar Chronicle: o Understanding Influenza o National Fertility Awareness Week o Stroke o Stress Awareness o COPD o Antibiotics o Eye Care in Diabetes (with the GHA Hospital Optometrist) o Borderline Diabetes o AIDS/HIV o Binge drinking o Food Safety at Christmas The following talks were given on GBC Radio Health File o Stress o Flu and colds The following new resources are being developed : Infection Control o A new infomercial on Dietary fats. o New infomercials jointly with GBC 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 22 P a g e

23 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: The officers carried out surveillance of sexually transmitted diseases and helped detect 32 patients during this quarter. They also support the twice monthly HIV clinics run by the visiting specialist from La Linea. Although this works well, it also highlights the need for a more comprehensive sexual health service. Daily surveillance continued for dangerous pathogens such as Methicillin Resistant Staphylococcus Aureus (MRSA), Carbapenem Resistant Enterobacter (CRE) and Extended-Spectrum beta- Lactamases (ESBL). All patients are returning from tertiary Hospitals are screened for MRSA and CRE. Six monthly screening of wards for MRSA are regularly carried out, taking each ward in turn. The annual vaccination programme against Seasonal Influenza was commenced for GHA staff, long stay residents of St Bernard's Hospital, officers and inmates of HM Prison and residents of care institutions. This work is currently on-going. Several wards in St Bernard's Hospital were systematically given training in Aseptic Non-Touch Technique (ANTT), which is now rapidly gaining recognition as a key practice in the prevention of infections. ANTT trays were distributed to several wards. As part of their professional development, the officers attended a day course on Legionella & Pseudomonas contamination of water systems. Presentations on Sexual Health were given to Bayside School students (year 12) in October. A total of 5 sessions arranged by the head teacher and health promotion team. The officers participated at a Stand set up for World AIDS day on 1st December to raise awareness of this infectious disease, which continues to remain a threat. The officers gave advice given to the Port authority regarding a Cruise liner with a Norovirus outbreak on board. Separately, the officers also gave training to the Port Crews on donning and doffing of protective clothing and on Hand Hygiene. January to March 2017 Colorectal Cancer Screening Programme During the period spanning the months of January to March, a total of 710 invitations were mailed to eligible participants inviting them to take part in the Colorectal Cancer Screening Programme. During this same period 721 testkits were prepared and mailed to the participants and 264 samples were 23 P a g e

24 returned to the hospital laboratory for analysis. The breakdown of the results is as follows: 224 Negative for occult blood results 22 Inconclusive for occult blood results 18 Positive for occult blood results 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. Of the 33 invitations extended to eligible participants residing in Spain, 7 individuals expressed interest in participating in the screening programme. A small number of participants continue to visit the screening office seeking replacement test-kits or clarification on the method. It was noted that during this quarter a number of individuals who did not accept their screening invitations 2 years ago did seem to do so on this occasion. Some of these participants would say that the reason for accepting their invitations was the fact that friends of theirs were taking the test and talking about it openly. It could be possible that having family and friends talking about their experiences in participating in the Colon Cancer Screening Programme can have a positive peer pressure effect on non-participants. The Response Rate of the programme continues to be disappointing at 37.2%, when compared to that of the UK, which is around 60%. Abdominal Aortic Aneurysm Screening Programme During the period of January - March, 117 invitation letters were mailed to eligible participants and 40 accepted their invitations (34% response). All these participants were issued with ultrasound appointments. In addition, 34 participants accepted their invitation after being prompted by either a reconsider or notification of refusal letter. A total of 1 reconsider letters were issued to participants who did not reply. No expressed refusals were recorded during this period. However, 83 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 an elective case. This adds to the 1 such request in the previous quarter. During this period, 62 men were screened. One man who was diagnosed in the previous quarter to have a medium sized aneurysm was found that after 3 months during re-screening the aneurysm had grown to a large aneurysm. A second man was found to have an undiscovered large aneurysm on first screening. Both gentlemen were according to the medical protocol referred for vascular surgery. Health and Lifestyle Survey The Report of the Health & Lifestyle Survey which was published in December 20 has now been distributed. 24 P a g e

25 About one hundred print copies of the full 200-page report have been produced and distributed to parliamentarians, heads of government departments, libraries, schools and other locations where the public can access it. A condensed -page version of the report has been distributed to people s homes in Gibraltar. A PDF version of the full report has been posted on the GHA website to enable download. Health Improvement The two Health Promotion Officers continue to have a busy schedule of work. The following are some of the activities undertaken by them during this quarter: Public Events A flu awareness campaign was held outside the ICC building on Thursday 12 th January with a focus on hygiene, how to treat the flu and when to access primary/secondary care. The Health Promotion Officers attended the Childline event at John Mackintosh Hall on 8th February, aimed at providing information on support and recognition of mental health issues in children. The Health Promotion Officers organised a public awareness campaign for No Smoking Day on the 8th March highlighting the importance of quitting and where one can get support. Event materials were provided for several departments/companies prior to the event, including ocean views, HM Customs, the Police, Boarders & Coastguards and several gambling firms. On-going Infomercials were relayed on GBC, topics covered including: Antibiotic Awareness, Change for Life Sugar, Dementia, Stop smoking, and Smoking cessation. A new Health Promotion Website is under production In conjunction with the department for Environment and the Alameda Wildlife Park, the Health Promotion Officers are developing a cut meat not trees initiative highlighting health and sustainability as important considerations for food choices. The Health Promotion Officers joined a focus group aimed at developing strategic events and methods to reduce obesity in young children led by a consultant paediatrician and including the GHA Dieticians, Education adviser, members of Gib Culture and the Sports Authority. The Health Promotion Officers met with several members of the Environmental Agency and agreed the importance of collaborative working for several community issues, including food safety, hand hygiene, the impact of cigarette smoking, and concerns regarding dog fouling/litter. 25 P a g e

26 The Health Promotion Officers met with the School of Health Studies regarding the development of a Men s Health Campaign and a Men s Health Passport. The campaign event advertising the series of talk is set to run on May 10th. The Health Promotion Officers met with the Cancer Services Coordinator to discuss an awareness event for the importance of cervical screening. The Health Promotion Officers met with the Mental Welfare Officer for the Royal Gibraltar Police to discuss potential collaboration on events promoting health and wellbeing in the Police. One intention is to hold the first Being Healthy event week of June 26th. New Resources New Leaflets on Diabetes care, Know your labels and Diagnosed with Diabetes, produced by Diabetes UK have been purchased and are ready for distribution. A gazebo and several new boards for the Primary Care Centre were purchased for immediate use. A new Change For Life infomercial was produced, with the focus on fats. A new hand-washing leaflet was designed. More colorectal DVDs were ordered. Assistance to Support Groups The Health Promotion Officers participated in the regular meeting held with Clubhouse, various mental health services and social services to discuss events for the forthcoming year. They attended the Let s Talk about Mental Health event on Friday 3rd February and welcomed collaborative working for World Health Day which this year focuses on Depression. The Health Promotion Officers supported the World Cancer Day event which took part in casemates Saturday 4th February, alongside several cancer charities and the GHA staff. Following this event they met with Cancer Relief and discussed collaborative working for the year. The Health Promotion Officers supported the Gibraltar Alzheimer s and Dementia Society evening, which explored how to help make Gibraltar Dementia Friendly, as well as The World Rocks for Dementia event at Mount Alvernia. At the request of St Joseph s School, several posters were given to the school covering good mental health. The Health Promotion Officers attended the Communication: The Art of Leadership conference organised by the Argus CIPD group, focusing on the importance of effective communication and suggestions on how to build trust in professional environments. Media engagement Articles for the Gibraltar Chronicle included: 26 P a g e

27 o Flu Awareness o Importance of hand Hygiene o Obesity Awareness Week 9-15th January o Cervical Cancer Prevention Week 22nd-28th January o Bug Busting Day 31st January o World Toothache Day 9th February o Reynaud Awareness Month o Tinnitus Awareness Week o No Smoking Day o World Glaucoma Day o Spring is in the Air (Allergy Article) Article for Insight Magazine- Beat Colds and Flu, Benefits of Yoga 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: The officers carried out surveillance of sexually transmitted diseases and helped detect 39 patients during this quarter. Daily surveillance continued for dangerous pathogens such as Methicillin Resistant Staphylococcus Aureus (MRSA), Carbapenem Resistant Enterobacter (CRE) and Extended-Spectrum beta- Lactamases (ESBL). All patients are returning from tertiary Hospitals are screened for MRSA and CRE. One GHA employee who had cared for a patient with tuberculosis raised concern when found to be positive in a test designed to detect early tuberculosis. Although the alleged exposure was felt to be too recent to have caused the infection, on a precautionary basis, seven other staff were tested but found to be unaffected. A person aboard a ship was reported to have been found dead of unknown causes. The Infection Control Practitioners assisted with the enquiry primarily to advise of health risks to the investigators. Respectfully submitted Dr. V. Kumar Director of Public Health 27 P a g e

28 July to September Medical Director I would like to present my first GHA Board report since I was appointed as Medical Director in June 20. This report covers the third quarter of the year 20. Education & Training The structured medical CPD sessions continue at St Bernard s Hospital on the first Friday of the month and on Wednesday lunchtimes every fortnight at the Primary Care Centre. The CPD sessions at St Bernard s Hospital are set out below. CPD Study Day Friday 1 st July am 9.45am Case Presentation- Dr Bronwyn James, Medical NCHD Tumour Lysis Syndrome Case Presentation Dr Keith Gracia, Medical NCHD Spinal Cord Compression 10.00am GHA Paediatric Department Dr Danny Cassaglia, Paediatric Consultant An overview of the current service for paediatric oncology at the GHA 10.15am 11.15am Visiting Lecture - Dr. Rafa Trujillo,Consultant Oncologist, Xanit Hospital Management of Oncological Emergencies Q & A CPD Study Day Friday 2 nd September am 10.30am Visiting Speaker: Mr Mario Hook, Ombudsman The GHA Complaints Handling Scheme Update: The New Chemotherapy Day Unit - Isobel Ellul 10.45am Dr Richard Roberts, Consultant in ITU and Chairperson of the Resuscitation Committee. NEWS - National Early warning System Introduction in GHA 28 P a g e

29 GP/PCC Medical CPD Programme I enclose an extract of the report by the PCC medical Team on their CPD activities for this year. This Academic Year in Primary Care (Sept 2015 to July 20) the GP/PCC team will have had 27 Talks and 9 Journal Club Meetings in their CPD Programme. (Wednesdays in the PCC Board Room ) This constitutes 36 CPD Points (1 point = 1 hour of CPD) out of a minimum of 50 required per year by doctors for both those giving and attending Talks /Meetings. The PCC team felt that the format had been successful although they requested feedback so that improvements could be made for next year. Initially they booked one talk per month by GP, Nurse, Paramedic, Consultant, Groups etc and one Journal Club (where any interesting journal articles were discussed). Meetings were held every 2 weeks as a baseline. This year they have had numerous extra meetings on the Wednesdays in between due to demand. These sessions are run primarily for GPs/ Primary Care to complement any other CME /CPD available but anyone medical is welcome. The primary aim is to provide continuing medical academic education relevant to primary care in an informal and interactive setting. The PCC medical team want to continue the age old tradition of continuing voluntary medical education for the health profession by the health profession. Medical Appraisals Annual appraisals of all GHA medical staff occur on a yearly basis. These appraisals are provided by the Health Education England Wessex Appraisals Service. The second annual report (covering the year April 2015-April 20) was presented to the CEO on 13 th July 20. A total of 78 doctors (out of 78 eligible) were appraised over the year, this represented an uptake of 100%. The feedback from GHA doctors was very positive with the vast majority saying that their appraisal was useful for improving patient care and promoting quality improvement. GHA doctors also felt that the process was very useful in their preparation for revalidation with the GMC. 29 P a g e

30 October 20 to March 2017 Medical Education & Training Regular monthly Medical Education CPD sessions continue on the first Friday of every month in the School of Health Studies Lecture theatre. Sessions are open to all doctors and other relevant GHA staff. October 20 & February 2017 ATLS (Advanced Trauma Life Support ) Course and ATNC (Advanced Trauma Nursing) Course. These advanced teaching courses were held in Gibraltar for the first time in October 20 and again in February 2017 with 60 local medical, nursing and paramedic GHA staff attending. A team of 15 staff came from St Georges Hospital London and around the UK to deliver the courses which was a great success. This course ensures that all our staff are qualified in the provision of Gold Standard care to Trauma patients. Friday 2 nd December Diabetes Update by EDEN.A study day designed to enhance knowledge and skills in managing patients with diabetes Friday 6 th January Generic CPD day presented by Intensive Care Team Dr Hamish Thomson, Consultant in Anaesthetics & ITU M & M Case Presentation Dr Richard Roberts, Consultant in Anaesthetics & ITU Update Lecture Bleeding and Emergency Surgery in anti-coagulated patients Jan Peter Bengtsson, Consultant in Anaesthetics & ITU Monday 13 th February 2017 to Thursday th February 2017 New Mental Health Act 4 day training course provided to GHA Psychiatrists, GPs, A&E Doctors, and mental health workers. This training is vital to enable staff involved in looking after patients with mental health problems to fully understand the provisions of the new Mental health act. The new act is designed to make Mental Health care more efficient and transparent with a more pronounced emphasis on the rights of individual patients. Friday 3 rd March 2017 Generic CPD day with visiting lecture by oncologist and a presentation by the ophthalmic department Dr Jorge Contreras, Radio-Oncologist Clinical Magna, Spain Update Lecture (external speaker) "Oncological Hyperthermia: The fourth pillar on cancer treatment" Dr Helena Cilliers, Dr Keti Pachkoria Introduction - Newly Appointed Ophthalmology Consultants 30 P a g e

31 Trevor Guilliano (Ophthalmic Nurse) Update Red Eye Differential Diagnosis Michelle Brown (Senior Orthoptist) Update Visual Fields (Interpretation and Clinical use), Keti Pachkoria, Consultant Ophthalmologist. Case Presentation Angle Closure Glaucoma (Real life case presentation) Isabella Crisp, Senior Optometrist Update Diabetic retinopathy screening, Low risk optometry led clinics Helena Cilliers (Consultant Ophthalmologist) Update Diabetic Retinopathy screening, High risk consultant led clinics Helena Cilliers, Keti Pachkoria, Consultant Ophthalmologist Service reconfiguration - New ways of working Ophthalmology and Optometrist and Ophthalmic nurses Medical Regulation On 5 th October 20 Professor Derek Burke FRCSEd FRCEM FRCPCH was appointed as the second Responsible Officer. Prof Burke was also been recognised by the GMC as a Suitable Person and appears on the list of GMC approved Suitable Persons (web page link Suitable_Person_details DC4964.pdf_ pd f) Prof Burke is well known to GHA staff and has been coming to Gibraltar 3-4 times per year for the last 15 years to teach on UK Resuscitation Council approved courses (ALS, EPALS, PILS, ILS). Prof Burke is the Medical Director and Responsible Officer at Sheffield Children s Hospital and has a clinical background in Paediatric Emergency Medicine and Medical Education. Quality Improvement & Service Development Adult Surgical Prophylaxis Antibiotic Guidelines published in October 20. authored by our consultant microbiologist Dr. Nick Cortes, based on UK best practice and NICE recommendations, as well as adapted to match Gibraltar s microbial flora wherever possible. The guidelines have been subject to consultation amongst clinicians, reviewed at the GHA Antibiotic Stewardship Committee, approved by the GHA Infection Control Committee and adopted by the GHA as policy. 31 P a g e

32 A new and highly specialised visiting perinatal pathology service has been set up to provide the option of post mortem examinations for perinatal deaths and still births. This service will be provided by a visiting team from St Georges Hospital in London as required. Patients requiring treatment for Hepatitis C will now be seen and treated at St Bernard s Hospital as from October 20. The service is provided by Dr Gloria Garcia, visiting consultant in Infectious diseases. An automated system that s blood results to the requesting clinicians was rolled out in March The system s the requesting clinician automatically as soon as results are available. At the same time clinicians who work off site and need immediate access to patient results will be able to access these via a fully encrypted and secure smart phone App. These innovations represent a significant clinical quality and safety improvement. The A&E department will be employing a Consultant in A&E to provide a senior presence in the department and lead in the development of clinical services. The department will also increase its complement of Sister/Charge Nurses to 3 in order to ensure there is always a senior member of the nursing team in each shift. Bed Management Increasing pressure on beds towards the end of 20 resulted in plans to further enhance the bed management system. This was achieved using a three pronged approach 1) Proactive bed management strategy implemented in January 2017 with weekly Bed Management meetings of the ward managers and multidisciplinary team, including social workers and chaired by the MD and DoN. This has resulted in successful discharge of patients with complex needs who require help in the community. 2) Immediate, temporary expansion of long term Elderly Care beds by converting the Gym into a Temporary Ward in January 2017, increasing capacity by 7 beds 3) Expansion of elderly care provision in the community (Opening of Bellavista Dementia Day care facility in January 2017) and planned opening of Hillside Dementia Residential Care facility in April Further increase in beds planned to John Mackintosh Wing, Old St Bernard s Hospital by converting ground floor into a ward with additional beds. These improvement resulted in an increased average daily bed availability, there were no cancellations due to lack of beds since 10 th January 2017, the number of major surgery requiring an inpatient stay has approximately 32 P a g e

33 doubled between January and March 2017 compared to the same period in 20. Primary Care Centre A repeat Prescription service was introduced on 8 th February to allow patients to request a repeat prescription without necessarily having to book an appointment with their GP. The Dermatology Service based in Primary Care has continued to grow. Dr Ferrera, GP with Special interest in dermatology has now more than doubled his availability in the dermatology clinic from 2 half days to 5 half days ore week. Dr Ferrera also carries out minor operations list at St Bernard s Hospital Day Surgery unit once per month. In February 2017, Dr Elaine Flores a GP with interest in Musculoskeletal medicine was appointed to start a musculoskeletal service. Dr Flores has started on a part time basis and will be based in hospital with the Orthopaedic Team. Her role will be to bridge the gap between primary and secondary care. Dr Flores will be involved in providing faster access to treatment including rehabilitation and joint injections. She will work closely with the orthopaedic team to ensure patients requiring surgery are fast tracked and prioritised. This new service will be further developed after a period of monitoring and audit. Three part time GPs were appointed to work as doctors in the elderly residential service to provide personalised care to all residents of Mount Alvernia, John Mackintosh Wing and Hillside Dementia Residential centre. This will result in improvements to the medical care of residents. In March 2017, the GHA introduced a dedicated phone line for patients requiring a sick note. These calls are triaged by trained clinical staff who will issue the certificate if the patient does not need to see a doctor. Sick certificate will be issued for up to 2 days and no more than one certificate per patient every three months. All patient medical notes at the PCC will be digitised over the coming months and uploaded on the electronic patient record. This will mean that all past medical information will now be available to clinical staff on their GHA computer. This will release admin staff to attend to patients face to face and on the telephone. The new prescription service and sick note service have released approximately 500 extra GP appointments every month, improving the number of available appointments for patients who need to see a doctor. 33 P a g e

34 5.4 Director of Estates and Clinical Engineering July to September Department 3 year Strategic Plan work-streams. Over the last 3 months as a department we have developed our quality manual along with all of the core procedures which underpin it. We have now completed the final drafts of the main quality manual and the 9 procedures that will underpin it; 6 Mandatory and 3 Operational (based on ISO9001:2008 requirements). Supporting the procedures we are currently aligning our current processes and practices, and further developing new forms and processes where needed. Forming part of our quality based approach we have been working to fully develop and utilise our CAFM system with a particular focus on asset management, lifecycle planning and planned maintenance. The current status is as follows, however there has been little movement particularly for the electrical section due to staffing issues: Mechanical CAFM - asset register now 100% complete. PPM s 20% (progress slow but this will be stepped up due to the employment of the new D4 Engineering Manager). Electrical CAFM asset register now 90% complete; PPM s 10% (Progress has been slow due to staffing issues; sickness.) Clinical CAFM asset register now 100% working status; PPM s 100% Based on the asset registers formulated within CAFM, a bespoke Lifecycle plan is also in development. This is a live working document which will clearly identify and track each assets lifecycle plan and prioritise its replacement based on both risk and cost. On an operational level we have also been working with IM&T to develop a reactive ticketing system based on the current technology IM&T have in place. This will allow us to track and monitor our reactive works and performance online via the GHA internet. We are pleased to inform the board that this system went live on 9 th September. This system covers Clinical Engineering (Medical Equipment), Electrical Installations, Mechanical Installations and Minor Works. The ticketing system is staffed during normal working hours. For emergency support outside normal working hours, On-Call support personnel can be contacted through the call-centre as per existing arrangements. 2. Projects Completed and On-Going St. Bernard s Hospital: New Chemotherapy Suite COMPLETE 34 P a g e

35 This state of the art facility has now been opened by the chief minister. The unit was largely completed by the in-house team in accordance with current standards and guidance notes, particularly in terms of its own Cytotoxic facility which allows for the safe production of medicines for the unit. Opening on 28 th September 20 Cytotoxic Suite (based on HTM03-01; as per a Pharmacy aseptic suite) 35 P a g e

36 St. Bernard s Hospital: Redevelopment Plan for A&E Due to the nature of this project and its close proximity to existing vital emergency service we have encountered some delay, the project overall is currently 60% complete with 90% of the electrical and mechanical infrastructure being completed; this has largely been achieved by our excellent in house team. This first phase is now moving into M&E final fix, decoration and the laying of flooring, with the plan to open up the new A&E entrance along with part of the new unit to enable the project to move into the second phase and internal works. This phase will be more challenging as it will mean working around an operational A&E department. New Façade and entrance to A&E, this will be covered with a new canopy to allow ambulances to disembark patients under cover. New three bed bay 36 P a g e

37 The formation of two new clinics and a staff kitchen and rest room. St. Bernard s Hospital: New Ultrasound room Radiology We are currently creating a new ultrasound room within Radiology, this is being constructed completely by our own team. Works are expected to be completed within the next three weeks. St. Bernard s Hospital: Maternity Early Pregnancy Room (EPR) This project revolves around moving the current observation room within the department, and to enable the formation of an early pregnancy loss room (EPR). The room will be used for sensitive issues such as pregnancy loss /stillbirth, and will offer better privacy and dignity; enable patients to enter and exit the department without being exposed the other patient s pre and post natal. These works are in the very early stages but we anticipate completion by the end of October. St Bernard s Hospital: Disabled Lift Enabling Works This project involves the initial enabling ground and structural works in preparation for the future installation of a disabled lift located on the West ramp. This will enable disabled patients to arrive unaided to the front entrance ground floor level of the hospital. This will ensure that 37 P a g e

38 the hospital continues to ensure that we continue to work towards the DDA requirements now laid down in the Equality Act St Bernard s Hospital: Temporary move of the Ambulance Service Refurbished facilities on the ground floor behind security reception and the installation of ambulance charging stations in the two FOH lay-by s. Primary Care Centre: Reception Desk This work involves the creation of glass security screens and privacy booths; this work is vital for both the protection of our receptionists, and privacy of patients. The order has been raised but due to long lead times for the delivery of the glass the installation works is not expected to start until 31 st October (latest). Primary Care Centre: Unit 53F - New Psychotherapy Clinic/Consulting Room This will enable the creation of vital additional doctor s clinic space within the unit. 38 P a g e

39 October to December Department 3 year Strategic Plan work-streams. Over the last 12 months as a department we have been developing our quality manual along with all of the core procedures which underpin it. We have now completed the final drafts of the main quality manual and the 9 procedures that support it; 6 Mandatory and 3 Operational (based on ISO9001:2008 requirements). The procedures have now been uploaded to the CAFM system documents folders for reference and comment. Supporting the procedures we are currently aligning our current processes and practices, and continuing the development new forms and processes where needed. Forming part of our quality based approach we continue to fully develop and utilise our CAFM system with a particular focus on; asset management, lifecycle planning and planned maintenance. The current status is as follows, however there has been little movement particularly for the electrical section due to staffing issues: Mechanical CAFM - asset register now 100% complete; PPM s 40% (progress slow but this will be stepped up due to the recent employment of the new D4 Engineering Manager). Electrical CAFM asset register now 90% complete; PPM s 10% (Progress has been slow due to staffing issues; sickness.) Clinical CAFM asset register now 100% working status; PPM s 100% Note: although we indicate complete CAFM is a live data base and needs to be continually updated. Based on the asset registers formulated within CAFM a bespoke Lifecycle plan has also been developed, this is a live working document which will clearly identify and track each assets lifecycle plan and prioritise its replacement based on both risk and cost. It is therefore a significant step forward to have reformulated the Medical Devices Committee to ensure that we have an integrated approach to lifecycle replacement. Our first committee meeting was held on the 12 th of January, with the next meeting scheduled for April. On an operational level we have also been working with IM&T to develop a reactive ticketing system based on the current technology IM&T have in place. This allows us to track and monitor our reactive works and performance online via the GHA internet. The system went live on 9 th September and is proving to be an asset to the departments monitoring and control of reactive calls. This system covers Clinical Engineering (Medical Equipment), Electrical Installations, Mechanical Installations and Minor Works. External Specialist Maintenance completed in the last 4 months: Month Due Equipment Service Provider October Fire Damper checks/maintenance AirisQ 39 P a g e

40 Ultrasound Equipment Theatres and Wards medical devices Pulmonic equipment November Air Tube System Medical Gas Equipment Ultrasound Equipment Audiology Equipment Calibration December Anaesthesia Equipment Scope Maintenance Siemens Draeger Vitalograph Aeocom Midland Medical Philips GN-Resound GE Healthcare Olympus 2. Clinical Engineering The clinical engineering division has seen a number of personnel changes over the past few months due to the retirement of the Clinical Engineering Officer; this has meant staff acting into positions, the workload shared and the frequency of on-call increased. There is some concern that although reactive calls can be maintained, maintenance will slowly run into backlog. Current progress is as follows: Clinical CAFM: o Data Update and development of the asset register and PPMs - On-going o Development of a quick reference guide for Clinical CAFM to assist on the use of the system and to teach other staff members On-going Routine Maintenance (PPM): o No schedule maintenance completed over this period Priority to cover high risk equipment resulted in management measures to improve service for the next quarter. Reactive Maintenance: o Number of jobs logged into our system this quarter = 467 o Number of pending jobs = 36 o Number of jobs completed by external contractors = o External contractor pending jobs = 1 GHA Development & Projects: o Completion of oxygen and vacuum pipeline installation for A&E extension Pending QA Test next week. o Identified Issue with the emergency O2/Vac assembly on A&E patient trolleys Ordered and replaced O2 regulator to all trolleys. 40 P a g e

41 o Arrange and implement annual maintenance for Anaesthetic machine vaporizers still pending. Equipment Life Cycle Plan: o Research and procurement of approximately 17 medical equipment o Installation/Commissioning of 220 medical equipment 3. Electrical Engineering Due to its current complement, the electrical section is extremely busy and struggles to cope with the routine, particularly when there are projects on the go; on occasion we have had to rely on contractors to fill the gap which is not ideal. The following items have been the main focus in the period: Pathology Lab looking at wiring solutions to deal with the capacity issues on-going; PAT testing PAT testing of our portable appliances is on-going; Continue the upgrade of lighting to LED technology across all departments; LED lighting trial for ward corridors on-going; Project support, however mainly via contracted labour due to staffing issues; Upgrade and maintenance of the nurse call system; Various access control modifications in light of ministerial changes; ACB essential maintenance see below pictures. Relocation of main distribution boards in dental PCC following the floods in December. Checking and proving power circuits in the PCC following the December floods. Distribution boards moved away from potential further flooding. 41 P a g e

42 4. Mechanical Engineering The mechanical engineering division has also seen some personnel changes over the past few months due to the promotion of the Mechanical Engineering Officer (D5) into the Senior Engineering Managers role; this has meant two members of staff sharing the acting role for the D5 position; in this case the workload is shared. Current progress is as follows: o PPM and reactive works - All service and maintenance requirements have been undertaken for this period; however we need to liaise more closely with nurse management to create a programme that allows us to access patient areas to undertake essential works in these areas. o Air handling units major maintenance works is on-going this is picking up defects raised within the annual verification reports carried out by AirisQ. This work entails the replacement of Attenuators and Air dampers in some cases. Outstanding pulley replacement works will be undertaken in the next quarter. These major repairs are expected to reduce the system downtimes. o Installation of new A/C within server and UPS/IPS rooms has taken place; Theatres, Maternity, ITU, 3 No. IM&T server rooms and new PBX all were commissioned and completed in November 20. o Emergency works carried out over the period: October = 28 calls, November 32 calls, December = 25 calls. o Works Requests carried out over the period via the new helpdesk system: October 20 = 3, November 20 =, December 20 = 5 o Number of out of hours call-outs in the period: October 20 = 22, November 20 = 8, December 20 = 7. o Installation of a second sump pump and controls within the escalator sump following issues caused by the floods in December. VSD drive enclosure being dried out following the flooding. 42 P a g e

43 5. Projects Completed and On-Going St. Bernard s Hospital: Redevelopment Plan for A&E Due to the nature of this project and its close proximity to existing vital emergency service we have encountered some delay, the first phase extension of minors is currently 95% complete, pending the commissioning of medical gasses by the QA Pharmacist next week. This second phase of the works is on-going, with the formation of the new infusion room, refurbishment (flooring and redec) of the old minor s area, creation of a new plaster room and locker rooms. There is currently a third phase currently out to tender for the installation of a canopy to protect the new ambulance entrance from inclement weather. New Façade and entrance to A&E; this will be covered with a new canopy to allow ambulances to disembark patients under cover. New three bed bay St. Bernard s Hospital: New Ultrasound room Radiology 43 P a g e

44 We have completed a new ultrasound room within Radiology; this has been constructed completely by our own teams, including new lighting (LED dimmable) and power, full A/C with local BMS control, and nurse call. St. Bernard s Hospital: Maternity Early Pregnancy Room (EPR) This project involved moving the current observation room to an alternative space within the department; this enabled the formation of an early pregnancy room (EPR). The room will be used for sensitive issues such as pregnancy loss /stillbirth, and will offer better privacy and dignity; enable patients to enter and exit the department without being exposed the other patient s pre and post natal. These works are nearing completion. New Observation Triage room 44 P a g e

45 As part of these works we have also established a memorial garden for this unit. Primary Care Centre: Reception Desk This work involved the creation of glass security screens and privacy booths, and vital for both the protection of our receptionists, and privacy of patients. 45 P a g e

46 On this back of this work we are remodelling the registration are to offer the same protection and privacy benefits to both staff and patients. The quote is with the minister for consideration. 6. Projects Presently at Design / Feasibility stages Sponsored Patients Redevelopment of unit, to improve patient access and data protection. Currently on hold pending funds. Fire Escape plant room 5, provision of secondary means of escape structural design complete and quotes received - awaiting for funding. A&E Containment/Isolation Suite Currently investigation several both temporary and permanent locations for this facility. As a temporary location we are looking at placing this facility within the existing patient assessment area within A&E. Electrical and Mechanical Resilience- Feasibility study to install emergency generator at higher than basement and ground floor level, and install drainage and sump pump pits within the basement (as a means of protecting the main electrical HV and LV distribution. We are also looking into the installation of sump pumps in the basement to guard against flooding. Ophthalmic department reorganisation of the department to create new consulting rooms. PCC New primary care building planned on the St Bernard s Hospital site. There is now a steering group in place to produce a detailed brief for the developer. Speech and Language- for 2017 estimates Improvements to the department; The construction of a walk-in cupboard within the therapy 46 P a g e

47 office to house larger equipment, stationery, patient appliances and assessment materials etc. Maternity Phase 2 Improvements to the department; conversion of the disabled labour room into a new operating theatre. Conversion of bathroom into a birthing pool room, various infection control changes to birthing rooms, and the reconfiguration of the main reception. St Bernard s Hospital: Disabled Lift Enabling Works This project involves the initial enabling ground and structural works in preparation for the future installation of a disabled lift located on the West ramp. This will enable disabled patients to arrive unaided to the front entrance ground floor level of the hospital. This will ensure that the hospital continues to ensure that we continue to work towards the DDA requirements now laid down in the Equality Act In light of the recent storms and the issues this caused with the escalators being out of action, the addition of a disabled lift will be a welcomed. Respectfully submitted Derek Alman Director of Estates and Clinical Engineering January to March Department 3 year Strategic Plan work-streams. Over the last 15 months as a department we have been developing our quality manual along with all of the core procedures which underpin it. 47 P a g e

48 As previously reported we have completed the final drafts of the main quality manual and the 9 procedures that support it; 6 Mandatory and 3 Operational (based on ISO9001:2008 requirements). The procedures have been uploaded to the CAFM system documents folders for reference and comment pending role out. Supporting the procedures we now need to align current processes and practices, along with the development of new forms and processes where needed. This process has been somewhat stalled due resources; with two out of three divisional engineering officer positions vacant and the recent release of our director. Forming part of our quality based approach we continue to fully develop and utilise our CAFM system with a particular focus on; asset management, lifecycle planning and planned maintenance. This stage has also stalled due to resourcing with the current status as per previously reported: Mechanical CAFM - asset register now 100% complete; PPM s 40% (progress slow but this will be stepped up due to the recent employment of the new D4 Engineering Manager). Electrical CAFM asset register now 90% complete; PPM s 10% (Progress has been slow due to staffing issues; sickness.) Clinical CAFM asset register now 100% working status; PPM s 100% Note: although we indicate complete CAFM is a live data base and needs to be continually updated. Based on the asset registers formulated within CAFM a bespoke Lifecycle plan has also been developed, this is a live working document which will clearly identify and track each assets lifecycle plan and prioritise its replacement based on both risk and cost. It is therefore a significant step forward to have reformulated the Medical Devices Committee; however it is imperative that a meeting is planned ahead of capital budgets being released (hopefully in June/July) so that a timely procurement process can be implemented. External Specialist Maintenance completed in the last 4 months: Month Equipment Service Provider Due January SBH Dry Risers G4S Radiology Fluorostar, XR Max 4 plus GE Autoclaves etc Steris Patient Hoists Servitest February Laminar Flow Equipment Weiss Technik X-Ray Modalities Philips Pulmonic and Hyp Air Vitalograph Dental Chairs SBH and PCC Graham Parsons Audiology Equipment Calibration GN-Resound March Lifts Otis 48 P a g e

49 SBH Fire Alarms PCC Fire Alarms CMHT Radiology Printers Monitoring Equipment VIE Oxygen Radiology Mamography G4S G4S G4S AGFA Philips Linde GE 2. Clinical Engineering As previously reported the clinical engineering division has seen a number of personnel changes over the past year due to the retirement of the Clinical Engineering Officer and the loss of one apprentice; this has meant staff acting into positions, with the operational workload being shared and the frequency of on-call duties increased. There is still therefore concern that although reactive calls can be maintained, maintenance will slowly run into backlog. Current progress is as follows: Clinical CAFM: o Data Update and development of the asset register and PPMs - On-going o Development of a quick reference guide for Clinical CAFM to assist on the use of the system and to teach other staff members On-going Routine Maintenance (PPM): o Again no scheduled maintenance was completed over this period Priority has been given to cover high risk equipment resulted in management measures to improve the service for the next quarter. Reactive Maintenance: o Number of jobs logged into our system this quarter = 315 o Number of pending jobs = 25 o Number of jobs completed by external contractors = 12 o External contractor pending jobs = 2 GHA Development & Projects: o Completion of oxygen and vacuum pipeline installation for A&E extension QA Testing was completed successfully by Midland Medical on 6 th March. o Identified Issue with the emergency O2/Vac assembly on A&E patient trolleys This has now been resolved by replacing O2 regulators to all trolleys. 49 P a g e

50 o Implement annual maintenance for Anaesthetic machine vaporizers we are close to resolving this issue; on speaking to GE it is suggested that we carry out an annual performance check on these units, any discrepancies will be resolved directly via GE. Training and procedures will need to be planned. Equipment Life Cycle Plan: o Medical devices procured in the last period have now been deployed and commissioned - Installation/Commissioning of 220 medical devices in /17. o Installation of a new pathology sterilizer is still pending due to workload. 3. Electrical Engineering Due to its current complement, the electrical section continues to be extremely busy and struggles to cope with the routine, particularly when there are projects on the go; on occasion we have had to rely on contractors to fill the gap which is not ideal. The following items have been the main focus in the period: Pathology Lab looking at wiring solutions to deal with the capacity issues on-going; PAT testing PAT testing of our portable appliances is on-going; Continue the upgrade of lighting to LED technology across all departments; LED lighting trial for wards corridors, budget permitting on-going; Project support; installation of Temporary ward, A&E extension, 1 st floor outpatients clinics; however mainly via contracted labour due to staffing issues; Upgrade and maintenance of the nurse call systems to support projects; Support for the on-going upgrade of the access control system; Installation of new 400A switch for the Solar HWS project. 4. Mechanical Engineering The mechanical engineering division has also seen some personnel changes over the past few months due to the promotion of the Mechanical Engineering Officer (D5) into the Senior Engineering Managers role; this has meant two members of staff sharing the acting role for the D5 position; in this case the workload is shared. Current progress is as follows: 50 P a g e

51 o Reactive works - All service and maintenance requirements have been undertaken for this period; we have carried out 27 reactives in January, 30 reactives in February, and 43 reactives in March ONLY 7 via the on-line reporting system. o Planned and emergency works humidifiers, AHU s, dirty extract and general supply units, PCC servicing of split A/C units, upgrading of old water pump manifold, installation of stabins and bypass for the new Solar HWS project, major repair of the basement AHU cooling coil. o Air handling units remedial works are on-going this is picking up defects raised within the annual verification reports carried out by AirisQ. This work entails the replacement of Attenuators and Air dampers in some cases. Outstanding pulley replacement works will be undertaken in the next quarter. These major repairs are expected to reduce the system downtimes. o Emergency works carried out over the period: Jan March 12 No. o Major repair on the west wing cooling cool in February. o Major remedial works carried out on the CSSD AHU. o Installation of Temporary Ward and refurbishment of A/C in the area. 5. Projects Completed and On-Going St. Bernard s Hospital: Redevelopment Plan for A&E Due to the nature of this project and its close proximity to existing vital emergency service we have encountered some delay, however the first phase extension is now complete. The second phase of the works is on-going, with the formation of the new infusion room, refurbishment (flooring and redec) of the old minor s area, creation of a new plaster room and locker rooms. Unfortunately due to budget closures and current restrictions on capital spend we are not able to progress phase 2 to completion. However the infusion room has progressed and is now almost complete. There is now a third phase, which has been tendered, for the installation of a canopy to protect the new ambulance entrance from inclement weather. Progress is reliant on ministerial approval and capital budget being released. New Façade and entrance to A&E; this will be covered with a new canopy to allow ambulances to disembark patients under cover. 51 P a g e

52 New three bed bay St. Bernard s Hospital: Maternity Early Pregnancy Room (EPR) This project involved moving the current observation room to an alternative space within the department; this enabled the formation of an early pregnancy room (EPR). The room will be used for sensitive issues such as pregnancy loss /stillbirth, and will offer better privacy and dignity; enable patients to enter and exit the department without being exposed the other patient s pre and post natal. These works are nearing completion, pending the release of capital. Primary Care Centre: Registration Area On this back of main reception security works we have looked at the remodelling the registration are to offer the same protection and privacy benefits to both staff and patients. The quote is with the minister for consideration. 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 save the hospital in 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. This project has commenced and due to be completed in late May. Temporary Ward due to bed pressures over the Christmas period we converted the physiotherapy gym into a ward. This was carried out largely over a weekend as is testament to the ability and skills of our team. The ward will be decommissioned once all patients are transferred to Hillsides. 52 P a g e

53 6. Projects Presently at Design / Feasibility stages Speech and Language- for 2017 estimates Improvements to the department; The construction of a walk-in cupboard within the therapy office to house larger equipment, stationery, patient appliances and assessment materials etc. Maternity Phase 2 Improvements to the department; conversion of the disabled labour room into a new operating theatre. Conversion of bathroom into a birthing pool room, various infection control changes to birthing rooms, and the reconfiguration of the main reception. Respectfully submitted, Tony Dolding MARU MSc, MIHEEM Head of Estates and Clinical Engineering 53 P a g e

54 54 P a g e

55 July to September 20 Primary Care. 5.5 Director of Nursing Services Child Health: The child health team were invited to attend to a multidisciplinary team meeting as part of the maternity strategic overview. Work flow mapping and processes continuous to be on-going. Influenza vaccination programme: Influenza vaccine campaign to commence on the week 24 th October. Due to delays from UK manufacturers due to unexpected challenges in the final stages of the production of the vaccine we have had to delay the flu campaign. EHR: Nursing staff are now more familiar with the working processes and templates that have been incorporated within the electronic health system. There remain some small issues regarding information retrieval and the templates are being adjusted according to the required needs as they are highlighted. These working processes are on-going and unexpected challenges resolved through emis support group. AN Zamara Espinosa attended a two day phase 1 UAT S testing the EHR system. Diabetic Service: The Nursing team continues to update the existing annual review register incorporating EMIS into the recall system. Patients are now being called to advice of forthcoming recall before sending the letters. An Audit process is in place to establish feasibility, time and adverse events. Nurse Practitioners: As part of a sexual health promotion strategy Lynn Angove and Elizabeth Borges have been delivering presentations on sexual health in Bayside comprehensive school in the month of September. They were supported by the health promotion officers and infection control officers. Acting CNM Linda Castro has submitted a business case with proposals to improve the current cytology screening programme provided by the nurse practitioners. We aim to adopt evidence based UK NHS cervical screening programme and implement best practise. Training: Several updates and training modules specific to Primary Care Nursing services have been commenced with the SHS. In addition, several members of staff continue undergoing independent studies in their specialist fields. In the month of July five practice nurses and five district nurses undertook a leg ulcer work based module delivered by senior lecturers from Kingston University. The course was covered over the period of five days. Feedback 55 P a g e

56 from staff was very positive as they need to keep up with evidence based practice to support their work in leg ulcers. The teams are currently awaiting results. Three registered nurses undertook the immediate life support day course in the month of September to maintain competence in resuscitation procedures. District Department: The number of patients requiring palliative care services or end of life care is increasing in demand in the last year. The district team are now discussing the possibility of either implementing an on call rota or increasing staff compliment to meet the requirements of the service. A proposal was submitted to the Acting director of nursing services. We are still awaiting approval from the chief executive officer. The District department team members successfully completed the competencies in the management of a patient with a porta-a- cath assessed by the palliative care nurses. In addition the team was also introduced to the guidelines for the continuous subcutaneous administration of medicine via the T34 Syringe driver for adult palliative care patients. They have now all become acquainted with the use of the syringe drive. A group of six team members were introduced to the new model of oral anticoagulation clinic proposed by the haematologist Mr Duran. Primary Care Clinics: A total of four practice nurses were introduced to the new model of oral anticoagulation clinic proposed by the haematologist Mr Duran. The purpose of this project is to implement a primary care anticoagulation service with the support of POCT and CDSS, managed by PCC nurses and GP S with the supervision of the consultant haematologist in the hospital. This proposal is still at its initial stages and shortly in the next month we will start piloting this new model of care with some patients to be able to make comparative studies and assess feasibility, cost and adverse events. Cardiac Rehab: The cardiac rehab service CNS and acting CNM have identified gaps in the care and delivery and are currently analyzing a service review for the following reasons: Improve care co-ordination Improve data and evaluation Improve the update of chronic heart failure model of care Improve programme evaluation Improve collection of clinical performance and outcome data Improve referral processes Improve patient follow up Compile evidence of patient s journey and perspective through the programme to promote the value of the programme. In the last three month the only significant change has been the introduction of a phase IV instructor Sports development and training officer. 56 P a g e

57 The purpose for this was to enable all phase three patients who had completed the cardiac rehab programme move to phase IV for a long term maintenance programme in the community under the supervision of a qualified instructor. We have actively pursued further training for a second nursing specialist post which will hopefully open the way for a secondment post. We have managed to improve the referral process from cardiac patients discharged from the CCU under cardiac rehab phase 2. We continue to work with other consultants and physicians to raise awareness about the importance of cardiac rehab. Primary Care Nursing workload Activity July to September 20 July Aug Sep Child Health Dept Dr's Clinic Health Visitors/Nurse Team Weighing Clinic HV Assessments HV Primary Visits School children assessed School Health visits Eneuresis Clinic Immunisation Clinic Total 1,024 1,012 1,443 Cardiar Rehab. Nurse Diabetic specialist Nurse Nurse Practitioner 864 1, Practice Nurses Treatment Room 892 1, Phlebotomy Clinic 1,080 1,313 1,140 Ear Syringing Clinic ECG Clinic Vaccinations Nurse clinics Total 2,554 3,472 2,783 Cryotherapy (Dermatology Nurse) P a g e

58 MWO District Nursing Team Diabetic/Insulin Dressings Injections Visits- Support/Monitoring Terminal Care Catheter Care INR and Blood Samples Admissions Influenza vaccination Total 788 1, Grand Monthly total 6,833 8,219 7,623 Total numbers until end of September 46,539 54,758 62,282 Surgical Directorate Ophthalmics: The Ophthalmic team continue to undergo in- house training to ensure high quality standards of patient assessments, treatment and better flow of patient s through the department, this with the one stop clinics has assisted in eliminating waiting times for patients requiring Cataract Extractions under L.A. Nurse led clinics have continued to impact on the number of patients that the department is now able to attend to. This includes a continuous improvement in the number of ophthalmic conditions diagnosed and treated in house and an extension in the services provided to the General Public. The Nursing staff compliment has been under revision as a result of the workload and the number of patients seen and treated within the department and as a consequence there has been an additional Registered Nurse joining the Ophthalmic team who is also a trained scrub nurse with experience in Ophthalmic Surgery. Additionally one of the Nursing assistants has presently just completed her Enrolled Nurse Training to further enhance the Nursing complement with additional qualified staff. Furthermore one of the Registered nurses within the department recently underwent further ophthalmic training with Hull University in the United Kingdom and represented the Gibraltar Health Authority at an Ophthalmic Conference in Manchester as well attending a clinical placement in the Imaging / Casualty unit at the Royal Manchester Ophthalmic Hospital. This clinical expertise is currently offered to patients locally within St Bernard s Hospital. 58 P a g e

59 The Nursing Ophthalmic team have undertaken a Patient Satisfaction Survey which was commenced in May 20 to September 20. The results and patient comments will be presented by the Ophthalmic Team to the Executive Team in due course. Operating Theatres: As part of the on-going development of our Nursing staff in conjunction with the Gibraltar Health Authority Strategic aims the GHA in collaboration with Edge Hill University where able to deliver locally an acclaimed academic module to four Registered Nurses / experienced Theatre Practitioners. The modules were based on the Surgical First Assistant role as outlined by the U.K perioperative Care collaborative. The course covered a number of topics including the legalities of the role, risk assessment, principles of the role from draping, positioning, tissue retraction, assisting with haemostasis and electro surgery. The principle aim of the modules were for the Theatre Nursing staff to be recognised for their role / lead they currently undertake which is the equal of the NCHD role within Theatres. All four candidates passed the academic modules and have received their Surgical First Assistant (HEA 3055) part 1 qualification and are now undertaking the part 2 Enhanced Surgical skills module (HEA 3056) which allows them to become advanced practitioners in wound closure, Knot tying / suturing, direct Diathermy, wound infiltration (LA) as well as the academic aspects of the legal, ethical and professional issues associated with surgery. Following the successful collaboration between the Gibraltar Health Authority and Edge Hill University, both the School Of Health studies and the Clinical Nurse Manager for Theatres are working closely together to explore the possibility of introducing the Operating Department Practitioner training locally in September Historically all Operating Department practitioners have been trained and recruited from the United Kingdom as it has not been possible to do so in Gibraltar. The training programme would consist of a three year course at BSc (Hons) level covering all aspects of Theatre practice. A further member of the Theatre Nursing Team will be undertaking her MSc in Peri- Operative Medicine in 2018 funded by the Department of Education. Additionally one of the Charge Nurse s will be attending The Effective Operating Theatre Summit in London on the 12 th November representing the Gibraltar Health Authority. The Theatre Nursing Team continue to work together with the Medical Director, Surgeons and the Anaesthetic team to maximise Theatre capacity and productivity, by utilising free sessions and Theatre 3 to undertake additional Theatre lists such as Visiting Consultants, Special needs Dentistry plus regular Ophthalmic G.A lists to further reduce surgical waiting lists. There has also been re scheduling of Theatre sessions due to the forthcoming commencement of two new General Surgeon s and additional Urologist. 59 P a g e

60 This has resulted in Management together with the Theatre Management Group exploring the possibility of building an additional Theatre suite within the existing department or another option explored would be to convert Labour Ward 3 to a fully functional Obstetrics / Gynae Theatre. Releasing Theatre 2 or Theatre 3 as an emergency Theatre in keeping with Clinical Governance guidelines / policies to minimise risk and optimise patient safety. TMG STATEMENT 2015 = An emergency Theatre should be available at all times provision of a Theatre 24 hours a day 365 days a year. General Surgery 93 Obstetrics 25 C.Sections 70 Gynae 18 E.N.T. 9 Eye 3 Genito Urinary 3 Fascial Maxillary 7 Dental 6 Orthor Trauma 120 Proximal femoral Fractures P a g e

61 Total amount of 402 Surgical Emergencies performed in Surgical Emergencies are being collated on a monthly basis for presentation to the TMG at the end of this year for comparison. Day Surgery: The Day Surgery unit continues to expand its services by undertaking Cardiac procedures such as Cardio versions, Urology surgical lists, Dermatology sessions as well as General Surgery and Maxillofacial General Anaesthetic lists within its own Theatre suite. The Day Surgery Unit continues to undertake on average 88 95% of all elective patients requiring surgical procedures of all sub specialities with even more surgical procedures now being performed under laparoscopic techniques which allows for patients to heal in the comfort of their own homes, with the assurance of a quality aftercare service provided by the Day surgery Team. During the period of January 20 September 20 a total of 2,181 patients have been admitted through Day surgery with 1,980 surgical procedures undertaken within the Day Surgery Theatres its self. (A total of 2,487 surgical procedures had been undertaken within the Day Surgery Unit during 2015). DSU Monthly Statistics 20:- Month Total Day Surgery % JAN % FEB % MAR % APR % MAY % JUNE JULY AUG SEPT % 91.03% 88.79% 89.36% Following an initial article in the Gibraltar Chronicle two years ago covering A Day in the Day Surgery unit the Chronicle Published a second article titled Day Surgery on the increase in the GHA This article provided the local community with an update on the number of surgeries performed within the last two years as well as the positive patient feedback received about our patient focused service, which led two of our Registered Nurses and an Operating Department Practitioner being funded by the School of Health Studies to attend a conference on the 13th October for 61 P a g e

62 Improving and Enhancing Peri-Operative Medicine. The main aim being to further optimise all our patients undergoing surgical procedures. Out Patients Clinics / Department: With the appointment of additional surgeons including an urologist and visiting vascular surgeon we have recruited Registered Nurses who have clinical backgrounds in Urology, Tissue viability / wound care and Vascular Nursing. Our Vascular Nurse is an independent practitioner who is able to assess, evaluate and treat patients with Peripheral Artery disease as well as provide an educational link with the G.Ps to assist vascular referrals and chronic disease management. Additionally the surgical colonoscopy waiting list and upper G.I endoscopies continued to be managed by the Surgical and Endoscopy Nurses will the assistance and collaboration of the locum surgeon and Dr Latin the Medical G.I Endoscopist. MIU/ Out Patients Department: The Colorectal Screening Programme continues with nursing actively undertaking the lead in the re-design of policies and care pathways for patients who are recalled to undergo further screening. The visiting Gastroenterologist s from St Georges Healthcare Trust and our own General Surgeon' continue to provide support and teaching / training session updates on Endoscopic Practice and procedures for the Endoscopy Nursing Team to maintain service delivery to patients in accordance to NICE Guidelines and quality assured standards. Furthermore one of our Endoscopy Nurses will be undertaking further training to become a fully accredited Nurse Endoscopist this will encompass a full training package that will deliver a holistic care package to patients attending for upper G.I endoscopies and Colonoscopies. The training will be under supervision from a fully accredited Consultant allowing the Nurse Endoscopist to undertake independent flexible sigmoidoscopies. Medical Directorate. Victoria Ward: Ward Activity: The summer continued to see a high inpatient capacity with the ward now expectantly catering for 34 complex/long stay patients. Staff nurses Lisa Bennett Long, Annie Rourke and Kaylee Pecino remain as acting ward managers pending the recommencement of the PSC Board. Training: Staff continues to access training with the majority attending mandatory training days such as Dignity, manual handling and Infection control. 62 P a g e

63 Maternity Services: Ward Activity: These three months persist with the higher rate of booking of Pregnancies continuing with the team betting on the new record delivery rate for Gibraltar in 20. Sir Jonathan Asbridge and Mrs Rosemary Macalister Smith have regularly visited Gibraltar throughout Jul September with Two project boards coming to finalisation. New Initiatives: Maternity maintains the audit of ward attenders as well as the on-going evaluation of Maternity Services. Wound Audit Dr D Van De Borden initiated a review of consultant outcomes from all LSCS. Refurbishment of the current store room in Maternity commenced for its designation as triage room. Training: July 14th project Emis seminar 1 midwife attended July 18th Project board 4 midwives attended September 26th Project Board Lecture by Pathologist from UK. Training session by St Georges on Safe test. Staff: September saw the final of eight midwives delivery safely Four Bank staff given contracts to cover Maternity /unpaid Maternity contracts Donations: regular donations of chocolates, biscuits and cakes Maternity Statistics July September 20 Total Nº of Births: 107 July 27 August 43 September 37 John Ward: Ward Activity: inpatient capacity remains at an all-time high with months seeing up to 12 Medical patients cared for in the surgical ward. Updating of falls risk scores, pressure sore risk scores and weekly weighing continues to be developed. Environmental safety checks are being accomplished out e.g. suction machine and oxygen machine checks. Staff: Staffing levels remain short with sporadic period of sickness a well as one member of the team on long term sick. With 380 bank hours a week difficult to fill due to the fact that the bank staff, in essence, get to pick and 63 P a g e

64 choice their hours therefore leaving the contracted staff to do all unsocial hours, this often means that the ward is left short staffed at. Congratulations to Sister Helena Kelly who was successful at interview for the post of Ward Sister. Ward philosophy- Staff are working hard to make patient safety a top priority on JMW. Everyone is becoming much more conscious in areas such as: pressure area care and skin inspection- on admission and daily thereafter. Sr Kelly is wishing to design and implement a new audit tool concerned with staff-patient ratio's/ patient dependency scores and patient safety. Critical Care Unit: Ward Activity: As with the rest of the Hospital CCU continues with its steady inpatient capacity at a high. Staffing levels have been short with two members of the team on long term sick. Teaching sessions to all departments throughout St. Bernard s are sporadic but the team persists New staff: CCU saw the departure of SN Tara Ferrary, who joins A&E on a part time basis& welcomed two new members to the team SN Rafael Leon from the Bank compliment. Rainbow Ward: Ward Activity: Outpatient waiting times and activity continue to rise compared to this period in EPR Process mapping continues Staff Movement: The beginning of the summer saw the team bid farewell to Sr Jodie Crook who sets off to Australia to further her experiences and knowledge. Staff nurse Lorna Kennedy joined the team from the UK. The opportunity arose for both Amy Reeves and CaryAnne Taylor to undertake the task of Acting into the vacant Sister s position. Training: SR Sarah Smith completed the EPLS and is now a qualified Generic instructor. 20 Paed HD U ENT Dental Ortho Eye Surg Total Ward Attender July August September A&E Department: Department Activity: Re-design of our dressing ordering form & Re-design of laboratory list forms. A&E extension works are underway. Following 64 P a g e

65 consultation with the Eye Department, all Eye care medications have been reduced to what is essentially needed for eye injuries. Staff: S/N N. Digman has been acting A&E Sister Training: Teaching sessions have been provided by product Representatives to the A&E team. Sister N. Cerisola has attended a 2 day ILS course as instructor. In-house training has been taught by other professional & the A&E Team in areas such as - basic and advanced airway techniques. Sr Cerisola, S/N Clinton & S/N L. Netto completed their Mandatory Training. S/N J. Rovegno attended the mentorship preparation programme A&E Statistics: 01/07/20 31/09/20 New Attendances 6795 Planned Return Attendances 471 Unplanned Return Attendances 421 Clinic Attendances (Arrived) 866 Total Attendances 8553 Injury at Work Attendances 83 Visitor Attendances 608 Attendances for Children 15> (non 1248 MOD) Attendances for MOD < 14 Attendances for MOD 15> 81 Presenting Complaint - Bite Ape/Monkey Bite 43 Dog Bite 22 Insect Bite 85 Human Bite 6 Cat Bite 6 Presenting Complaint - Sting Sting Fish 1 Sting Jelly Fish 0 Presenting Complaint - Other Chest Pain / Palpitations 297 Intoxication Alcohol 14 Cardiac/Respiratory Arrest 5 Attendance Reason Overdose 19 Road Traffic Collision 33 Referral 105 Arrival Mode 190 Ambulance 1007 Non Urgent Ambulance 42 Admissions Surgical 94 Medical P a g e

66 Paediatric 54 Gynaecology 7 Orthopaedic 0 Total Admissions 454 Treatment Dress/Bandage or Splint 608 Dressing or Wound Cleaned or Wound 148 Closure Plaster of Paris 90 Outcomes Referred to Trauma Clinic 268 Phlebotomy Blood Department Department activity: The appointment system continues in its pilot scheme. These changes are showing to be successful and well received by service users. Practice Development. Mandatory Training Practice Development have arranged Manual Handling Instructor Up-dates via Charlie Bloe. These will take place on 21 st and 22 nd November for all current Manual Handling Instructors so they can continue to provide this mandatory training for staff. The next One Day Mandatory Training Sessions will be delivered in January. NEWS Steering Group Dr Richard Roberts, CNM Gizelle Tosso and Tutor Noleen Jones are taking the lead in implementing the National Early Warning System (UK) in Gibraltar to enable standardisation and safer, more timely and effective medical/ nursing interventions and care of acutely ill patients. A steering group has been formed and introduction to NEWS have taken place with further introductory sessions/ training planned including a session by Noleen Jones at the Nursing and Midwifery Conference in September. Safeguarding Adults at Risk 30 Staff Members attended a Safeguarding Adults at Risk Workshop on 30 th September in the Primary Care Centre which was delivered by GHA Safeguarding Adults at Risk team This was part of an on-going programme to help raise awareness about Safeguarding Adults at Risk of Abuse, Policies and Procedures. The next Workshop is being planned to take place in Ocean Views. 66 P a g e

67 Dignity in Care Report Marisa Desoiza and Elizabeth Gonzalez attended the Nurse Executive Team Meeting in August and gave feedback regarding the Dignity in Care Training that has taken place over the previous months at the Gibraltar University. 38 staff members had attended and recommendations made on how to help promote safe, effective, person-centred care by embedding the 6Cs Care, Compassion, Competence, Communication, Courage and Commitment into everything we do in the GHA. Increased recognition of the pressures staff are under and the effects of staff stress and burnout was highlighted, as was the need for more staff support, supervision and health promotion with sessions being planned to help increase resilience and team building. A rolling programme of Dignity in Care Training is being planned with the next training days arranged for November. End of Life Care Training This was carried out by Beverley Bagnall via Charlie Bloe over 2 days in September. 55 nursing staff and other Multi-disciplinary team members participated in the School of Health Studies. A number of staff members involved in palliative care have formed a focus group to explore future inhouse training with support from practice development. Stoma Care Training has been arranged for October Falls Prevention Training has been arranged for November, both via Charlie Bloe. Diabetes Management Eden Bespoke Diabetes Course is due to take place in November. Diabetes nurses, practice development and ward staff on John Ward are looking at how to improve systems to manage diabetes. This project will then be rolled out on the other wards. Medicine Policy Review This has been reviewed, revised and sent to the Executive Board to be ratified. Additional information about medication needed for transfers to Xannit Hospital was added. Preceptorship Staff Development Programme A programme is being designed to guide and support all Newly Registered Nurses to help make the transition from Student/ Pupil Nurse and develop their further practice Patient Information Leaflet Practice Development and Health Promotion are planning to provide an information leaflet 8 Simple Steps to Keep Your Stay in Hospital Safe. 67 P a g e

68 Infection Prevention & Control Department. Norovirus Outbreak (July-August) on 2nd floor Mount Alvernia, Calpe and Cochrane ward. o 2 nd floor Mount Alvernia 12 Residents, 5 staff. o Calpe ward - 11 residents, 3 staff. o Cochrane ward- 5 residents. (Report forwarded to Dr Kumar) Twice monthly HIV clinics are held with most patients currently being seen in GHA. 27 in total (aim to introduce HCV patients into clinic). Although 7 already seen and awaiting treatment approval. Xanit visit to establish communication links and meet infection control team. Report forwarded to Dr Kumar. Clostridium difficile cases period June- Sept- 10 in total. All followed up and treated. Daily surveillance of MRSA, CRE & ESBL. All patients returning from tertiary Hospitals are screened for MRSA and CRE. In August first reported case Carbapenemase Producing Enterobacteriaceae (Vim) isolated from a stool specimen obtained from routine surveillance carried out on patient returning from Xanit. Patient and 9 contacts isolated and followed up and constant communication with Consultant microbiologist. (Report forwarded to Dr Kumar) Two further cases from returning patient s from Xanit isolated Carbapenemase Producing Enterobacteriaceae one isolated Oxa 48 and the other Vim & KPC. Both remain currently isolated as long term carriers. STI surveillance total cases seen for period of June-Sept 52 patients seen in total. Organisms isolated for this period; o Chlamydia- 2 o Gonorrhoea-6 o HSV -3 o Others- 5 Environmental audits follow up of agreed action plans; o A&E o John ward o Captain Murchison o CCU 68 P a g e

69 o Rainbow ward o Maternity o Dudley Toomey ward Dental Line water sampling- on going. Once works are carried out on chairs no follow up required as self-cleansing mechanism. Blood cultures June-Sept total- 455 o 13 Bacteraemia o 1 Candidaemia (All hospital acquired Blood cultures discussed at Infection Control Committee meetings) Needle stick injury for period June-Sept 13 Total o 10 low risk o 3- moderate risk All incidents followed up and reported at monthly Nursing Clinical Governance group. PEP administered on 3 occasions during the period June Sept. o 1- Occupational exposure o 2- Post sexual exposure Patients followed up by visiting consultant and bloods monitored. Travellers (x2) who had returned from Nepal developed Diarrhoea and High fevers admitted and isolated and contact precaution placed. Bloods sent to Porton Down on Consultant microbiologist advice. One confirmed leptospirosis the other awaiting confirmation of screen, however both improved and discharge home. Dialysis Patients- Hep B immunisation programme on going. Training 3 rd Year students carried out. Advice given to Port authority regarding two vessels; o One 22 years old crew member was disembarked post Port Dr assessment with 69 P a g e

70 Breast Care. GHA Board report July 20 to March 2017 fever (38.7), rigors, abdominal discomfort, lethargy, nausea and vomiting, reduced appetite, headache, jaundice. Diagnosed with Falciparum malaria. o Cruise liner with Norovirus on board advice on necessary precautions given. 10 new patients diagnosed with breast cancer surgery/chemotherapy/radiotherapy support 8 (onging)patients with secondary breast cancer supportive care and coordination of treatments/administered/liaising with tertiary oncology centres. Addition of summer student to assist with admin much needed Weekly cancer treatments (bisphosphonates) and TIVAD clinic average 6 patient weekly, preparation, admin, bloods prior to clinic (with Palliative nurses and Cancer relief nurse) Weekly prosthesis clinic average 3 patients week Breast cancer related lymphoedema - patient appointments average 6 weekly. Arranged visit of expert to Gibraltar to provide lecture on Breast Cancer Genomics to Friday morning medical CPD session. Attended new syringe driver training Meetings with Breast Cancer Support Group/GHA managers to discuss/evaluate lymphoedema service and possible improvements in services Review clinic planned. Arranged and attended Breast Cancer Care educational teleconference held in my office Bed Management Report for period August 20: The month of August 20 has demonstrated a continuation in high bed occupancy for adult patients at SBH. Extra beds have been in use persistently during the month. Total admissions for August 20 for SBH are as follows: Admissions all areas 297 Admissions via A&E 218 Admissions Adult & CCU 189 Admissions via A&E 150 Paediatrics 52 Admission via A&E 28 Maternity 56 Non elective P a g e

71 (Data captured from Bed Management Database). August continues to see high bed occupancy with the average adult occupancy at 105%. This percentage remains substantially higher than the average occupancy recommended by the DOH (2001) - 85% sealing. A sustained high overall bed occupancy level in CMW, JMW and VMW remains as a consequence of: A constant high number of long stay/complex, Dementia & Palliative cases populating acute hospital beds ( snapshot 103 beds held on 12/08/20). Despite these issues the following efforts continue: MDT working both on acute & long stay wards (rehab). Improving patient flow on JMW (acute medical). Proactive approach to the discharge process. DC hour s availability to support discharge (delays on occasions). Closer integration with The Care Agency (availability of long term beds in order to expedite patient flow). Utilisation of John Mackintosh Wing (Old SBH). There are, however, historical bottle necks which continue to delay the discharge process which together with an anticipated increase in seasonal demand, will in the balance of probability, cause pressure on bed availability & patient flow in the coming months. These are: Housing/rehousing/buildings & works issues delays Absence of a dedicated in house Hospital Social Worker. Limited long term care beds (Care Agency) in relation to demand hence a backlog in SBH/KGV. A dedicated multidisciplinary team to include the social worker 71 P a g e

72 Fig 1: Occupancy levels (adult wards & CCU 30 & 10 beds respectively) Jan August % % % % 95.00% 90.00% 85.00% Jan- 15 Feb- 15 Mar- 15 Apr- 15 May- 15 Jun- 15 Jul-15 Aug- 15 Sep- 15 Oct- 15 Nov Dec- 15 Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Average Occupancy Adults % % 103% 100% % 102% 101% 102% 101% 110% 109% 111% 108% 106% 104% 106% 105% 106% % % Note: 85% sealing for occupancy as per DOH 2001 recommendations Fig 2: Average (Adult) Bed Occupancy SBH inclusive of CCU January 2011 to August % 100% 50% 0% Jan Feb March April May June July Aug Sept Oct Nov Dec Average Occupancy 2011-Adults 97% 94% 96% 93% 92% 89% 95% 94% 96% 95% 109% 103% Average Occupancy 2012-Adults 107% 109% 104% 82% 88% 96% 91% 87% 81% 85% 89% 92% Average Occupancy 2013-Adults 96% 97% 98% 102% % 102% 97% 95% 90% 97% 92% Average Occupancy Adults 102% 104% 96% % 94% 97% % Average Occupancy Adults % 100% % 101% 102% 101% 110% 109% 111% Average Occupancy 20-Adults 108% 106% 104% 106% 105% 106% % 72 P a g e

73 Fig 3.1: Distribution of elderly long stay/dementia/complex by 12/08/20 Fig 3.2: Distribution of elderly long stay/dementia/complex by 12/08/20 73 P a g e

74 Fig 4: The collective breakdown of this cohort of patients is as follows. Complex Discharges 31 Elderly Stay Long- 32 Average age 85 years Dementia Long- Stay 24 Identified from nursing assessment. Palliative Total Beds Held adult beds SBH 103 = 27 acute beds available Fig 4.1: Total Admissions SBH January August 20 (adult wards) Number of patients Total Admissions per ward Jan- 15 Feb- 15 Mar- 15 Apr- 15 May- 15 Jun- Jul Aug- 15 Sep- 15 Oct- 15 Nov- 15 Dec- 15 Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- ADMISSIONS DTW ADMISSIONS Capt.M ADMISSIONS JOHN * ADMISSIONS VICTORIA ADMISSIONS CCU DTW average admission rate per month (last 8 months) = 92.1 patients per month JMW average admission rate per month (last 8 months) = 44.8 patients per month 74 P a g e

75 Fig 5: Total Cancellations elective inpatient surgery January 2015 to August 20 due to bed shortage 18 Total cancellations due to beds Total Number of Patient's 8-2 Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Cancellation due to unavailability of bed Patient flow out of VMW & CMW remains dependent on transfers to The Care Agency & successful rehabilitation candidates. There have been 3 cancellations of elective inpatient surgery specifically due to bed unavailability in August 20. Bed management meetings continue to incorporate Sister s & Charge nurses in the format. This continues to be welcomed as first hand input on current & future dynamics can be discussed in a mutually supportive manner. Medical attendance is unfortunately limited. Care Agency: Social Services Adult services team: Team Lead: Ms Debbie Guinn Senior Social Workers: Mrs Jennifer Poole Jo Smith Social Workers: Dean Lopez, Lianne Cano, Vanessa Hitchcock & Julie Scott Administration support: Mrs Christine Bottino All referrals regarding hospital discharges or any concerns to be sent to: referral.adultservices@careagency.gov.gi Telephone number: October to March 2017 Primary Care Child Health The child health team are working with the paediatric team, speech and language and The Nuffield hospital to improve the hearing service to those children under 5. This will mean a further 500 children will be offered hearing tests here in Gibraltar which is more cost effective. Influenza vaccination programme The influenza vaccine campaign is mostly finished although one or two vaccines are still given weekly 75 P a g e

76 EHR Improvements continue to be made to the working processes and templates that have been incorporated within the electronic health system. There remain some small issues regarding information retrieval and the templates are being adjusted according to the required needs as they are highlighted. These working processes are on-going and unexpected challenges resolved through emis support group. Diabetic Service The EDEN training programme was delivered on the week of November 29 th where a number of disciplines were able to participate. The feedback has been very positive and hopefully later this year it can be repeated to allow others to participate. A Diabetes strategy has been prepared and presented to the board and been approved. This strategy shows the care pathways for To facilitate this 1 part time E/N and 1 part time S/N have been released to carry out the Yearly ADRC reviews and the S/N is qualified in foot care and is currently preparing protocols and guidelines for diabetic foot care. This will be a working progress and changes made according to demand and feasibility. Nurse Practitioners As part of a sexual health promotion strategy two members of staff delivered presentations on sexual health in Bayside comprehensive school in the month of September. They were supported by the health promotion officers and infection control officers. There has been positive feedback from this exercise. There is no news yet on the submitted business case proposals to improve the current cytology screening programme provided by the nurse practitioners. However there are plans to have a Cervical screening awareness week in June where women who have not previously been screened will be provided with the opportunity. Training Several members of staff from different disciplines attended the EDEN training programme at the end of November. There are still several members of staff undergoing independent studies in their specialist fields. District Department The number of patients requiring palliative care services or end of life care is increasing in demand in the last year. The district team are now discussing the possibility of either implementing an on call rota or increasing staff compliment to meet the requirements of the service. The District department team members successfully completed the competencies in the management of a patient with a porta-a- cath assessed by the palliative care nurses. In addition the team was also introduced to the guidelines for the continuous subcutaneous administration of medicine via the T34 Syringe driver for adult palliative care patients. They have now all become acquainted with the use of the syringe drive. 76 P a g e

77 A group of six team members were introduced to the new model of oral anticoagulation clinic proposed by the haematologist Mr Duran. Primary Care Clinics A total of four practice nurses were introduced to the new model of oral anticoagulation clinic proposed by the haematologist Mr Duran. The purpose of this project is to implement a primary care anticoagulation service with the support of POCT and CDSS, managed by PCC nurses and GP S with the supervision of the consultant haematologist in the hospital. This proposal is still at its initial stages and shortly in the next month we will start piloting this new model of care with some patients to be able to make comparative studies and assess feasibility, cost and adverse events. Cardiac rehab The cardiac rehab service CNS supported by SN R Moreno and acting CNM S Romero have identified gaps in the care and delivery of the service and are currently analyzing a service review for the following reasons: Raise awareness of the cardiac rehab programme Improve referral pathways Improve the structure to the programme Introduce lipid screening processes Improve clinical performance by introducing a pre and post screening programme to evaluate health outcomes Introduce a more robust patient follow up service In the last three month the only significant change has been the introduction of a phase IV instructor Sports development and training officer. The purpose for this was to enable all phase three patients who had completed the cardiac rehab programme move to phase IV for a long term maintenance programme in the community under the supervision of a qualified instructor. We have actively pursued further training for a second nursing specialist post which will hopefully open the way for a secondment post. We have managed to improve the referral process from cardiac patients discharged from the CCU under cardiac rehab phase 2. We continue to work with other consultants and physicians to raise awareness about the importance of cardiac rehab. Primary Care Nursing workload Activity October to December 20 October November December Child Health Dept Dr's Clinic Health Visitors/Nurse Team Weighing Clinic HV Assessments HV Primary Visits P a g e

78 School children assessed School Health visits Eneuresis Clinic Immunisation Clinic Total 1,321 1,521 1,143 Cardiac Rehab. Nurse Diabetic specialist Nurse Nurse Practitioner Practice Nurses Treatment Room 1,836 1,351 1,088 Phlebotomy Clinic 1,180 1,256 1,031 Ear Syringing Clinic ECG Clinic Vaccinations Nurse clinics ,017 Total 3,6 4,125 3,430 Cryotherapy (Dermatology Nurse) MWO District Nursing Team Diabetic/Insulin Dressings Injections Visits- Support/Monitoring Terminal Care Catheter Care INR and Blood Samples Admissions Influenza vaccination Total ,384 Grand Monthly total 8,010 10,447 8,377 Total numbers until end of December 70,291 80,738 89, P a g e

79 Primary Care Nursing Workload Activity January 2017 to March 2017 January February March Child Health Dept Dr's Clinic Health Visitors/Nurse team New born hearing test Social services attendances HV Primary visits HV 8 weeks School children assessed No children seen in school Eneuresis Clinic weighing clinic, feeding advice Immunisation Clinic Total 1,426 1,366 1,497 Cardiar Rehab. Nurse Inpatients visits Pre clinics post clinics Cardiac rehab programme self help group community o 0 0 Drop in Total Diabetic specialist Nurse ADRC OTHER Diabetic Review Diabetic ward patients Diabetic ward/ antenatal patients Tel consults Total P a g e

80 Nurse Practitioner Smoking Cessation clinic review Smoking Cessation clinic new Asthma Clinic/COPD Driving medical Emergency clinic Spirometry Review clinic Womans health Cervical Smears Comment/admin Telephone consultation TOTAL ,015 Practice Nurses Phlebotomy Clinic 1,180 1,202 1,320 Ear Syringing Clinic ABPM Clinic ECG Clinic House calls General wound Lymphoedema clinic Leg Ulcer Clinic Doppler Clinic Blood pressure check Hypertension clinic Triage Blood Glucose Admission to A/E tel consults other Tel sick note lineconsults Flu vaccines Total 3,818 4,591 4,505 Dermatology team Cryotherapy light therapy photos clinic Pre- derm clinic Joint Ancillary see and treat Telephone consultations P a g e

81 Minor-ops Hyfrecator Patch testing CDM TOTAL MWO District Nursing Team Diabetic/Insulin Dressings Injections Baths/General Care Visits- Support/Monitoring Terminal Care Catheter Care INR and Blood Samples Admissions Discharges Flu Vaccinations Total Grand Monthly Total 7,505 9,207 9,341 Total seen since January 7,505,712 26,053 Surgical Directorate Operating Theatres The Gibraltar Health Authority in collaboration with Edge Hill University were able to deliver locally an acclaimed academic module to four Registered Nurses / experienced Theatre Practitioners. The modules were based on the Surgical First Assistant role as outlined by the U.K perioperative Care collaborative. The course covered a number of topics including the legalities of the role, risk assessment, principles of the role from draping, positioning, tissue retraction, assisting with haemostasis and electro surgery. The principle aim of the modules were for the Theatre Nursing staff to be recognised for their role / lead they currently undertake which is the equal of the NCHD role within Theatres. All four candidates passed the academic modules and have received their Surgical First Assistant (HEA 3055) part 1 qualification and are now undertaking the part 2 Enhanced Surgical skills module (HEA 3056) which allows them to become advanced practitioners in wound closure, Knot tying / suturing, direct Diathermy, wound infiltration (LA) as well as the academic aspects of the legal, ethical and professional issues associated with surgery. There will be a further four more local candidates undertaking the Surgical First assistant (part 1) commencing this September. 81 P a g e

82 The Gibraltar Health Authority, Nurse Management and the School Of Health studies are working closely together to explore the possibility of introducing the Operating Department Practitioner training locally. Historically all Operating Department practitioners have been trained and recruited from the United Kingdom as it has not been possible to do so in Gibraltar. The training programme would consist of a three year course at BSc (Hons) level covering all aspects of Theatre practice. The specific role of the ODP focusses on patient care, assisting the patient prior to surgery and providing individualised care in the pre, peri and postoperative periods. ODP s undertake a role involving many clinical skills, such as the preparation of a wide range of specialist equipment and drugs, this included anaesthetic machines, intravenous equipment and devices to safely secure the patients airway during anaesthesia. When used effectively the ODP has the potential to have a positive effect on the surgical waiting lists as their role is specifically focused on the operating Theatre. Day Surgery The Day Surgery unit continues to expand its services by undertaking Cardiac procedures such as Cardio versions, Urology surgical lists as well as General Surgery and Maxillofacial General Anaesthetic lists within its own Theatre suite. The Day Surgery Unit continues to undertake on average 90% 95% of all elective patients requiring surgical procedures of all sub specialities with even more surgical procedures now being performed under laparoscopic techniques which allows for patients to heal in the comfort of their own homes, with the assurance of a quality aftercare service provided by the Day surgery Team. The Day Surgery team was recently the recipients of the Extra Mile award on the 4 th April 2017 after being nominated and selected by the Rotary Club of Gibraltar in recognition of the service they provide to the community. During the period of January 2017 March 2017 a total of 781 patients have been admitted through Day surgery with 704 surgical procedures undertaken within the Day Surgery Theatres its self. DSU Monthly Statistics 2017:- Month Total Day Surgery % JAN % FEB % MAR % 82 P a g e

83 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 Medical Directorate Victoria & John Mackintosh Ward Ward Activity: The beginning of 2017 has seen a continued high inpatient capacity with both wards now expectantly catering for 34/36 complex/long stay patients. During the period of January 2017 March patients have been admitted via A&E Sister H Kelly continues to develop services and works closely with the Acting Sisters in Victoria Ward to develop topics such as the new student pack and Multidisciplinary guidelines between the areas. Training: Mandatory Training: January March saw a total of 36 staff members complete this in-house training which included Infection Control updates, Introduction to NEWS, BLS & Manual handling.those who didn t complete the NEWS Introduction Sessions agreed to read through the NEWS Policy which can be found on the School of Health Studies/ Mandatory Training link via the intranet. 83 P a g e

84 JMW Monthly Statistics 2017:- Maternity Services Month Total Admissions: JAN 119 FEB 82 MAR 115 Training: The Gibraltar Health Authority in collaboration with Kingston University delivered educational updates in documentation, litigation & accountability. A total of 12 Midwives attended. The course was based on NMC Code of Conduct and Nice Guidelines. The principle aim of the course was for the Midwifery team to be standardise practice. Ward Activity: May 2017 the Early Pregnancy service will commence. To facilitate staff the Gibraltar Health Authority, Nurse Management and the School Of Health studies have worked closely together with Anna Sherliker Programme Lead BSc (Hons) Midwifery the University of Salford to organise training locally to staff from Maternity, DSU, Dudley Toomey & A&E. thus ensuring proficiency in current research based care in Gynaecological issues. Maternity Statistics (January March 2017): Total Nº Total births 99 Male 41 Female 58 Premature <37 2 IOL 19 EM LSCS 2 URG LSCS 5 SCH LSCS 1 EL LSCS 8 Total LSCS 15 Ventouse 4 Forceps 1 Twins LSCS 1 set 2 Midwives Deliveries 78 Transfer to Spain in Utero 2 Transfer to Spain Neonates 0 SCBU Admissions 5 84 P a g e

85 Critical Care Unit Ward Activity: The beginning of 2017 has seen a continued high inpatient capacity. During the period of January 2017 March patients have been admitted via A&E Sister J Gonzalez conducted surveys on: Patient satisfaction, patient safety and nurse morale, as well as conducted audits on Nurse dependency, nurse to patient ratio and staffing in CCU. Staff Nurses A Velez and M Garrote have developed and implemented the CCU guidelines and protocol for Pre-eclampsia. Training: Mandatory Training: January March saw all the CCU team complete the NEWS online training... All senior staff finalised their Modulab training, which has led to them to request blood samples. The Palliative Care Nurse Selina provided the staff teaching sessions on the new Syringe Drivers thus improving pain management for all Palliative patients. Hemofiltration Freshener was provided to the team by the Fresenius representative. Staff & Departmental Development: Sr J Gonzalez undertook two weeks of CNM shadowing. Staff Nurse M Gil has been Acting Charge Nurse. On-going CCU development in progress: Bespoke training secured for May CCU Statistics January March 2017:- Total Admissions 294 Deaths 8 Patients requiring 3 RRT Ventilated patients 12 Non Invasive 19 ventilation Rainbow Ward Ward Activity: Rainbow ward provides paediatric nursing to children of all ages suffering from many different conditions. The team play a key role in assessing children's nursing needs, taking into account their medical, social, cultural and family circumstances and plan and deliver care accordingly. The team in Rainbow care for and support children and young people, they work alongside their families in conjunction with other healthcare professionals. Training: SR S Smith as a qualified Generic instructor in EPLS has offered inhouse training to all those working with children in the GHA. All the team attended and completed Mandatory Training. Three of the staff are undertaking a teaching in Practice module offered by the University of Kingston. 85 P a g e

86 Paediatric Statistics January March Paed HDU ENT Dental Ortho Eye Surg Total Ward Attender January February March Accident & Emergency Department Department Activity: The beginning of 2017 has seen a steady patient flow through the department, as evident in the statistics table illustrated below. Training: Teaching sessions have been provided by product Representatives to the A&E team. The team have continues to keep updated and have attended Mandatory Training which included Infection Control updates, Introduction to NEWS, BLS & Manual handling. Period 01/01/2017 to 31/03/2017 New Attendances 5863 Planned Return Attendances 394 Unplanned Return Attendances 345 Clinic Attendances (Arrived) 55 Total Attendances 7156 Injury at Work Attendances 48 Visitor Attendances 259 Attendances for Children 15> (non 14 MOD) Attendances for MOD < 17 Attendances for MOD 15> 45 Total Attendances 1533 Ape/Monkey Bite 6 Dog Bite 21 Insect Bite 9 Human Bite 2 Cat Bite 2 Total Attendances 40 Sting Fish 1 Sting Jelly Fish 0 Total Attendances 1 86 P a g e

87 Chest Pain / Palpitations 325 Intoxication Alcohol 12 Cardiac/Respiratory Arrest 3 Overdose 14 Road Traffic Collision 27 Referral 129 Total Attendances 510 Ambulance Non Urgent Ambulance 52 Total Attendances 1056 Surgical 118 Medical 3 Paediatric 50 Gynaecology 10 Orthopaedic 46 Total Admissions 540 Treatment = Dress/Bandage or Splint Triage Treatment = Dressing or Wound Cleaned or Wound Closure Treatment = Plaster of Paris 69 Total Attendances 561 Referral to Trauma Clinic 284 Total Referrals 284 Phlebotomy & Blood Donation Department Department activity: The beginning of 2017 has seen the new appointment system complete its first year. The new appointment system is proving to be a success. Training: All the team attended and completed Mandatory Training. Staff Nurse Audrey Baglietto continues to train all grades within the GHA in the theory and practical competences in in two main areas: Venepuncture & Phlebotomy i.e. drawing blood & its storage & transport it for testing. 87 P a g e

88 Practice Development World Mental Health Day - 10th October Practice Development, Health Promotion and other gha staff members joined up with The Care Agency, Psychological Support Group and Clubhouse to provide support and information for World Mental Health Day in Casemates Square, helping to raise awareness, reduce stigma about Mental Health issues, improve access to services and learn more about the patient s journey and experiences. 7 th Nursing and Midwifery Conference This took place at the Europa Retreat Centre on 11 th October and was attended by 103 nursing and other staff members from the GHA, Elderly Residential Services, Cancer Relief and Xanit Hospital. The Conference has been described by participants as an outstanding success, informing, engaging, exciting and energising. The theme was Innovation in Practice with emphasis on new ways of working in order to enhance the experiences of patients and families. The standard of key note speeches and presentations by staff was extremely high. Stoma Care Training This was delivered via Charlie Bloe on 24 th and 25 th October. 53 staff members completed this training which got excellent feedback. Resource packs with all the information from the course have been made available for St Bernard s staff in the library, Ocean Views and PCC. Falls Training This successful training took place between 7 th 11 th of November via Charlie Bloe with 73 multi-disciplinary team members attending. There were 4 x 1 day courses delivered and a feedback session on the 5 th day to the Managers and key professionals. As a follow on from the training and feedback a multiprofessional group of staff have formed a Falls Group to reduce/ help prevent and manage falls within the GHA. Non-slip socks for those without appropriate footwear are to be introduced amongst other falls prevention measures. Dignity in Care Training Practice Development and Marisa Desoiza delivered 3 courses in November and March at Gibraltar University for 36 staff members from GHA and Elderly Residential Services enabling people to make improvements in safe, effective person-centred care based on compassion, empathy and the 6Cs of nursing. Building resilience and exploring ways to support staff and prevent staff burnout have also been incorporated into this training. World Wide Pressure Ulcer Prevention Day A campaign event took place in the St Bernard s Hospital lobby on 17 th November to raise awareness about best practice and pressure damage prevention with videos being shown and leaflets re Pressure Injury Prevention 88 P a g e

89 Points and other info from the National Pressure Ulcer Advisory Panel being distributed by gha staff. A number of multi-disciplinary staff members have formed a Pressure Ulcer Prevention Group and are planning an audit to explore pressure damage within the GHA. Manual Handling Instructors Up-Dates This was delivered on November 21 st and 22 nd to 4 Nurses and 1 Occupational Therapist so they can continue to instruct other staff members during mandatory training. Issues regarding health and safety and equipment were discussed during these Train the Trainer sessions including problems regarding old equipment that was still in use in certain areas. Latest developments and aids including some excellent slide sheets were demonstrated and need to be purchased and used appropriately to help prevent injury to patients and staff. New hoists have been purchased and delivered to Ocean Views. Eden Diabetes Training This was arranged with the School of Health Studies by Diabetes Nurses Julie Parker and Susan Edwards and took place in the last week of November 1 day for Health Care Assistants, 2 days for 21 Qualified Nurses and 1 day for 32 Doctors/ Medics. Mandatory Training Mandatory Training took place on 18 th, 19 th, 25 th and 26 th January in the School of Health Studies. 102 multi-disciplinary staff members (majority were from nursing) carried out their Infection Control up-dates, 51 Introduction to NEWS (National Early Warning Scores) 87 Basic Life Support and 83 Moving and Handling. Practice Development and Ward Managers have been reminding staff to complete the on-line NEWS training and to keep a record of all staff members that have completed this. CCU and Day Surgery have all completed their NEWS on-line training as have the majority of the staff on the wards at St Bernard s Hospital. The NEWS observation charts have been printed and are ready for distribution and use with the NEWS Steering Group leading on this. BSc 15 Student Nurses - Mental Health sessions Sessions on mental health conditions have been delivered by Practice Development in Gibraltar University and the School of Health Studies in February and March. Enrolled Nurse 17- Pupil nurses Safeguarding Adults Head Physiotherapist Caroline Abrines and Practice Development have delivered training on Safeguarding Adults to the 20 Pupil Nurses/ Enrolled Nurse 17 cohort who have recently commenced their training. ETB Trainee Nursing Assistant induction week An induction week for 20 trainees was facilitated by Practice Development at Gibraltar University and Bleak House in January. Sessions were delivered by GHA staff including School of Health Studies, CNM Kay Rajkumar and ERS Staff (Practice Development Sisters). Sessions covered included the Role of a 89 P a g e

90 Nursing Assistant, Communication Skills, Dignity, Respect and Compassion in Care, Infection Control, Basic Life Support, Fire Training, Basic Hygiene Needs, Pressure Damage Awareness and Safeguarding Adults. Following the Induction Week the trainees commenced placements in St Bernard s Hospital, Ocean Views and for the Elderly Residential Services. Continuing Professional Development Programme A provisional programme has been put together by Nurse Management, School of Health Studies and Practice Development. Gail Munoz - Administrator from Nurse Management will be providing admin support for this programme following on from the work done by Rosemary Baglietto, SHS. Although the programme may be subject to changes it will be easier for staff to plan ahead and get an insight into courses available throughout the year. Gail has started to input data from the CPD programme courses as they are completed onto the CPD Training Data Base which has been recently set up. End of Life Care - personal care after death policy Palliative Care, Cancer Relief and Practice Development have been finding out more about current practice in Gibraltar/ GHA with regards to Personal Care after Death (previously called Last Offices) and up-dating the Policy to ensure the Royal Marsden Guidelines are followed, taking into account the up-dated Disposal of Cadavers Policy by Infection Control 20. Nicole Fawden, Palliative Care Nurse, has led on this. Nurse Management drive for Specialist Nurses initiative in schools Nurse Management and Practice Development recognised gaps in service provision for nurses in specialist areas in Gibraltar. Building on work carried out by the School of Health Studies to attract applicants for the BSc Hons Nursing (Adult) GHA nursing staff from specialist areas in Mental Health, Midwifery, Paediatrics and Operating Theatres have delivered sessions to over 500 pupils in Westside and Bayside Schools. The 10 sessions have been delivered during February and March with very positive feedback from the schools and some expressions of interest from pupils already. A newsletter has been produced to give feedback and raise awareness about this initiative. Dementia friends and Champions Awarenes sessions Gibraltar Alzheimer s and Dementia Society Practice Development, Multi-Disciplinary/ Agency staff attended an Alzheimer s Society Awareness Day organised by GADS and held in St Bernard s Hospital on 1st March and became Dementia Friends, joining the UKs biggest ever initiative to change the way people think, act and talk about dementia. An Awareness event about GADS and Dementia was held at the Mediterranean Rowing Club on Thursday 2 nd March attended by GHA and ERS staff from many diverse backgrounds as well as other professionals, ministers and members of the public. A Senior International Officer from Alzheimer s Society UK presented at this well-supported and well received talks. Staff Development Placement, SGH October P a g e

91 Promoting Nursing Career Pathways in Comprehensive Schools 2017 Infection Prevention & Control Department. October December 20 Infection Prevention and Control Board Report for the period 1 st Oct st Dec 20. Sexual Health presentations given to bayside students (year 12) over the month of October. A total of 5 sessions arranged by the head teacher and health promotion team. On-going twice monthly HIV clinics held with Dr Gloria Garcia- Awaiting arrival of treatment for Hep C patients and a Stand set up for world Aids day (1 st Dec) to raise awareness. Clostridium difficile cases period Oct- Dec- 4 in total. All followed up and treated. One of the cases was a recurrence. ANNT (Aseptic non-touch technique) guidelines and trays distributed to the following wards; o John ward o Victoria ward o Blood department o Dudley Toomey ward o Medical investigation unit o OP department (ENT, pre assessment, surgical etc.) o Oncology department o CCU o Captain Murchison ward. o Maternity o A&E o Rainbow o X-ray department. o Theatres & Day surgery. o Laboratory o Primary Care Centre. Commenced Influenza vaccination programme for staff and long term residents and HMS prison officers and inmates. Currently on going. 91 P a g e

92 Daily surveillance of MRSA, CRE & ESBL. All patients are returning from tertiary Hospitals are screened for MRSA and CRE. 6month screening of CMW carried out. STI surveillance total cases seen for period of Oct-Dec 32 patients seen in total. Organisms isolated for this period; o Chlamydia- 2 o Gonorrhoea-2 o HSV -1 o Others- 1 Needle stick injury for period Oct-Dec 10 Total All incidents followed up and reported at monthly Nursing Clinical Governance group. PEP administered on 1 occasion during the period Oct-Dec. o 1- Post sexual exposure After consultation with specialist consultant Dr Gloria Garcia patient was offered PEP due to exposure. Initially agreed and starter pack given plus baseline bloods taken same. However, patient called again next day and informed us he had opted not to take PEP- this against medical advice. Attended Legionella & Pseudomonas talk presented by Clira water hygiene specialist. Training to PORT crew on donning and doffing of PPE and Hand Hygiene. Advice given to Port authority regarding a Cruise liner (Aurora) with Norovirus on board advice on necessary precautions given. Female Moroccan national 66yrs old admitted SOB and chest infection subsequently diagnosed as miliary TB post investigations. Same deteriorated and treated in isolation on CCU liaising with consultant microbiologist. Staff advised of PPE to be used and follow up of contacts carried out. One contact Quanteferon Negative the other contact first sample invalid same to be repeated. Currently on going. 92 P a g e

93 January March 2017 Patient presented in A&E claiming he had unprotected vaginal sex with HIV + partner. Patient was reviewed and sexual health history taken on discussion with Dr Garcia (HIV specialist) patient was offered PEPSE on her advice. PEPSE starter pack given and patient advised to come following day for prescription of full treatment. Patient came following day and informed department he had thought it through and did not want to have PEPSE. Staff member from CCU who had cared for Miliary TB case patient raised concerns that on one particular day he had been exposed to an excessive amount of aerolisation with said patient. After discussion with Dr Kumar (DPH) staff member had Gold Quanteferon test performed same came back positive likely TB infection. Staff member had CXR performed and reviewed by Dr Haider and was offered latent TB treatment for 3 months. Other contact of miliary TB patient (friend) who also had Quanteferon test performed as part of contact tracing was also positive. This lady was also reviewed by Dr Haider and CXR performed and also commenced on latent TB treatment for 3 months. Both positive contacts were asymptomatic. Decision was taken to screen CCU Staff with potential exposure these were defined as those with prolonged direct contact (8 hours or more); or those who participated in aerosolisation procedures. Total of 5 S/N, 2 Intensivists and 1 consultant had a quanteferon performed all results negative. STI surveillance total cases seen for period of Jan-March 39 patients seen in total. Organisms isolated for this period; 5 Chlamydia 1 Candida Infection Prevention and Control Training provided to GHA staff: o OSCE for Enrolled nurse 14 in total -6 th Jan. o Mandatory Training to GHA staff- 18 th, 19 th & 25 th -26 th Jan- 81 staff. o Infection prevention and Control Training to Dr Giraldi and St Bernadette s staff-53 staff. o New Enrolled nurse intake 19 in total. o 24 in total Auxillary Nurse Training induction 12 th Jan. 93 P a g e

94 Daily surveillance of MRSA, CRE & ESBL. All patients are returning from tertiary Hospitals are screened for MRSA and CRE. 6 month MRSA screening of VMW still on going. Attended meetings; o Infection Control Committee o Clinical Governance meeting o Bed Escalation contingency plan meeting Death on board vessel MV Ice Glacier, unknown causes assisted locum DPH (Dr Ashton) in advising port authority. Advised PPE, use of body bag and Port doctor to go on board ship. Coroner s case, report sent by port doctor sent to Locum DPH. Visited HMS prison and Ocean Views with locum DPH (Dr Ashton) for orientation visit. Clostridium difficile cases period Jan-March 6 in total. All followed up and treated. One of the cases was a recurrent Breast Care Comments Clinical/Patient Care New patients diagnosed primary/secondarybreast cancer-11 patient contact SOPD/Ward -74 Lymphoedema patient appointments - 27 Prosthesis+fitting clinic appointments 13 IV clinic + PAC care + treatments(with pal. Care nurses) - 95 Patient telephone calls 134 Wound care +seroma care appointments 18 Home visits-3 Teaching/Training Teaching School of nursing (students) 2 sessions Students with BC nurse days 7 Lymphoedema review training + compression garments update days 2 (Gibraltar) Attended Breast Cancer Study Day RMH Completed Work based Learning module (Msc 94 P a g e

95 Policies/Clinical meetings level) Attendance at weekly Breast radiology MDT Attendance at weekly Oncology MDT Innovations Breast cancer related lymohoedema review clinic 35 patients seen Attended scalp cooling master class UK (selffund) Aim to provide this option locally for future patients undergoing chemotherapy induced alopecia-support group interested in funding this. Met with line manager and Mr Salman to discuss scope of role/practice to include additional tasks inview of reduced medical cover for breast patients.(mr Grama left GHA) Issues Lymphoedema (for all) services developments Administrative Support please -This would also benefit breast services, with results to patients, best practice MDT(breast)outcome of meeting in patient records. Bed Management Report for period October 20: The month of October 20 has demonstrated a continuation in high bed occupancy for adult patients at SBH. Extra beds have been in use persistently during the month. Total admissions for October 20 for SBH are as follows: Admissions all areas 306 Admissions via A&E 205 Admissions Adult & CCU 181 Admissions via A&E 153 Paediatrics 61 Admission via A&E 39 Maternity 64 Non elective 52 (Data captured from Bed Management Database). 95 P a g e

96 October continues to see high bed occupancy with the average adult occupancy at 100.6%. This percentage remains substantially higher than the average occupancy recommended by the DOH (2001) - 85% sealing. A sustained high overall bed occupancy level in DTW, CMW, JMW and VMW remains as a consequence of: A constant high number of long stay/complex, Dementia & Palliative cases populating acute hospital beds ( snapshot 95 beds held on 21/10/20). Despite these issues the following efforts continue: MDT working both on acute & long stay wards (rehab). Improving patient flow on JMW (acute medical). Proactive approach to the discharge process. DC hour s availability to support discharge (delays on occasions). Closer integration with The Care Agency (availability of long term beds in order to expedite patient flow). Utilisation of John Mackintosh Wing (Old SBH). There are, however, historical bottle necks which continue to delay the discharge process which together with an anticipated increase in seasonal demand, will in the balance of probability, cause pressure on bed availability & patient flow in the coming months. These are: Housing/rehousing/buildings & works issues delays Absence of a dedicated in house Hospital Social Worker. Limited long term care beds (Care Agency) in relation to demand hence a backlog in SBH/KGV. A dedicated multidisciplinary team to include the social worker Fig 1: Occupancy levels (adult wards & CCU 30 & 10 beds respectively) Jan October P a g e

97 115.00% % % % 95.00% 90.00% 85.00% Jan- 15 Feb- 15 Mar- 15 Apr- 15 May- 15 Jun- 15 Jul- 15 Aug- 15 Sep- 15 Average Occupancy Adults % 100% % 101% 102% 101% 110% 109% 111% 108% 106% 104% 106% 105% 106% % Oct- 15 Nov Dec- 15 Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Note: 85% sealing for occupancy as per DOH 2001 recommendations Fig 2: Average (Adult) Bed Occupancy SBH inclusive of CCU January 2011 to October % 100% 80% 60% 40% 20% 0% Jan Feb March April May June July Aug Sept Oct Nov Dec Average Occupancy 2011-Adults 97% 94% 96% 93% 92% 89% 95% 94% 96% 95% 109% 103% Average Occupancy 2012-Adults 107% 109% 104% 82% 88% 96% 91% 87% 81% 85% 89% 92% Average Occupancy 2013-Adults 96% 97% 98% 102% % 102% 97% 95% 90% 97% 92% Average Occupancy Adults 102% 104% 96% 85.30% 95.20% 95% 94% 97% 99.60% 97.60% 88.70% 91% Average Occupancy Adults 96.90% 99.46% 103% 100% 96.70% 102% 101% 102% 101% 110% 109% 111% Average Occupancy 20-Adults 108% 106% 104% 106% 105% 106% % P a g e

98 Fig 3.1: Distribution of elderly long stay/dementia/complex by 21/10/20 Fig 3.2: Distribution of elderly long stay/dementia/complex & Palliative by 21/10/20 98 P a g e

99 Fig 4: The collective breakdown of this cohort of patients is as follows. Complex Discharges 29 Elderly Stay Long- 34 Average age 85 years Dementia Long- Stay 23 Identified from nursing assessment. Palliative 9 Total Beds Held adult beds SBH 95 = 35 acute beds available Fig 4.1: Total Admissions SBH January October 20 (adult wards) DTW average admission rate per month (last 10 months) = 93 patients per month JMW average admission rate per month (last 10 months) = 43.2 patients per month 99 P a g e

100 Fig 5: Total Cancellations elective inpatient surgery January 2015 to October 20 due to bed shortage Patient flow out of VMW & CMW remains dependent on transfers to The Care Agency & successful rehabilitation candidates. There have been 0 cancellations of elective inpatient surgery specifically due to bed unavailability in October 20. Bed management meetings continue to incorporate Sister s & Charge nurses in the format. This continues to be welcomed as first hand input on current & future dynamics can be discussed in a mutually supportive manner. Medical attendance is unfortunately limited. Care Agency: Social Services Adult services team: Team Lead: Ms Debbie Guinn Senior Social Workers: Mrs Jennifer Poole Jo Smith Social Workers: Dean Lopez, Lianne Cano, Vanessa Hitchcock & Julie Scott Administration support: Rosanne Hosken Administrative Officer (Adult Services) Rosanne.Hosken@CareAgency.gov.gi All referrals regarding hospital discharges or any concerns to be sent to: referral.adultservices@careagency.gov.gi Telephone number: Bed Management Report for period November 20: The month of November 20 has demonstrated a continuation in high bed occupancy for adult patients at SBH. Extra beds have been in use persistently during the month. Total admissions for November 20 for SBH are as follows: Admissions all areas 273 Admissions via A&E 202 Admissions Adult & CCU 195 Admissions via A&E P a g e

101 Paediatrics 54 Admission via A&E 32 Maternity 24 Non elective 7 (Data captured from Bed Management Database). November continues to see high bed occupancy with the average adult occupancy at 102 %. This percentage remains substantially higher than the average occupancy recommended by the DOH (2001) - 85% sealing. A sustained high overall bed occupancy level in DTW, CMW, JMW and VMW remains as a consequence of: A constant high number of long stay/complex, Dementia & Palliative cases populating acute hospital beds ( snapshot 106 beds held on 13/12/20). Despite these issues the following efforts continue: MDT working both on acute & long stay wards (rehab). Improving patient flow on JMW (acute medical). Proactive approach to the discharge process. DC hour s availability to support discharge (delays on occasions). Closer integration with The Care Agency (availability of long term beds in order to expedite patient flow). Utilisation of John Mackintosh Wing (Old SBH). There are, however, historical bottle necks which continue to delay the discharge process which together with an anticipated increase in seasonal demand, will in the balance of probability, cause pressure on bed availability & patient flow in the coming months. These are: Housing/rehousing/buildings & works issues delays Absence of a dedicated in house Hospital Social Worker. Limited long term care beds (Care Agency) in relation to demand hence a backlog in SBH/KGV. A dedicated multidisciplinary team to include the social worker Fig 1: Occupancy levels (adult wards & CCU 30 & 10 beds respectively) Jan November P a g e

102 115.00% % % % 95.00% 90.00% 85.00% Jan- 15 Ma y- 15 Feb-Mar-Apr Au Jun-Jul- g Average Occupancy Adults Se p- 15 Oct- No 15 v De c- 15 Jan- Feb- Ma y- Mar-Apr- Au Jun-Jul- g- Se p- No Octv- Note: 85% sealing for occupancy as per DOH 2001 recommendations Fig 2: Average (Adult) Bed Occupancy SBH inclusive of CCU January 2011 to November % 100% 80% 60% 40% 20% 0% Jan Feb March April May June July Aug Sept Oct Nov Dec Average Occupancy 2011-Adults 97% 94% 96% 93% 92% 89% 95% 94% 96% 95% 109% 103% Average Occupancy 2012-Adults 107% 109% 104% 82% 88% 96% 91% 87% 81% 85% 89% 92% Average Occupancy 2013-Adults 96% 97% 98% 102% % 102% 97% 95% 90% 97% 92% Average Occupancy Adults 102% 104% 96% 85.30% 95.20% 95% 94% 97% 99.60% 97.60% 88.70% 91% Average Occupancy Adults 96.90% 99.46% 103% 100% 96.70% 102% 101% 102% 101% 110% 109% 111% Average Occupancy 20-Adults 108% 106% 104% 106% 105% 106% % % 102 P a g e

103 Fig 3.1: Distribution of elderly long stay/dementia/complex by 13/12/20 Fig 3.2: Distribution of elderly long stay/dementia long stay/complex & Palliative by 13/12/ P a g e

104 Fig 4: The collective breakdown of this cohort of patients is as follows. Complex Discharges 45 Elderly Stay Long- 33 Average age 85 years Dementia Long- Stay 26 Identified from nursing assessment. Palliative 2 Total Beds Held adult beds SBH 106 = 24 acute beds available (plus 19 extra beds) Fig 4.1: Total Admissions SBH January November 20 (adult wards) Number of patients Total Admissions per ward Jan- 15 Ma y- 15 Feb-Mar-Apr Au Jun-Jul- g Se p- 15 No Octv ADMISSIONS DTW ADMISSIONS Capt.M ADMISSIONS JOHN * ADMISSIONS VICTORIA ADMISSIONS CCU De c- 15 Jan- Ma y- Feb-Mar-Apr- Jun-Jul- Au g- Se p- No Octv- DTW average admission rate per month (last 11 months) = 102 patients per month JMW average admission rate per month (last 11 months) = 43 patients per month 104 P a g e

105 Fig 5: Total Cancellations elective inpatient surgery January 2015 to November 20 due to bed shortage Total Number of Patient's Total cancellations due to beds Ja Fe Ma Ap Ma Ju Jul- Au Se Oc No De Ja Fe Ma Ap Ma Ju Jul- Au Se Oc No Cancellation due to unavailability of bed Patient flow out of VMW & CMW remains dependent on transfers to The Care Agency & successful rehabilitation candidates. There have been 0 cancellations of elective inpatient surgery specifically due to bed unavailability in November 20. Bed management meetings continue to incorporate Sister s & Charge nurses in the format. This continues to be welcomed as first hand input on current & future dynamics can be discussed in a mutually supportive manner. Medical attendance is unfortunately limited. Care Agency: Social Services Adult services team: Team Lead: Ms Debbie Guinn Senior Social Workers: Mrs Jennifer Poole Jo Smith Social Workers: Dean Lopez, Lianne Cano, Vanessa Hitchcock & Julie Scott Administration support: Rosanne Hosken Administrative Officer (Adult Services) Rosanne.Hosken@CareAgency.gov.gi All referrals regarding hospital discharges or any concerns to be sent to: referral.adultservices@careagency.gov.gi Telephone number: Bed Management Report for period December 20: The month of December 20 has demonstrated a continuation in high bed occupancy for adult patients at SBH. Extra beds have been in use persistently during the month. Total admissions for December 20 for SBH are as follows: Admissions all areas 254 Admissions via A&E 192 Admissions Adult & CCU 177 Admissions via A&E 3 Paediatrics 53 Admission via A&E P a g e

106 Maternity 24 Non elective 3 (Data captured from Bed Management Database). December continues to see high bed occupancy with the average adult occupancy at 107 %. This percentage remains substantially higher than the average occupancy recommended by the DOH (2001) - 85% sealing. A sustained high overall bed occupancy level in DTW, CMW, JMW and VMW remains as a consequence of: A constant high number of long stay/complex, Dementia & Palliative cases populating acute hospital beds ( snapshot 101 beds held on 31/12/20). Despite these issues the following efforts continue: MDT working both on acute & long stay wards (rehab). Improving patient flow on JMW (acute medical). Proactive approach to the discharge process. DC hour s availability to support discharge (delays on occasions). Closer integration with The Care Agency (availability of long term beds in order to expedite patient flow). Utilisation of John Mackintosh Wing (Old SBH). There are, however, historical bottle necks which continue to delay the discharge process which together with an anticipated increase in seasonal demand, will in the balance of probability, cause pressure on bed availability & patient flow in the coming months. These are: Housing/rehousing/buildings & works issues delays Absence of a dedicated in house Hospital Social Worker (this may help expedite discharges with very early input and follow up of a dedicated SW for SBH) Limited long term care beds (Care Agency) in relation to demand hence a backlog in SBH/KGV. A dedicated multidisciplinary team to include the social worker Fig 1: Occupancy levels (adult wards & CCU 30 & 10 beds respectively) Jan December P a g e

107 115.00% % % % 95.00% 90.00% 85.00% Jan- 15 Feb- 15 Mar- 15 Apr- 15 May- 15 Average Occupancy Adults % 100% % 101% 102% 101% 110% 109% 111% 108% 106% 104% 106% 105% 106% % % 107% Note: 85% sealing for occupancy as per DOH 2001 recommendations Jun- 15 Jul- 15 Aug- 15 Sep- 15 Oct- 15 Nov Dec- 15 Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Fig 2: Average (Adult) Bed Occupancy SBH inclusive of CCU January 2011 to December 20. Fig 3.1: Distribution of elderly long stay/dementia/complex by 31/12/ P a g e

108 Fig 3.2: Distribution of elderly long stay/dementia long stay/complex & Palliative by 31/12/20 Fig 4: The collective breakdown of this cohort of patients is as follows. Complex Discharges 37 Elderly Stay Long- 29 Average age 85 years Dementia Long- Stay 31 Identified from nursing assessment. Palliative 4 Total Beds Held adult beds SBH 101 = 29 acute beds available (plus 19 extra beds)= P a g e

109 Fig 4.1: Total Admissions SBH January December 20 (adult wards) Number of patients Total Admissions per ward Fe Janb Ma r- 15 Ma Apry Ju n- 15 Au Julg Se p- 15 No Octv ADMISSIONS DTW ADMISSIONS Capt.M ADMISSIONS JOHN * ADMISSIONS VICTORIA ADMISSIONS CCU De c- 15 Fe Janb- Ma r- Ma Apry- Ju n- Au Julg- Se p- No Octv- De c- DTW average admission rate per month (last 12 months) = 92 patients per month JMW average admission rate per month (last 12 months) = 42 patients per month Fig 5: Total Cancellations elective inpatient surgery January 2015 to December 20 due to bed shortage Total Number of Patient's Cancellation due to unavailability of bed Total cancellations due to beds Ja Fe Ma Ap Ma Ju Jul- Au Se Oc No De Ja Fe Ma Ap Ma Ju Jul- Au Se Oc No De Patient flow out of VMW & CMW remains dependent on transfers to The Care Agency & successful rehabilitation candidates. There have been 6 cancellations of elective inpatient surgery specifically due to bed unavailability in December 20. Bed management meetings continue to incorporate Sister s & Charge nurses in the format. This continues to be welcomed as first hand input on current & 109 P a g e

110 future dynamics can be discussed in a mutually supportive manner. Medical attendance is unfortunately limited. Care Agency: Social Services Adult services team: Team Lead: Ms Debbie Guinn Senior Social Workers: Mrs Jennifer Poole Jo Smith Social Workers: Dean Lopez, Lianne Cano, Vanessa Hitchcock & Julie Scott Administration support: Rosanne Hosken Administrative Officer (Adult Services) Rosanne.Hosken@CareAgency.gov.gi Tel All referrals regarding hospital discharges or any concerns to be sent to: referral.adultservices@careagency.gov.gi Telephone number: Bed Management Report for period January 2017: The month of January 2017 has demonstrated substantial increase in bed occupancy for adult patients at SBH. Extra beds have been in use persistently during the month. In order to manage the seasonal influx of patients, CMW and VMW have temporarily increased their bed capacity to 36 as per Bed Management Escalation Policy. A pro-active approach has been taken whereby a temporary ERS ward has been opened on the ground floor at SBH with 7 beds and long stay patients awaiting transfer to the ERS have been relocated. These patients have adapted extremely well to the move and their close relatives have expressed their satisfaction at the homely care setting. The Bed Escalation Policy is currently under review for updates and improvements. The introduction of a dedicated hospital social worker and the escalation of bed management meetings have significantly improved the discharge process. Total admissions for January 2017 for SBH are as follows: Admissions all areas 305 Admissions via A&E 219 Admissions Adult & CCU 207 Admissions via A&E 170 Paediatrics 56 Admission via A&E 28 Maternity 42 Non elective 21 (Data captured from Bed Management Database). January continues to see high bed occupancy with the average adult occupancy at 110 %. 110 P a g e

111 This percentage remains substantially higher than the average occupancy recommended by the DOH (2001) - 85% sealing. A sustained high overall bed occupancy level remains in the acute wards remains as a consequence of: A constant high number of complex and long stay cases populating acute hospital beds Despite these issues the following efforts successfully continue 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 hour s availability to support discharge. Close integration with The Care Agency (availability of long term beds in order to expedite patient flow). Transfer of patients to Temporary Ward (interim measure) There are, however, bottle necks which continue to delay the discharge process which together with an anticipated increase in seasonal demand, will in the balance of probability, cause pressure on bed availability & patient flow. These are: Housing/rehousing/buildings & works issues delays Process of patients long term care entitlement (CSRO) Limited long term care beds (Care Agency) in relation to demand hence a backlog in SBH/KGV. (This is improving with the above mentioned strategies undertaken) Fig 1: Occupancy levels (adult wards & CCU 30 & 10 beds respectively) Jan Jan P a g e

112 115.00% % % % 95.00% 90.00% 85.00% Jan- 15 Feb- 15 Mar- 15 Apr- 15 May- 15 Jun- 15 Jul- 15 Aug- 15 Sep- 15 Oct- 15 Nov Dec- 15 Average Occupancy Adults %100% %101%102%101%110% 109%111%108%106%104%106% 105%106% % %107%110% Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- 17 Note: 85% sealing for occupancy as per DOH 2001 recommendations Fig 2: Average (Adult) Bed Occupancy SBH inclusive of CCU January 2015 to January % % % % 95.00% 90.00% 85.00% Jan Feb March April May June July Aug Sept Oct Nov Dec Average Occupancy Adults 96.90% 99.46% 103% 100% 96.70% 102% 101% 102% 101% 110% 109% 111% Average Occupancy 20-Adults 108% 106% 104% 106% 105% 106% % % 107% Average Occupancy 2017 Adults 110% 112 P a g e

113 Fig 3.1: Distribution of elderly long stay/dementia/complex by 05/02/2017 Fig 3.2: Distribution of elderly long stay/dementia long stay/complex & Palliative by 05/02/2017 NB: There are a total of 8 complex patients (2 have confirmed dementia) in CMW & VMW, 4 of which are non-entitled, 3 are unable to apply to ERS as <60 yrs. and 1 is awaiting housing. The non-entitlement & housing issues are being dealt with by Social Services 113 P a g e

114 Fig 4: The collective breakdown of this cohort of patients is as follows. Complex Discharges 28 Elderly Stay Long- 32 Average age 85 years Dementia Long- Stay 43 Identified from nursing assessment. Palliative 2 Total Beds Held adult beds SBH 105 = 25 acute beds available (plus 23 extra beds)= 48 Fig 4.1: Total Admissions SBH January January 2017 (adult wards) 120 Total Admissions per ward Number of patients Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan-17 ADMISSIONS DTW ADMISSIONS Capt.M ADMISSIONS JOHN ADMISSIONS VICTORIA ADMISSIONS CCU DTW average admission rate per month (last 12 months) = 92 patients per month JMW average admission rate per month (last 12 months) = 42 patients per month CCU average admission rate per month (last 12 months) = 54 patients per month 114 P a g e

115 Fig 5: Total Cancellations elective inpatient surgery January 2015 to January 2017 due to bed shortage Total Number of Patient's Total cancellations due to beds Jan- Feb- Mar- Apr- May-Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May-Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Cancellation due to unavailability of bed There have been 2 cancellations of elective inpatient surgery specifically due to bed unavailability in January Care Agency: Social Services Adult services team: Team Lead: Ms Debbie Guinn Senior Social Workers: Mrs Jennifer Poole Jo Smith Social Workers: Dean Lopez, Lianne Cano, Vanessa Hitchcock & Julie Scott SBH dedicated Social worker Tiffany Biddlecombe Administration support: Rosanne Hosken Administrative Officer (Adult Services) Rosanne.Hosken@CareAgency.gov.gi Tel All referrals regarding hospital discharges or any concerns to be sent to: referral.adultservices@careagency.gov.gi Telephone number: Bed Management Report for period February 2017: The month of February 2017 has demonstrated a slight decrease in bed occupancy for adult patients at SBH. Extra beds have been used intermittently during the month. CMW and VMW continue with the increased bed capacity to 36 patients as per Bed Management Escalation Policy. A positive approach was taken early January in order to free up acute beds whereby a temporary ERS ward was opened on the ground floor at SBH with 7 beds and long stay patients awaiting transfer to the ERS were relocated from the wards and this remains unchanged. Bed management meetings continue to be held weekly with a proactive team approach. The introduction of a dedicated hospital social worker, and the escalation of bed management meetings continue to have a positive impact on the discharge process. Total admissions for February 2017 for SBH are as follows: Admissions all areas 269 Admissions via A&E P a g e

116 Admissions Adult & CCU 158 Admissions via A&E 129 Paediatrics 62 Admission via A&E 22 Maternity 49 Non elective 12 (Data captured from Bed Management Database). Although February continues to see high bed occupancy with the average adult occupancy at 107%, there has been a slight decrease from January (110%) This percentage remains substantially higher than the average occupancy recommended by the DOH (2001) - 85% sealing. A sustained high overall bed occupancy level remains in the acute wards remains as a consequence of: A constant high number of complex and long stay cases populating acute hospital beds Despite these issues the following efforts successfully continue 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 hour s availability to support discharge. Close integration with The Care Agency (availability of long term beds in order to expedite patient flow). Transfer of patients to Temporary Ward (interim measure) There are, however, bottle necks which continue to delay the discharge process which together with an anticipated increase in seasonal demand, will in the balance of probability, cause pressure on bed availability & patient flow. These are: Housing/rehousing/buildings & works issues delays Process of patients long term care entitlement (CSRO) Limited long term care beds (Care Agency) in relation to demand hence a backlog in SBH/KGV. (This is improving with the above mentioned strategies undertaken) Fig 1: Occupancy levels (adult wards & CCU 30 & 10 beds respectively) Jan Feb P a g e

117 115.00% % % % 95.00% 90.00% 85.00% Jan- 15 Feb- 15 Mar- 15 Apr- 15 May- 15 Jun- 15 Jul- 15 Aug- 15 Sep- 15 Oct- 15 Nov Dec- 15 Average Occupancy Adults Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb Note: 85% sealing for occupancy as per DOH 2001 recommendations Fig 2: Average (Adult) Bed Occupancy SBH inclusive of CCU January 2015 to February % % % % 95.00% 90.00% 85.00% Jan Feb March April May June July Aug Sept Oct Nov Dec Average Occupancy Adults 96.90% 99.46% 103% 100% 96.70% 102% 101% 102% 101% 110% 109% 111% Average Occupancy 20-Adults 108% 106% 104% 106% 105% 106% % % 107% Average Occupancy 2017 Adults 110% 107% 117 P a g e

118 Fig 3.1: Distribution of elderly long stay/dementia/complex by 05/02/2017 Fig 3.2: Distribution of elderly long stay/dementia long stay/complex & Palliative by 05/02/ P a g e

119 Fig 4: The collective breakdown of this cohort of patients is as follows. Complex Discharges 28 Elderly Stay Long- 32 Average age 85 years Dementia Long- Stay 43 Identified from nursing assessment. Palliative 2 Total Beds Held adult beds SBH 105 = 25 acute beds available (plus 23 extra beds)= 48 Fig 4.1: Total Admissions SBH January February 2017 (adult wards) 120 Total Admissions per ward Number of patients Jan- Feb- Mar- Apr- May- ADMISSIONS DTW ADMISSIONS Capt.M ADMISSIONS JOHN ADMISSIONS VICTORIA ADMISSIONS CCU Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan-17 Feb- 17 DTW average admission rate per month (last 12 months) = 100 patients per month JMW average admission rate per month (last 12 months) = 43 patients per month CCU average admission rate per month (last 12 months) = 58 patients per month 119 P a g e

120 Fig 5: Total Cancellations elective inpatient surgery January 2015 to February 2017 due to bed shortage Total Number of Patient's Total cancellations due to beds Jan- Feb- Mar- Apr- May-Jun- Jul- Aug-Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- Jul- Aug-Sep- Oct- Nov- Dec- Jan- Feb- Cancellation due to unavailability of bed There have been 0 cancellations of elective inpatient surgery specifically due to bed unavailability in February Care Agency: Social Services Adult services team: Team Lead: Ms Debbie Guinn Senior Social Workers: Mrs Jennifer Poole Jo Smith Social Workers: Dean Lopez, Lianne Cano, Vanessa Hitchcock & Julie Scott SBH dedicated Social worker Tiffany Biddlecombe Administration support: Rosanne Hosken Administrative Officer (Adult Services) Rosanne.Hosken@CareAgency.gov.gi Tel All referrals regarding hospital discharges or any concerns to be sent to: referral.adultservices@careagency.gov.gi Telephone number: Bed Management Report for period March 2017: The month of March 2017 has demonstrated a slight increase in bed occupancy for adult patients at SBH. Extra beds have been used regularly during the month. CMW and VMW continue with the increased bed capacity to 36 patients as per Bed Management Escalation Policy. A positive approach was taken early January in order to free up acute beds whereby a temporary ERS ward was opened on the ground floor at SBH with 7 beds and long stay patients awaiting transfer to the ERS were relocated from the wards and this remains unchanged. Bed management meetings continue to be held weekly with a proactive team approach. The introduction of a dedicated hospital social worker and the escalation of bed management meetings continue to have a positive impact on the discharge process. Total admissions for March 2017 for SBH are as follows: 120 P a g e

121 Admissions all areas 356 Admissions via A&E 237 Admissions Adult & CCU 213 Admissions via A&E 7 Paediatrics 84 Admission via A&E 38 Maternity 59 Non elective 32 (Data captured from Bed Management Database). March continues to see high bed occupancy with the average adult occupancy at 109.4% and there has been a slight increase from February (107%) This percentage remains substantially higher than the average occupancy recommended by the DOH (2001) - 85% sealing. A sustained high overall bed occupancy level remains in the acute wards remains as a consequence of: A constant high number of complex and long stay cases populating acute hospital beds Despite these issues the following efforts successfully continue 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 hour s availability to support discharge. Close integration with The Care Agency (availability of long term beds in order to expedite patient flow). Transfer of patients to Temporary Ward (interim measure) There are, however, bottle necks which continue to delay the discharge process which together with an anticipated increase in seasonal demand, will in the balance of probability, cause pressure on bed availability & patient flow. These are: Housing/rehousing/buildings & works issues delays Process of patients long term care entitlement (CSRO) Limited long term care beds (Care Agency) in relation to demand hence a backlog in SBH/KGV. (This is improving with the above mentioned strategies undertaken) 121 P a g e

122 Fig 1: Occupancy levels (adult wards & CCU 30 & 10 beds respectively) Jan March % % % % 95.00% 90.00% 85.00% Jan- 15 Feb- 15 Mar- Apr May- Jun- Jul Aug- 15 Sep- Oct Dec-Jan- Feb- Nov 15 Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- 17 Feb- Mar Average Occupancy Adults Note: 85% sealing for occupancy as per DOH 2001 recommendations Fig 2: Average (Adult) Bed Occupancy SBH inclusive of CCU January 2015 to March % % % % 95.00% 90.00% 85.00% Jan Feb March April May June July Aug Sept Oct Nov Dec Average Occupancy Adults 96.90% 99.46% 103% 100% 96.70% 102% 101% 102% 101% 110% 109% 111% Average Occupancy 20-Adults 108% 106% 104% 106% 105% 106% % % 107% Average Occupancy 2017 Adults 110% 107% 109% Fig 3.1: Distribution of elderly long stay/dementia/complex by 15/03/ P a g e

123 Fig 3.2: Distribution of elderly long stay/dementia long stay/complex & Palliative by 15/03/2017 Fig 4: The collective breakdown of this cohort of patients is as follows. 123 P a g e

124 Complex Discharges 26 Elderly Stay Dementia Stay 27 Average age 85 years 44 Palliative 7 Total Beds Held adult beds SBH 104= 26 acute beds available (plus 23 extra beds)= 49 Fig 4.1: Total Admissions SBH January March 2017 (adult wards) 120 Total Admissions per ward Number of patients Long- Long- Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- ADMISSIONS DTW ADMISSIONS Capt.M ADMISSIONS JOHN ADMISSIONS VICTORIA ADMISSIONS CCU Sep- Oct- Nov- Dec- Jan- 17 Feb- 17 Mar- 17 DTW average admission rate per month (last 12 months) = 93 patients per month JMW average admission rate per month (last 12 months) = 39 patients per month CCU average admission rate per month (last 12 months) = 57 patients per month 124 P a g e

125 Fig 5: Total Cancellations elective inpatient surgery January 2015 to March 2017 due to bed shortage Total Number of Patient's Total cancellations due to beds Jan- Feb-Mar- Apr- May-Jun- Jul- Aug-Sep- Oct- Nov-Dec- Jan- Feb-Mar- Apr- May-Jun- Jul- Aug-Sep- Oct- Nov-Dec- Jan- Feb-Mar- Cancellation due to unavailability of bed There have been 0 cancellations of elective inpatient surgery specifically due to bed unavailability in March Care Agency: Social Services Adult services team: Team Lead: Ms Debbie Guinn Senior Social Workers: Mrs Jennifer Poole Jo Smith Social Workers: Dean Lopez, Lianne Cano, Vanessa Hitchcock & Julie Scott SBH dedicated Social worker Tiffany Biddlecombe Administration support: Rosanne Hosken Administrative Officer (Adult Services) Rosanne.Hosken@CareAgency.gov.gi Tel All referrals regarding hospital discharges or any concerns to be sent to: referral.adultservices@careagency.gov.gi Telephone number: Respectfully submitted, Sandra Gracia Director of Nursing Services (Ag) 125 P a g e

126 126 P a g e

127 July to September Human Resources 1. RECRUITMENT & SELECTION ACTIVITY 46 posts have been processed during the operating period covered by this report. 2. STAFF AWARDS The new Staff Awards Committee will have their first meeting in early October 20 with the aim of planning and organizing the GHA s 9 th Staff Awards Ceremony. The new committee is made up of Mrs Jackie Ocaña, Mrs Linda Castro, Mr Christopher Bothen, Ms Kate Langton, Mrs Evelyn Cervan and Mrs Paula Galliano. The committee is ably assisted by Mrs Desiree Pocock and chaired by the Director of Human Resources. The next awards ceremony will take place in October 2017 and will see the presentation of the new GHA long service and good conduct medal, awarded to employees who have completed 20 years service in recognition of their contribution to Healthcare in Gibraltar. A press release announcing this year s awards scheme will shortly be published and posters promoting the scheme will shortly be distributed and placed within the various GHA sights. 3. HR DEPARTMENT 3.1 Occupational Health A booklet with guidelines for employees on occupational health referrals is currently being compiled and will be available for use shortly. The aim of the booklet is to give employees a general overview of the current occupational health service and what they, as service users, can expect from the service if referred for an assessment. Completion of the booklet is expected shortly and a copy will be attached in my next submission to the board. 3.2 HR IT System The bespoke IT system developed in-house by Mr Stuart Cornelio from the Information Systems Section of the IT Department is now operational. The system pulls together and consolidates a number of excel databases into one system, removing much of the data gathering and repetitive tasks that consume so much of our resources. The functionality of the new system is 127 P a g e

128 being closely monitored by all its users and adjustments and modifications are being made by the developer as soon as these are flagged up. October to December RECRUITMENT & SELECTION ACTIVITY 44 posts have been processed during the operating period covered by this report. 2. STAFF AWARDS The new Staff Awards Committee met on 11 November 20. The new committee discussed ideas for the design of the new GHA long service and good conduct medal and agreed to back to the chairman their individual design concepts that could form part of the final design. The committee agreed that sponsors for the individual awards should be approached with a view of requesting their continued participation to the scheme. The new committee has agreed for the individual categories to remain unchanged, these being as follows:- 1. Qualified Nurse/Midwife of the Year 2. Nursing Assistant/Auxiliary Nurse of the Year 3. Doctor/Dentist of the Year 4. Allied Health Professional/Healthcare Scientist of the Year 5. Innovation Award 6. Support Services Employee of the Year Frontline 7. Support Services Employee of the Year Behind the Scenes 8. Ward/Department of the Year As in previous years, there will also be an Employee of the Year award. As it is customary, this will be decided by the Staff Awards Committee from the nominations submitted in all the above 8 categories. Although the final date for the next awards ceremony remains to be confirmed it has been agreed that this will take place in October A press release announcing this year s awards scheme will be published in the new-year, and posters promoting the scheme will be distributed by the Human Resources Department and placed within the various GHA sights. 3. CAREERS FAIR 2017 The GHA will be participating in the biennial Careers Fair scheduled to take place on Tuesday 28 th February 2017 at the Cruise Liner Terminal. 128 P a g e

129 The Careers Fair provides students with the opportunity to find out more about potential career paths in Gibraltar as well as providing opportunities to meet and discuss relevant issues with potential employers and key personnel. The Human Resources Department is co-ordinating the GHA s participation and a multi-disciplinary meeting took place on 30 November 20 in order to finalise all the necessary arrangements for the event. The HR Department have compiled a new and updated Powerpoint Presentation that will be used as a backdrop to the stand and screened continuously throughout the Fair, thus providing visual information on Careers in Healthcare. Participation in this event is very important as students will be able to gain valuable insights into careers in healthcare by speaking directly with professionals from the different departments in the GHA. The event is organised by Bayside School, the Gibraltar College and Westside School and forms an important part of the careers guidance that is provided to students within Gibraltar s education system. HR DEPARTMENT 3.1 Occupational Health As outlined in my previous submission, a booklet with guidelines for employees on occupational health referrals is now in use and provided to all those referred for an occupational health assessment. The booklet aims to give staff a general overview of the current occupational health service and what they, as service users, can expect. A copy of the booklet is attached to this submission. 3.2 Staff training The HR staff continue to avail themselves of the training opportunities being provided through the Training Unit at the Government of Gibraltar s Human Resources Department. Staff in HR have had the opportunity to broaden their skill sets by undertaking further training and participating in the following workshops: Bullying in the Workplace Interviewing Skills Management & Interpersonal Skills Grievance, Discipline & Dismissals Data Protection Further workshops are being planned for next year and HR staff have confirmed their participation in the following: 129 P a g e

130 Managing Learning & Development Certificate in Training Administration The above will be delivered in March Respectfully submitted Peter Linares Director of Human Resources January to March EXECUTIVE SUMMARY The GHA has commissioned a comprehensive review of HR, which is being undertaken by the Public Sector HR Business Support Unit. The review focuses on understanding the current position of the department by evaluating existing HR practices, resources, expertise and systems in place, in relation to the ever-changing service pressures and demands, as well as longer-term service development requirements and opportunities. The outcomes of the HR review will provide a structured and evidence-based approach towards developing individuals, core HR functions and the department s service provision, enabling HR to become a strategic partner to the organisation. HR staff members are fully engaged in the current HR review and look forward to opportunities for learning and development as HR practitioners and to actively contributing to the department s improvement and future success. In 20 the GHA appointed Dr Daniel Cassaglia as Medical Director. HR is now working very closely with both Dr Cassaglia and Ms Sandie Gracia, as Director for Nursing Services (Ag), in developing a professional network where our HR service delivery best complements clinical service development. Emergent clinical service development initiatives will include the recruitment of a Consultant Nephrologist; 2 Matrons; an A&E Consultant and 5 Resident Medical Officers (RMOs) in Anaesthesia and Intensive Care. The introduction of the RMOs will deliver the longstanding objective of retaining a second on-call Intensivist, for simultaneously caring for complex critically ill patients and emergency patient transfers. The HR Department aims to develop standards of excellence in the delivery of strategic HR functions such as workforce succession planning; learning and development; leadership management; absence management, performance management and employee wellbeing. The department is fully committed to working in partnership with the Unions and Line Managers towards further developing positive industrial relations and communication, together with driving employee engagement and wellbeing across the GHA, as it sees this as a cornerstone of organisational success. 130 P a g e

131 The welcomed integration of services with our counterparts from Elderly Residential Services and the Care Agency will generate prospects for the transference of knowledge and expertise, improve communication and professional networking, as well as offer opportunities for a more holistic approach towards delivering a highly professional HR service to both health and care service professionals. Respectfully submitted, Mr Christian Sanchez Director of Human Resources (Ag) 131 P a g e

132 132 P a g e

133 July to September Introduction 5.7 UGM Hospital Services This board report covers the 2 nd Quarter period of the Financial Year from July to September 20. The new blood appointment system launched on the 2 nd March 20 at both St. Bernard s Hospital and Primary Care Centre Phlebotomy Clinics has generated circa 4800 booked appointments during this quarter. Following the visit to St. George s University Hospital and Queen Mary s Hospital in London during April 20 the GHA Physiotherapy and St. Georges teams have carried out several orthotic and prosthetic clinics at St. Bernard s Hospital which have addressed pending waiting lists and specific cases. Future clinics are at presently being discussed with St. Georges. The NIPT Safe Test offered by St. George s is being reviewed with a target set for the end of 20 to commence trials. In May 20 GoG agreed the transfer of the 3 rd Emergency Ambulance from GFRS to the EAS / GHA and the process for the recruitment of 7 ACA s and the purchase of a new Emergency Ambulance is underway. Works also continued with the Chemotherapy Day Unit and workshops have been taking place between Xanit and GHA to discuss operational and clinical matters in preparation for the completion and opening of the new facility. The facility is expected to be commissioned and operational by October 20. The GHA also participated in a table top Major Incident Exercise on the 21 st September 20 simulating a refugee rescue at sea with possible infectious diseases and marauding firearms or terrorist attack implications. A further Disaster Victim Identification symposium hosted by National Police Coordination Centre and the Royal Gibraltar Police is scheduled for October 20. GHA and EAS staff participated in the Gold, Silver and Bronze Command posts that included strategic and tactical application. A training provider has also be secured to conduct a three day course on Strategic and Tactical Major Incident Training for the GHA Senior Management Team. This is being planned for the 3 rd quarter. The Facilities Management team continues to support the new Dementia Day Facility project requirements. 133 P a g e

134 Further developments, projects and service improvements will be considered once the Estimates submissions for -17 are approved and funding provided. 2. Facilities Management Health & Safety The Health & Safety Committee continue to carry out Risk Assessments across GHA sites and a new Health & Safety At Work policy has been drafted and presented to the Corporate Governance Group and Senior Management Team for discussion and ratification. 3. (a) Catering Services The new Catering Unit will have been in operation for one year by the end of this 2 nd Quarter. The introduction of the bulk food system and catering assistants has been welcomed by all, especially the inpatients. The quality of food has improved and compliments keep on coming in with a reduction in complaints. The Associate Director of Catering now receives more positive feedback than negative which has not been the last case in the past 11 years. The Catering Unit is working with the project team for the new Dementia Day Facility which is expected to be partly in operation in a phased manner. The facility has three floors and each floor will host a maximum of 30 out patients that will gather for lunch from Monday to Friday at Initially the Catering Unit will provide meals for phase one which is 30 patients but ultimately a maximum of 90 patients will be attained in increments of 30 patients. Meals Provided It must be noted that the catering department also offers a pantry service to some of our external departments Kosher meals are no longer payable to private service provider and they are being prepared by the Jewish home. 134 P a g e

135 There has been an increase in prison inmates and a drop in kosher requirements for such department. Feedback Once again we continue to receive positive feedback from patients, see below. Environmental As per the last report the Catering Unit continues to monitor its environmental impact and consumption of electricity, gas and fuel. A year-end report shall be submitted for the next Board Report. 3. (b) Release of Records Statistics on the number of requests received from January 20 to October 20 are as follows. Average number of requests received on a monthly basis is now around 85 per month. Release of Records Statistics 20 Month No of Requests Requests Completed Requests Active Jan Feb Mar Apr May Jun Jul Aug P a g e

136 Sep The requests are divided as follows: Requests Jan- Feb- Mar- Aprl May- Jun- Jul- Aug- Sep- Lawyers Insurance Companies DSS Private Clinic RGP Patients GHA Management Total Ambulance Services The latest issue of the Emergency Ambulance Service newsletter was published in September 20. EMT medication administration continues to be effective and safe. Nebulised salbutamol has proven essential in the alleviation of asthma attacks and COPD 136 P a g e

137 exacerbations. Aspirin and GTN spray, together with 12 lead ECG monitoring have resulted in rapid diagnosis and treatment of pre-hospital cardiac conditions. The safety profile of the six EMT mediations is further confirmed in the 2015 ERC guidelines, which permits first aiders in the UK to administer aspirin, salbutamol, glucagon and epipens in emergency situations. EMT MEDICATION ADMINISTRATION 20 salb atrovent GTN aspirin glucagon Epipen July August September TOTAL Paramedic medication administration continues to be stable with approximately patients a month receiving paramedic interventions and approx. half of those for analgesia. The range of paramedic medication ensures that there is safe and effective treatment for all significant emergencies such as prolonged seizures, bradycardia, overdoses and anaphylaxis. PARAMEDIC MEDICATION ADMINISTRATION 20 July August September Amiodarone Adrenaline IM Adrenaline IV/IO Atropine Nalaxone IM Diazepam Odansetron Glucose IV Paracetamol Morphine P a g e

138 Chlorphen Saline EMERGENCY AMBULANCE OPERATIONS Emergency Ambulance Deployments - July 20 September 20 Month Total Average per day July 485 August September 473 Main Zone Deployments Month July August September Total Gib Port North Area Eastside Area Westside Area South District Upper Town Town Area Frontier/Airport Nature Reserve P a g e

139 AMBULANCE ROUTINE TRANSFERS OPERATIONS Summary of Patient taken for Scans and or Transfers to Spain - - July 20 September 20 Destination July August September Algeciras Benalmadena (Xanit) Cadiz Gibraltar La Linea Malaga Seville Jerez Marbella Totals Summary of Local Patient Transfers - - July 20 September 20 Month Total Average per day July August September Pathology Services Dr. Duran, Consultant Hematologist was employed on a full time basis on the 9 th May 20. Dr. Duran continues to work with the Laboratory and Consultants on developing areas such as the Warfarin and Hematology Clinics, hospital bed rounds and blood bank services amongst others. The new Anticoagulation/Warfarin Clinic are being planned to commence end of P a g e

140 The recruitment process of the Pathologist Consultant continues. Screening for Sickle Cell Disease and Thalassaemia in pregnancy The Department of Pathology, in conjunction with the Obstetric Unit, has introduced a new screening programme for Sickle Cell Disease and Thalassaemia in pregnancy. The aims of this are to support people in making informed choices before conception and during pregnancy, to improve infant health through prompt identification of affected babies, to provide high quality and accessible care to our patients, and to promote greater understanding and awareness of the disorder and the value of the screening. In line with current UK guidelines for high prevalence areas, all pregnant women will be offered the tests in early pregnancy. In cases where women are identified as carriers, screening will also be offered to the father. The assessment of abnormal antenatal screening results will be undertaken by the Consultant Haematologist as a part of the role s haematology input to diagnosis and patient management. ISO Accreditation The Department of Pathology continue to work with the Innocam Group towards the ISO15189 accreditation of the Department of Pathology s Donation and Transfusion services. The drafting of the Quality Policy, Quality Manual, portfolio of services and works to the Pathology Stores were established and expect the full range of works to be completed by early 2017 when the United Kingdom Accreditation Services (UKAS) will be engaged for the ISO15189 accreditation of both Donation and Transfusion services. 6. Radiology Services During this quarter the Radiology Department commenced an evening mammography initiative in order to bring the mammography-screening programme up to date. It is envisaged that the programme shall be completed in October 20. Training and CPD Dr Rodriguez and Dr Novotny were both successfully revalidated by GMC following their appraisals in July. Dr Rodriguez attended the Royal College of Radiologists Annual Scientific meeting in September followed by a 2-day attachment at St Georges Neuroradiology department. Dr Novotny is due to attend an MSK Radiology Erasmus course next week. 140 P a g e

141 7. Sponsored Patients Services The refurbishment and expansion of the Sponsored Patients Department has commenced with design proposals and estimates being carried out. It is intended to complete this project by end of 20. This quarter the Sponsored Patients team has also been involved in the review of tertiary referrals and service arrangements in UK and Spain. SUMMARY OF FIGURES FOR THE PERIOD 1 ST JULY th SEPTEMBER 20 October to December 20 Introduction This board report covers the 4 th Quarter period of the 20 from October to December 20 and the 3 rd Quarter of the Financial Years During this quarter there have been major changes in the in the Ministerial and Executive Leadership within the Gibraltar Health Authority. The 141 P a g e

142 announcement by Government of a ministerial reshuffle during October 20 saw the welcome of the Hon Neil Costa as the new Minister for Health, Care and Justice and the departure of the Hon Dr John Cortes to another portfolio. The Chief Executive, Mr. Freddie Pitto, after 34 years of service and 3 1/2 years as CEO also announced his retirement during November 20. However, the GHA continued its day to day operations and between October and December 20 the Estimates Submission for were completed and new initiatives were introduced. A new Patient Advocacy and Liaison Service ( PALS ) was launched on the 30 th November 20. Located within St. Bernard s Hospital the staff at PALS will act as intermediaries to hospital and clinical staff in order to assist patients and their families. PALS will ensure a swift turnaround of meeting requests and the resolution of queries and problems from patients and their families in a timely manner. PALS will also provide advice, support and information to patients, service users and the general public to ensure optimum delivery of health care and services. The new Ayling-Buttigieg Chemotherapy Day Unit became fully operational during October 20. Patients presenting with solid malignant tumours no longer need to travel to another country such as Spain or the UK in order to receive their Chemotherapy treatment. This removes the stress of travel and dependence on others for transport. The new Unit also means local, in-house support for cancer patients and family members. The added benefit to having an in house Chemotherapy Unit means that weekly Oncology Multi-Disciplinary Team meetings will take place at St Bernard s Hospital. Therefore, Radiology, Pathology, Oncology, Medical & Surgical Consultants and specialist nurses will discuss patients together and make holistic recommendations on treatment pathways collectively improving the communication between professionals and the patients themselves. Due to the high bed occupancy levels and winter surge pressures during December 20 it was decided to convert the Rehabilitation Gym into a 7 bed elderly care ward. The design and refurbishment works was conducted by a multi-disciplinary in house team and completed within two weeks. The Facilities Management team continues to support the new Dementia Day Facility project requirements. Further developments, projects and service improvements will be considered once the Estimates submissions for -17 are approved and funding provided. Facilities Management Fire Prevention GHA Senior Management continues to review and improved the general management of Fire & Emergency Evacuation. 142 P a g e

143 The commissioning of the Fire Safety Management Plan was completed in September 20 for final review and implementation by the Fire Safety Group before end of 20. Health & Safety The Health & Safety Committee continue to carry out Risk Assessments across GHA sites and a new Health & Safety At Work policy has been drafted and presented to the Corporate Governance Group and Senior Management Team for discussion and ratification. Medical Health Record Library Filetrail has now been implemented and commissioned for all external users i.e. Ward/Clinic clerks and all patient notes are being tracked on the new system. This tracking and paper management system will also be introduced in Mental Health. We are still faced with challenges and difficulties, as this is a manual system. Notwithstanding, the difficulties due to manning levels and increase in clinic activity, the Medical Records output performance for outpatient consultations continues to be maintained in the high 90% success rates. This can be seen on the graphs from our internal audits. Table 1 Records Performance To Date Jan- Feb- Mar- Apr- May- Jun- Jul- Records Requested Records Sent Records Missing Performance % Loss P a g e

144 The figures and performance outlined in Table 1 can be contrasted with the output achieved in terms of the volume of requests and the actual number of Records delivered within the given period in Table. Table 2. RR v RS Performance To Date Security Door Access System The commissioning and implementation of the new door access system is still on going and the Facilities Management team shall be organizing the distribution of the new ID/Access cards by end of 20. The works to replace the old card readers shall take place once the cards have been issued. Jan- Feb- Mar- Apr- May- Jun- Jul-1 Records Requested Records Sent Reception / Call Centre As per my previous report the Call/Centre staff continue to report on daily cardiac arrests call-out. Weekly reports on the response rates are submitted to the Clinical Director Anaesthesia, Intensive Care and to the Deputy Director of Corporate Services. All staff have been trained on EMIS WEB the new electronic patient record system introduced in PCC. This system is now being used to schedule outpatient appointments at the PCC. Call Centre staff assist with appointment booking at peak hours. Release of Records Statistics on the number of requests received from January 20 to December 20 are as follows. Average number of requests received on a monthly basis has increased to 87 per month. 144 P a g e

145 Requests Jan- Feb- Mar- Aprl May- Lawyers Insurance Companies DSS Private Clinic RGP Patients GHA Management Total Jun- Jul- Aug- Sep- Oct- Nov- Dec- The requests are divided as follows: Month No of Requests Requests Completed Requests Active Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Patient Advisory & Liaison Service The service was created late October 20 and is run by the Records Manager. Currently there is a receptionist who has been deployed to the department to assist the Manager in all cases received. Statistics on the number of requests received from January 20 to December 20 are as follows. Month No of Requests Requests Completed Requests Active Nov Dec of the 114 cases were received via the Ministry for Heath. Catering Services New initiatives undertaken by the Catering Services Unit during this quarter include the provision of meals or light snacks for patients undergoing Chemotherapy Treatment in the new Chemotherapy Unit and the planning for the provision of meals to the Dementia Day Centre 145 P a g e

146 The DDC is expected to be partly in operation as from early January 2017 on a phased manner. The facility has three floors and each floor will host a maximum of 30 out patients that will gather for lunch from Monday to Friday at Initially we will only have phase one which is 30 patients but ultimately a maximum of 90 patients will be attained in increments of 30 patients.a maximum of 90 patients will be attained in increments of 30 patients. The catering unit is also providing the meals for the new 7 bed unit in St. Bernard s Hospital. Meals Provided during October and December 20 Minor Works A total of 387 works requisitions excluding those arising from department/ward inspections have been received this period, 1 st January 20 to 31 st December 20. This figure is not very realistic as the new reporting system; (ticketing system) is not being used yet adequately by users, which at present is to a degree acceptable as it is a new system. This has increased the amount of work defects found in the ward rounds. Add to the above figure for this last quarter has risen to 38 requisitions/defects per month, previously the average was 28 requisitions/defects per month therefore having an increase of approximately 10% as a result of investigations on clinical areas at SBH. A further 40 to 50 defects/repairs per month on average arise from the TMV maintenance regime. Again this figure has risen considerably as a direct result of the non-use of the hot water pumping system as inverters have to be installed to balance the system. Currently the renewal of the hot water supply pumps by the mechanical section has commenced as presently the system is not balanced, therefore the additional works resulting from the TMV s inspection were daily, minor adjustment of temperature is required. Shower flexi and heads together with the inspection of all ward gullies continue to be done as part of the maintenance regime. Works to reinforce all pertinent doors edging by contractors is on-going to be completed early next year. Liaising with the main contractor for the A/E 146 P a g e

147 extension works is still on-going. New works at Maternity are also in progress together with all ward maintenance/refurbishments. John Ward, Captain Murchison, together with other common areas have been inspected and completed during this period. Again as previously stated, the non-reporting of defects and misuse of facilities continues to produce a high amount of defects within wards. 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 has been 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 were completed in 4 days and the ward is now in full use. Major problems of water ingress have again affected areas throughout St Bernard s and the PPC. The PCC was worse affected were historic lack of maintenance by the building owner s has seen the Dental department having to close together with GP clinical areas. The increase in defects arising from shut downs affecting both the potable and brackish water supply continue, although the new approach of shutdowns is proofing effective, and these defects have been halved. The ironmongery schedule has been completed and sent to UK as continued maintenance of many existing items/articles is required. Ambulance Services Rocky Pigeon Exercise The ambulance service participated in the live Rocky Pigeon Exercise and was commended for its professional and competent clinical management as well as efficient communication. Designing of the Emergency Medical Responder The Ambulance Service by means of its Resilience & Special Operations Officer has designed a training package for members of the Blue Light agencies. EMERGENCY AMBULANCE OPERATIONS: Emergency Ambulance Deployments - Oct 20 Dec 20 Month Total Average per day Oct P a g e

148 Nov Dec Main Zone Deployments Month Oct Nov Dec Total Gib Port North Area Eastside Area Westside Area South District Upper Town Town Area Frontier/Airport Nature Reserve AMBULANCE ROUTINE TRANSFERS OPERATIONS Summary of Patient taken for Scans and or Transfers to Spain - Oct 20 Dec 20 Destination Oct Nov Dec Algeciras Benalmadena (Xanit) Cadiz Gibraltar La Linea Malaga Seville Jerez Marbella Totals P a g e

149 Summary of Local Patient Transfers - - July 20 September 20 Month Total Average per day Oct Nov Dec Pathology Services Immunohistochemistry service The Department of Pathology is studying the efficacy of introducing an inhouse immunohistochemistry service. The technique works by identifying molecules which are too small to be seen down a microscope under normal circumstances. Different types of cancer have their own unique fingerprint of these molecules. This allows the comparison of patient s samples to see if they fit the known pattern of particular subsets of cancer or other diseases. Wide research into patients with particular types of these molecular patterns shows they respond well to certain drugs or treatments. This aids the design of specific courses of treatment to individual patients identifying exactly what drugs they will and won t respond to, helping patient care and management and reducing costs on expensive and unnecessary treatments. ISO Accreditation The Department of Pathology continues to work with the Innocam Group towards the ISO15189 accreditation of the Department of Pathology s Donation and Transfusion services. The drafting of the Quality Policy, Quality Manual, portfolio of services and works to the Pathology Stores were established and expect the full range of works to be completed by early 2017 when the United Kingdom Accreditation Services (UKAS) will be engaged for the ISO15189 accreditation of both Donation and Transfusion services. Anti-Coagulation Clinic The new Anti-Coagulation (Warfarin) clinic started on the 18 th of October 20 as a one-stop clinic. The clinic led by resident Consultant Hematologist, Dr Durna, runs from Monday to Friday from 9.00am to 11.00am. Ten patients seen every hour approximately. During the first few weeks of operation approximately 90% of patients were seen in this way and development and reviews will be conducted to continue and adapt the service. 149 P a g e

150 Radiology Services Training and CPD Dr Novotny: Attended: Musculoskeletal MRI Comprehensive course, Heraklion, Greece 26-30/09/ Dr Zagurova: Attended - 7th to 9th November 20 - the Annual Scientific Meeting of the British Society of Breast Radiology, in Manchester, UK. Sponsored Patients Services The Sponsored Patients Department activity continues to grow based on the demand for tertiary services. There have been no significant changes to the provision of services, staff complement or changes to operational procedures. The refurbishment and expansion of the Sponsored Patients Department has commenced with design proposals and estimates being carried out. It is intended to complete this project in the next financial year. 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 Medical Directorate team. The Sponsored Patients team will be liaising with the Calpe House Trust to look at improving the administration and liaison services provided to patients that will be staying at new Calpe House Accommodation. 1 st October ST December 20 Spain Referrals 925 Spain Patients 435 UK Referrals 486 UK Patients 371 Flights 1759 Spanish Ambulance (Flying Drs) 23 Air Ambulance (Atlas Jets) 4 Holiday Dialysis 0 GHA Ambulance Request 199 UK Taxi Requests 696 Tourists Insurance Spain 0 ( UKRA 7) Visa Applications 8 Retrospective Sponsorships 0 Translations (Link Europe) 93 Assessments Average 3-4 per day January to March 2017 Introduction This board report covers the 1 st Quarter period of the 2017 from January to March 2017 and the 4th Quarter of the Financial Years P a g e

151 St. Bernard s Hospital coped significantly well with the unprecedented high levels of admissions over the December period reacting positively with an active bed management and implementing measures in unison with our partners from the Care Agency. The most significant event this quarter was the official opening of the Bella Vista Dementia Day Centre that opened its doors to patients on Monday th January 20. This is once again a testament of the GHA professionals who have been working collaboratively over the past years to create an environment that is fit for purpose for one of the most vulnerable demographic patient groups in our community. During the first week of February 2017, the GHA Senior Management team attended a 3 day Course on Major Incident Management. The Strategic and Tactical Command course was delivered at St. Bernard s Hospital by Mr Robert Flute and Dr Dave Sloggett who are both experts in the field of major incidents management. The aims and objectives were to understand the principles and practices required during a significant / major incident and to ensure the GHA incident management team provides skills conducive with the provision of operational resources, appropriate communications and management support of any given incident. The course also touched upon the current GIBMED and hospital response MAJAX plans. The GHA was once again present at the bi-annual Careers Fairs 2017 with the stand attracting a lot of interest from students wishing to learn more about the career opportunities available within health care and the GHA. The GHA shall continue to participate and support this event in the future. The GHA in conjunction with the Ministry of Health and the Department of Education launched a school competition to design the new logo for the GHA. The closing date of entries is the 21 st April We look forward to viewing all entries. Work continues in developing a new re-designed GHA website to be launched during the 2 nd Quarter of 2017 which will include a fresh design and navigation structure and a content management system. Further developments, projects and service improvements will be considered once the Estimates submissions for are approved and funding provided. 151 P a g e

152 Facilities Management Fire Prevention GHA Senior Management continues to review and improved the general management of Fire & Emergency Evacuation. The commissioning of the Fire Safety Management Plan has been completed and expected to be published during the 2 nd Quarter of Medical Health Record Library Filetrail has now been implemented and commissioned for all external users i.e. Ward/Clinic clerks and all patient notes are being tracked on the new system. This tracking and paper management system will also be introduced in Mental Health. We are still faced with challenges and difficulties as this is a manual system and fully Notwithstanding the difficulties due to manning levels and increase in clinic activity, the Medical Records output performance for outpatient consultations continues to be maintained in the high 90% success rates. This can be seen on the graphs from our internal audits. Patient Advisory & Liaison Service The service was created late October 20 and is run by the Records Manager. Currently there is a receptionist who has been deployed to the department to assist the Manager in all cases received. Catering Services Below are some of the initiatives that have been implemented during this quarter or shall commence shortly. 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 wards. We are considering offering sandwhiches or light snacks 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. This is still to be reviewed before a decision is taken. 152 P a g e

153 The evolution of the menu continues with all feedback being used to adapt the menu, for example, the least liked items will be removed and new items added. Exploratory discussions have begun with the hospital dieticians to evaluate if patients could choose menu choice in advance, it is complex challenge but we are optimistic that it can be attainable. At the end of the financial year -17 our provisions budget has seen a substantial reduction in expenditure. This is a result of tighter controls and better supervision thanks to the professionalism of the senior cooks. It is equally important to acknowledge that waste has been reduced and bulk food service has lower usages than the previous plated system. Meals Provided during January and March 2017 Ambulance Services Significant progress in the development of a future operational restructure plan was achieved by the Ambulance Restructure Working Group. Solutions for present shortcomings and measures to improve the day to day business of the service were discussed and a final draft of the plan has been produced and submitted to Senior Management for consideration. The working group is composed of a cross section of the service, including: Ambulance Management Emergency Ambulance Service Patient Transport Service Unite the Union representatives 153 P a g e

154 Government Agencies Training The GHA Ambulance Service continues to develop strong links with different Government Agencies. As a result Immersion and Emergency Responder Courses were delivered by our instructors to the following agencies: Gibraltar Fire and Rescue Service Airport Fire and Rescue Service HM Customs Port Authority Emergency Ambulance Deployments - Jan 2017 Mar 2017 Month Total Average per day Jan Feb Mar 486 Main Zone Deployments Month Jan Feb Mar Total Gib Port North Area Eastside Area Westside Area South District Upper Town Town Area Frontier/Airport Nature Reserve P a g e

155 Gib Dock Maritime AMBULANCE ROUTINE TRANSFERS OPERATIONS Summary of Patient taken for Scans and or Transfers to Spain - January 2017 March 2017 Destination Jan Feb Mar Algeciras Benalmadena (Xanit) Cadiz Gibraltar La Linea Malaga Seville Jerez Marbella Totals Summary of Local Patient Transfers - January 2017 March 2017 Month Total Average per day Jan Feb Mar P a g e

156 Pathology Services The Department of Pathology upgraded its Blood Gas Analyzers, as a part of planned renewal of equipment to ensure safe, robust and sustainable service provision in this important area of healthcare is continued. Blood gas analysis is crucial and central to the management of patients, particularly those that are on ventilators in a Critical Care setting. The analyzers are top of the range Radiometer machines and refresher training for all users has been scheduled. Sponsored Patients Services This quarter the Sponsored Patients team has been involved in the review of tertiary referrals and service arrangements in UK and Spain together with Medical Directorate team and a new referral software application developed by the IMT Dept is to be implemented in April P a g e

157 1 ST January th March 2017 Respectfully submitted, Darion Figueredo UGM Hospital Services 157 P a g e

158 July to September 20 Optometry Department 5.8 UGM Primary Care Services Incoming Referrals originating from outside the Ophthalmic Unit Referral Category July August September Total OCT Urgent - direct optom referral Child refraction Adult refraction Adult out patient Diabetic Retinopathy 92 Screening Glaucoma Screening Low vision Medical Contact lenses External eye Total Caseload Clinic Total consultations DNAs %DNA this Qtr Child Refraction 9 0 0% Adult Refraction % Joint Child Clinic with Orthoptist % Adult out patient % External eye % Post op Refractions % Diabetic Retinopathy Screening % Diabetic Retinopathy 0 0% 9 Management Glaucoma Screening % Glaucoma/OHT Management % Low Vision Refraction % Low Vision Aid assessment % Clinically required Contact lens 6 12% 49 appts Spectacle Rechecks 2 0 0% Total % New Developments No new developments to services this quarter. 158 P a g e

159 A peer review with local opticians was conducted to facilitate CPD points for registration for all optometrists in Gibraltar. This was on the new developments on myopia progression. Low vision Services This quarter, there has been 4 new CVI registrations. 2 as Severely Sight Impaired (SSI) and 2 as Sight Impaired (SI). Cause of Visual Impairment July - Sept 20 SI SSI Total ARMD dry and wet 2 2 Macular hole and ret detachment 1 1 ARMD and Glaucoma 1 1 Total Low Vision Statistics July - Sept 20 Low vision aids items loaned 37 patients loaned LVAs 24 LVAs returned 2 Unserviceable LVAs 1 Referral to ROVI 6 Px declined ROVI referrals 4 CVI Registration 3 Px declined CVI 2 registrations Medical Contact Lens Service- need to add IC patients for the quarter New CL cases Apr June 20 New This Qtr Total Cases Referred to MEH or Xanit this Qtr For CL fit For treatment/ Both consultation Keratoconus Pellucid Marginal Degeneration Post Surgery ectasia Anisometropia High ametropia Cosmetic/ prosthetic Corneal dystrophy/decompensation Post surgical complication Total MEH = Moorfields Eye Hospital who see complex cases required advanced contact lens fitting 159 P a g e

160 Patient Appliance Policy - Optical During this quarter there have been 2 early applications for assistance with the cost of spectacles. GHA funding of spectacles due to exceptional circumstances Cause :- July - Sept 20 Prescriber error - Intolerance - Surgical Intervention - Ocular/ Systemic Disease 2 Loss due to disability Child - Loss due to disability Adult - Total 2 Complaints No official complaints have been received or clinical incident reports filed this quarter. Dietetics HCPC Audit Two members of staff were selected for HCPC audit in April 20 (Katrina Skilton and Charles Russo). They submitted their CPD portfolio as requested before the end of June. By September both had been informed that they had passed. Congratulations to both dieticians. They have subsequently presented a CPD session to the department on the above. EMIS The department is now using EMIS for all outpatient clinic consultations, home visits and other outpatient contacts. Inpatient contacts are still on departmental record cards but a summary on discharge is included in EMIS. EMIS has significantly improved record keeping, access to patient records and reduced the use of paper within the department. It has been welcomed by all. October to December 20 This period saw the change of minister and therefore represented a big change for all departments in the Primary care Directorate. Though looking forward to working with the new minister with inevitably a new direction and priorities, I would like on behalf of the PCC team, to thank the old minister for his positive investment in primary care and the continuous positive regard expressed towards all our professional and clerical staff. 0 P a g e

161 BOARDS IN WAITING AREA We continue to use the white boards in the main waiting area to provide information regarding the Doctor s Clinics. The first board has the following information: Doctors with On the Day Clinic Doctor on first emergency Doctors on site Doctors not available The second board is used for the 48hr Advance Appointment System and displays the list of doctors available for booking that day. The Third Board shows details of all The Walk In Clinics to make users aware of when their particular GP is available. The boards continue to be updated daily, so that the information is available to the public when the PCC opens in morning. These boards together with the plasma screen provide the Public with information that they would otherwise have to go to the Main Counter to ask. WORKS AT MAIN COUNTER On 19 th December 20 the works started at the Main Counter to build the screen to enclose the area. These works were carried out over a period of three weeks during which time a temporary counter was set up in the Main Waiting Area to provide the service that is usually provided at the Main Counter. The main counter has improved the service we provide to service users by ensuring a better demarcation of the different receptionist positions and therefore more privacy. DATA PROTECTION All new clerks commencing at the PCC are briefed on the Data Protection Policy and are given a copy of the document to read and sign. We continue to work to improve on this vital aspect. WEEDING EXERCISE An exercise was carried out over the month of October to weed the files and file the notes that are already on EMIS under a separate section. This has helped the clerks find the notes and be able to pull the notes required for clinics quicker, as over time many of these notes had been misfiled. 1 P a g e

162 ACHIEVEMENTS GHA Board report July 20 to March 2017 Some of the clerks have been trained to be able to cover the different sections within the PCC. This means that the clerks will cover those posts during periods of Annual and Sick Leave, which is especially important in the Departments who only have one clerk. The staff have been working towards reducing the backlog of scanning and Doctor s filing. CLINICS IN GENERAL & APPOINTMENTS The General Practitioners complement currently stands at 22.5 GP s with 2 of them on a part time basis, Dr Vassallo and Dr Robles. The GP s are still divided into three groups of 6/7 Practitioners each. Each group of GPs are working towards developing their own policies with regards to the following:- Further Improved patient access to doctors and nurses Increase in GP Training and Courses Better communication with hospital and other services Standardisation of treatments A more Improved repeat prescription system which will be implemented shortly Enhanced and new nurse roles Quality, Improvement and Increase of Appointments Discussions are in place to recruit more GP s and this will also soon be confirmed It is envisaged that this will further improve access to a GP or Nurse of choice. As is our aim, it is expected that structured standardisation of practice will lead to more efficient and more effective management of long term diseases like diabetes, Heart Diseases, asthma etc. As we informed you in our previous Board Report following our move to the EPR Programme, changes were required to be made to include catch-up slot for all clinicians clinic sessions. This consisted of a pattern of 3 patients + 1 patient admin slot and they still continue to be in place and being used as both catch-up or to call patients with their results, advice etc. The changes we made last time where we changed some of the emergency overflow appointments to Advance Slots did increase availability of slots for our users. We changed the Critical Illness Slot which had been added to the end of each clinic to three slots at the end of the Second Emergency Clinic only. It benefits those patients who are deemed to be critically ill and are seen promptly by a GP on site at that particular time. 2 P a g e

163 The Introduction of the ON THE DAY CLINICS proved to be quite a successful initiative. This consists of a full clinic made available for one doctor per area on a daily basis which is automatically released daily at 8.15am. As can be appreciated, this facilitates patients who have been unable to book with their GP of choice and find that on a particular day each week they have an on the day clinic with no pre-booked appointments. We continue to provide this information in advance for our users to be aware of when their GP of choice has a walk in clinic. We increased the Dermatology Clinics undertaken by our on-site GP specialising in Dermatology. These sessions previously consisted of 4 monthly sessions and has been changed this year to 7 sessions per month. In this increase of sessions we have added the following:- Dermoscopy Minor ops Review pre-derm Patients New Chronic Disease Any New skin ailment Regardless of these successful improvements, further initiatives are continuously being discussed by the Management Team to improve the Primary Care Centre as although there has been a marked improvement in access as a result of all these measures, we are still not completely satisfied and feel there is still more room to improve our services. ACHIEVEMENTS Our 48-hour Advanced Appointments System has been working satisfactorily with a decrease in patients complaints. As I mentioned in the previous Board report, on average we are pleased to say that we are releasing a staggering 100+ Advance Appointments daily for our patients which gives us great satisfaction. Dental Department The department continues to operate at near full capacity both at PCC and SBH, with visits to St Martin s School, Dr Giraldi Home and the prison. Appointments DNA October to December % 2015 October to December % 20 Cancellation of clinics still occurring due lack of nursing, however has decreased significantly since access to bank cover in June 20 3 P a g e

164 Number of cancelled Year appointments due to lack of nursing cover In December 20, the Dental Department suffered water ingress with the loss of, initially, all 5 clinics. Hundreds of patients had to be cancelled and clinics in the private sector, SBH and prison had to be utilised. This had a significant detrimental impact on the availability of appointments on an already overburdened department. The on-call dentist now works with a dental nurse at weekends and bank holidays on the emergency dental clinics. This brings the GHA into line with UK standards, and was put in place by the Medical Director and Director of Nursing Services. Waiting lists The orthodontic waiting list continues to rise and currently there are approximately 400 waiting with longest waiting since 04/01/2010. The time to next appointment for orthodontics is 12 weeks. The time to next appointment for children s dentistry is up to 26 weeks away. More resources have been requested in the budget for the next financial year. The welfare/exempt/dms waiting list has 86 people waiting, with the longest wait from 05/05/2015. The denture waiting list has 38 people waiting, with the longest wait from 28/10/2015. There has been no additional resources allocated to the dental department, however more are eligible every year to services and hence waiting times and waiting lists can only increase, affecting the standard of care that can be provided. Monthly department meetings are held to ensure the smoother running of the department. The health promotion programme Day at the Dentist continues to be a success in terms of ensuring all year 1 pupils are invited to the clinic with their peers (improved access). 4 P a g e

165 Optometry Department Incoming Referrals originating from outside the Ophthalmic Unit Referral Category October November December Total OCT Urgent - direct optom referral Child refraction Adult refraction Adult out patient Diabetic Retinopathy Screening Glaucoma Screening Low vision Medical Contact lenses External eye Total Caseload Clinic Total consultations DNAs %DNA this Qtr Child Refraction % Adult Refraction % Joint Child Clinic with Orthoptist % Adult out patient % External eye % Post op Refractions % Diabetic Retinopathy Screening % Diabetic Retinopathy 0 0% 7 Management Glaucoma Screening % Glaucoma/OHT Management % Low Vision Refraction % Low Vision Aid assessment % Clinically required Contact lens 3 7% 39 appts Spectacle Rechecks 2 0 0% Total % Next available appointment stands at:- Adult out patient service = 2 mths, Refraction = 3 mths, DR Screening = 5 months Joint Orthoptist/Optometrist child clinics = 1 month Post surgery slots = 2 weeks wait at most (these slots are blocked since they require to be seen at the 6 week post op period. Any unused appointments due to cancelled surgeries are released nearer the time to be used for urgent/priority referrals for all services, so no appointments are wasted). 5 P a g e

166 New Developments DR Screening 20 Audit The annual Diabetes screening service statistics continues to show the need for more resources to be able to cater for 100% of the Diabetic population, which stands at The Optometry dept performs this screening function, alongside all standard and specialized optometric services. Our statistics also shows the need to tackle the high rate of non attendance, as this represents a significant waste of appointments, for a service in very high demand. Review appointments are given at consultation, the dept continues to raise the need to introduce an appointment reminder service with senior management. Clinic type Tot Seen Dna Tot appts. offered DNA % DR SC % DR management % Volk % T1 children % Gestational DM % TOTALs % DR Screening Results No retinopathy 80% Mild non sight threatening 15% Pre-proliferative retinopathy 0% Proliferative retinopathy 0.1% Maculopathy with non proliferative 5% DR Year PRP Focal or Grid Total The Audit shows that Pan Retinal Photocoagulation laser treatment for Diabetic Retinopathy is at an all time low which demonstrates the benefit of having a screening programme for this condition. 6 P a g e

167 The Optometry dept continues to pursue funding to take part in an international quality assurance program for DR grading. It also continues to pursue with senior management, a new service delivery model to enable population based, instead of referral based screening, as well as to gain the necessary administrative and IT support structure required of screening programs, to be able to meet the standards of UK models of screening. Training Dr Pachkoria the new consultant Ophthalmologist taking over from Dr Haroon who retired in December, provided CPD on Diabetic Retinopathy for the dept as well as the local high street Optometrists. It gave Dr Pachkoria an opportunity to meet everyone and maintain the current strong relationship with the Optometrists in the community. Low vision Services This quarter, there has been 9 new CVI registrations. 4 as Severely Sight Impaired (SSI) and 5 as Sight Impaired (SI). Cause of Visual Impairment Oct - Dec 20 SI SSI Total ARMD dry and wet Macular hole and ret detachment Diabetic Retinopathy Myopic Degeneration Stargarts Neurological ARMD and Glaucoma Total Low Vision Statistics Oct - Dec 20 Low vision aids items loaned 28 patients loaned LVAs 19 LVAs returned 4 Unserviceable LVAs 0 Referral to ROVI 7 Px declined ROVI referrals 8 CVI Registration 9 Px declined CVI 0 registrations Medical Contact Lens Service- New CL cases Oct Dec 20 New This Qtr Total Cases Referred to MEH or Xanit this Qtr For CL fit For treatment/ Both 7 P a g e

168 consultation Keratoconus Pellucid Marginal Degeneration Post Surgery ectasia Anisometropia High ametropia Cosmetic/ prosthetic Corneal dystrophy/decompensation Post surgical complication Total MEH = Moorfields Eye Hospital who see complex cases required advanced contact lens fitting Patient Appliance Policy - Optical During this quarter there have been 2 early applications for assistance with the cost of spectacles. GHA funding of spectacles due to exceptional circumstances Cause :- Oct - Dec 20 Prescriber error - Intolerance - Surgical Intervention - Ocular/ Systemic Disease 1 Loss due to disability Child - Loss vulnerable child (Care 1 Agency) Loss due to disability Adult 1 Total 3 Complaints No official complaints have been received or clinical incident reports filed this quarter. Speech and Language therapy For the period comprising October 20 December 20 Staffing During this period the SLT Service Map is illustrated as follows: 8 P a g e

169 SLT provision to the ERS remains on an emergency dysphagia cover only. All urgent referrals are seen within an outpatient clinic unless admission to SBH is indicated in cases of significant poor health. Training During this period this service has benefitted from the following training opportunities: Senior II Paediatric Mainstream therapist attended a Paediatric Feeding Conference in UCL, London. Acting Head attended the International Autism Conference in Edinburgh, at the honourable Minister s request. Acting Head attended an In-service day at St Martin s school, organised by the Gibraltar Retts charity who had invited a world renowned Retts expert to deliver training on the use of TOBII eye communication technology. During this period this service has also delivered a further 4-session Makaton Beginners course to parents, professionals and carers. Service Initiatives A representative from this department continues to form part of the multi-agency Autism Strategy Group, this group reconvened at a second meeting in November 20, at the Department of Equality at Minister Sacramento s request. The Feeding Clinic protocols have been revisited and as a result of SLT attendance at the Paediatric Feeding Conference; Occupational Therapists have been invited to join SLT s and Dieticians and be in attendance at this clinic 1 x monthly. 9 P a g e

170 During this period the Multi-Agency Autism Pathway (MAAP) meetings became formalised. These developed from the original GHA autism pathway meetings and have been extended to encompass patient allocation, diagnosis and team discussion. These meetings occur the first Wednesday of every month, with representatives from all Paediatric therapy departments. Occupational Therapy SBH IN-PATIENTS SERVICE: In Patient OT Referrals: July to Sept 20 Sept to Dec a. OT Stores: There has been a huge change within the OT Stores service as a full time store supervisor was allocated to the OT dept at the end of Oct. The stores deliveries, collections and general management are now being incorporated into the storeman s timetable, with support from the SBH OT team. Training has been given and new procedures are being written up for requisitions and stock taking. OT is looking forward to the further development of this service over the next few months. OT Labourer Number of collections/deliveries + joint visits: 3rd November 20 to the 1st December 20 Deliveries/Joint Visits 24 collections 8 Rapid Response 6 fill up van 2 total 40 1st December 20 to the 20 Deliveries/Joint Visits 38 collections 15 Rapid Response 4 fill up van 2 total 59 *These figures do not include cleaning and store time 170 P a g e

171 1b. Hand Therapy: The OT / Hand Therapist post has had to be covered by the Locum SBH Sen I OT therefore, the service provided has had to be limited over this period of time as the Locum is not able to see the more complex cases. Referrals are being triaged and allocated where possible to the Locum. Close liaison with Physio and consultants aware of the temporary change in service. COMMUNITY OT SERVICE: Waiting times for Community OT Routine Referrals have increased as follows: September 20 7 months October 20 7 months, 21 days November 20 8 months, 20 days December 20 9 months, 21 days 2a. Community OT Palliative Care: The part-time OT with a special interest in Palliative Care continues to take the appropriate referrals from Community OT, attending the monthly Palliative Care meetings and in regular contact / visits with the CRC. 2c. Community OT / Rehabilitation for the Visually Impaired: At the end of Dec there were 19 referrals pending to be seen and 3 of those with complex needs and high priority. MENTAL HEALTH SERVICE: An average of 13 patient contacts have been seen daily. This has decreased from the beginning of the year - Jan/Feb/March = 18 per day and April/May/June = patient contacts per day. PAEDIATRIC SERVICE: The Sen II OT has started her last level of Sensory Integration training which once finished in the next next year will mean she will be able to assess and treat children with complex sensory problems using these evidence based and specialist techniques. Currently the service is under an internal review to ensure that we are providing the most effective service we can for the children referred, within the 171 P a g e

172 resources we have. With an overall aim for the future to concentrate the service within the home environment, supporting parents and within the special schools and on more of a consultancy basis within mainstream schools, in line with best practice / other GHA therapy services. Orthoptics: 1 st October 31 st December 20 Recent developments: Staff complement: No change. General service: Main Clinics running as usual. Urgent referrals are still fitted in as extras according to the nature and urgency of referral (triaged by Head Orthoptist). Waiting times for routine (non-urgent) reviews are currently 2.5 weeks for joint paediatric clinic with Optometrist, 4 weeks for a routine non-urgent school vision screening appointment and 8 weeks for an Orthoptic appointment. The longest wait is still for a routine visual field which has now increased up to 15 weeks. There has been a recent increase in urgent requests for visual fields of late, resulting in clinics being booked up this is due to the recent introduction of 2 new Consultant Ophthalmologists. Patient Satisfaction: Patient survey (continued from September) showed that patient satisfaction with their clinician and care received was still very high but that there remained a common dissatisfaction with the clerical and admin support (or lack of) in reception. Namely the telephone being unanswered and reception unmanned. The situation is currently being reviewed by management and extra clerical support has been requested to support the expanding range of services offered in the Ophthalmic Department. PHYSIOTHERAPY 1. Waiting lists: mid-september data a) Community Adult Rehab: Staffing levels: 3 physios and p/t assistant/ti. Routine waiting list is 11 months. Technical Instructor has enabled 1 st contact for low risk patients. b) MSK: Staffing levels: 4 physios and full time Technical Instructor/Assistant. Waiting time, currently 425 persons waiting for 17/52 since 3 rd October Training: 2 day paeds conference Birth to transition November 20 1 day Paediatric Manual Handling Training for physiotherapists and Assistants. Feb P a g e

173 Physiotherapy, Orthopaedic Nursing and GP training in Orthotics and Insole pathways Feb Advanced Physiotherapy Practitioner AAP Spinal Assessment Clinic Commissioning guidelines point to the need for a revised Spinal Assessment Clinic. This will give patients with a spinal diagnosis access to the right professional at the right time under a new approach to improve the patients experience, journey and outcome. This would be led by an AAP under agreement with all stakeholders. Awaiting approval by key clinicians. 4. Service Level Agreement with St Georges/Opcare Service. Final approved document awaited especially in light of legislation affecting supervised prosthetic arrangements. We will continue to audit this service which is coming up to a year in June. There has been significant improvement in terms of assessment and orthotic delivery. 5. Clinical Pathways: there are a number of clinical pathways under review; Spinal, Lycra garments, Foot Clinic, Falls management, Pressure management and Cardiac Rehab involving Physiotherapists and other members of the MDT. 6. Bed management: working with MDT to address in-patients bed situation; to include Care Packages, Early Supported Discharge and Rapid Response Teams, to prevent admission to hospital. This is work that brings added value to patients care, significant cost savings to the GHA and facilitates team working across Agencies in Health and Social Care. 7. GHA Adult Safeguarding: There have been 17 cases identified in 20 either on patient admission, by staff in the community or on the wards. 8. AHP/Physio: involved in initiative to reduce overall GHA budget through analysis of patients referred to tertiary centres. Cost savings have been made. Dementia Day Care Unit This service is now ready to be opened and plans to recruit / induct staff for this very necessary service were sprang into action during this quarter. The service was being utilised to house the memory clinic during the previous quarter, however this small opening had only involved the outpatient clinic part of the facility (top floor). The next quarter will see the first report with the service having been fully open. 173 P a g e

174 January to March WORKS AT MAIN COUNTER The works at the Main Counter were completed at the start of the year. This now means counters are better organised with clearer signage and better patient flow. The counters currently include a repeat prescription counter and a counter for the self-employed to discuss entitlement issues. 2. REGISTRATION CLERK AT MAIN COUNTER Once the works at the Main Counter were completed, one of the windows at the Main Counter was allocated for the Registration Department. This counter deals with self-employed individuals and to help those who need guidance on their entitlement issues. 3. LAST PRESCRIPTION COUNTER A new service was introduced on 6 th February 2017 which allows patients to obtain their repeat prescriptions without necessarily having to see a GP. The patient requests the prescription at Counter No 5 and is asked to return within two to three working days. The request is then passed on to the doctor who either issues the prescription or asks that the patient be given an appointment for the GP or a blood test or both. When the patient returns to the counter they are either given the prescriptions or the relevant appointments. This system has meant that we have less demand for Last Prescription Appointments and saves on average 297 appointments per month. 4. MEDICAL CERTIFICATES PHONE LINE A service where patients can call to obtain a Medical Certificate without seeing the doctor was implemented on 6 March The phone line is manned by the Nursing Staff who are able to sign the sick notes. A maximum of 2 days sickness certification is given and no more often than once every 3 months. This service is saving approximately 180 GP appointments per month. 5. DIGITALISING OF PATIENTS RECORDS Micro Business Systems (MBS) commenced the digitalising of all the patients records in February Approximately fifty medical records are taken at a time. Once scanned at the MBS premises they are securely returned as PDF files on an encrypted USB stick drive. One clerk has been allocated the task of uploading these files in to the individual patient records on EMIS. 174 P a g e

175 So far progress has been slightly slower than anticipated with this project as the number of documents per file to be scanned is more than anticipated and we have made the decision to ensure scan quality is as good as possible to guarantee details are not lost. To date 3540 PDF files have been uploaded to patient records, representing 14 full patient folders. 6. BABY CLINICS In keeping with the aim to repatriate services in to Primary Care, the Medical Director has allowed the PCC to take over the service of routine 6 week baby checks. Dr Daniela Martyn carries out clinic a week and now sees 10 babies per clinic. Appointments last 15 minutes to allow more time for questions and dealing with concerns. Dr Martyn is progressing her interest in children s health with the Postgraduate Diploma in Child Health. 7. GP WITH SPECIAL INTEREST IN MUSCULOSKELETAL MEDICINE 5 session GP seeing Orthopaedic patients referred by GPs. Dr Elaine Flores commenced this service based in SBH on 27 Feb 17. She has worked to establish a strong working link between primary and secondary care by sitting in on Orthopaedic clinics. She has helped to organise clinics and triage/sieve patients to be seen and treated as either by her or by the Consultants. To date 123 patients have been seen, joint injections carried out and patients fast-tracked to surgery where appropriate. 8. Statistics for PCC CLINICS JANUARY FEBRUARY MARCH GPs Derm Dr Ferera Derm - Nurses 703 To be submitted 531 Audiology Well Woman Clinic Diabetic Nurses Child Health Registration Dental Nurse Practitioners P a g e

176 Respectfully submitted Adam Wink UGM Primary Care Services 176 P a g e

177 177 P a g e

178 July to September 20 Introduction 5.9 UGM Mental Health Services This 3 rd quarterly board reports represents the months July Sept 20, during which time the emphasis has been on improvement of the services through closer links with allied professional and outside agencies, in order to ensure holistic individualised care is provided. The mental health services have and will continue to adapt the care it provides according to the needs of the patients we care for. This is evident in the data presented below where allied professionals have provided clinical input to in patients. The report represents the work carried out in all departments of the mental health services (in-patient, community and the ARC). It presents the activities from some of these groups, the visits completed in the community by the multi-disciplinary team and the work, which we hope to develop over the coming months. Section one monthly activity Community Mental Health Team (CMHT) Patient contact/staff activity. The community mental health team have continued to work hard with both their in-reach and outreach work with patients. As can be seen in the data presented below, many patients continue to access the services for a combination of care packages, from medication concordance to talking therapy with staff. 178 P a g e

179 Psychology therapy offered with the mental health services. Referrals Received Month Referrals Received June 70 July 66 August 68 Referring Agents: Source of Referrals Number of Referrals Received Primary Care 98 Community Mental Health Team 76 Secondary Care 17 Paediatrics 12 Other 1 Reasons for Referral: Depression 31 Anxiety problems including phobia, 69 PTSD Obsessive Compulsive Disorder 2 Stress/Adjustment 42 Bereavement 5 Psychotic illness 2 Psychosomatic symptoms 3 Self-harm 1 Substance misuse 4 Overweight/assessment for bariatric 7 surgery Cognitive/Neuro.Psych. assessment 3 Eating disorder 4 Health related problem/chronic pain 2 Behavioural assessment of 21 children/family Diabetes 2 Other 6 In-patient data and activities The data below captures a number of demographic details, such as; admissions, diagnosis, route of admission for Horizon and Sky ward as well as the number of patients admitted on section and numbers of appeals against section per month. Patients can and do access the services in a number of ways as can be seen in the tables below, Apart from this, also presented are just some of the groups developed with patients which would be in addition to the ARC activities. 179 P a g e

180 In-patient quarterly data Horizon / Sky In respect to diagnosis on admission, as can be seen from the data over the 3 month period, the main diagnosis on admission is mood disorders and psychosis which is more than 50% of presenting illness. Diagnosis on admission July to Sept 20 There has been a marked increase (doubled) in Aug / Sept for male admission to Ocean views, however as can be seen in the data female admissions appear to be reduced by half. 180 P a g e

181 The mode of admission, clearly demonstrates that access to the service can be from 4 main areas; CMHT Police A+ E Internal transfers The later relates to both transfers within the service / wards as well as transfers from SBH hospital. The following data below represents both formal and informal admissions to Ocean views and although as can be seen from the data patients do appeal their sections and detention to hospital this is relatively low in comparison to the number of sections in the first place. Month July 20 Aug 20 Sept 20 Section / appeals / outcomes July to Sept 20 Number of Number of Gender Outcome patients appeals / addmitted on Section section 15 admitted on section 3 admitted informaly 15 admitted on section 3 admitted informaly 21 admitted on section 3 admitted informaly 2 Male and Female Female section upheld Male withdrew appeal 1 Male Male section upheld 3 Male 2 Female - 1 Female withdrew appeal Male withdrew appeal Male awaiting date for appeal Other groups / activites held on the Horizon and Sky 181 P a g e

182 Arts and crafts x2 sessions every week Interactive games x2 every week Bingo x2 every week X2 patient meetings Ladies pamper groups Relaxation groups Commuity escorted leave, these will be for access to social events and for collection of fortnightly benefits. Rehabilitation in-patient services - Dawn Ward For the purposes of this report the data provided below has been separated into Dawn ward (rehabilitation) and the flats. The rationale for this is that over the last few months the dependency of patients has changed due to the acuity and the transfer of a number of elderly patients to the rehab services. As previously mentioned in reports the rehabilitation services (Dawn ward) provides an environment of both double and single rooms, enabling patients to both independence and social interaction. Recovery and reduction of stigma continues to be high on our agenda alongside, patient s physical wellbeing. Ward based activities continue with this new patient mix, which has enabled the continued emphasis of recovery. The data provided in these charts represent the current monthly totals of patients on the ward per month and their current level of dependency and the identified risks (such as falls, aggression or self-neglect). 9 male and 4 female in Dawn ward The dependency of each patient is monitored every week / month, this enables staff to adapt the care required to suit the needs of the patient. During the 3 month period presented in this report the overall dependency 182 P a g e

183 The main risks currently identified are falls, neglect and aggression. This is identified through MDT discussion and assessment tools such as risk assessment and falls assessment which will be carried out regularly. Rockside flats There are 2 flats within Ocean views (Male 4 bedded and Female 3 bedded). Patients are usually transferred to one of the flats following a period of assessment on the ward, which would include activities of daily living, ability to maintain personal safety and risk to others. The table below presents data with respect to current identified risk, diagnosis and dependency of each patient within the flat. From a dependency point most patients would be identified as low to medium risk, however, monthly assessments are carried out to ensure continued placement in the flats is appropriate. It may be necessary at times as patients mood and health fluctuate to increase the nursing observation in the flats, but this would be identified as a need similar to patients living in the community who may need more support, it would not necessarily require transfer to an acute setting, therefore enabling patients despite relapse maintain their living environment, much the same as patients in the community. As the same patients have resided in the flats during the 3 months presented, the dependency, diagnosis and risk have remained the same. Again, this reflects that despite risks being present patients can live more independently in the community with reduced support. July Sept Risk identified Dependency Diagnosis 1 self-neglect 6 aggression and self neglect 2- level one dependency 3 level two dependency 2 level three dependency 1 Bi-polar 2 depression 4 Schizophrenia Apart from the above data with respect to access to allied health professionals, patients on Dawn and in Rockside flats will have access monthly to clinics in order to address physical health care needs, these are represented in the data below. 183 P a g e

184 Specialist clinics held and Dawn ward patients seen by colleagues within ocean views. July 20 Clinic Professional Number of patients seen General Practitioner Dr Haider/ DR Marin 18 Physiotherapist Jan Wink 4 Dermatology Linda Castro 7 Palliative care / District care team District Nurses / Dr Robles / SN Fawden Specialist clinics held and Dawn ward patients seen by colleagues within ocean views. Aug 20 Clinic Professional Number of patients seen General Practitioner Dr Haider/ DR Marin 41 Physiotherapist Jan Wink 7 Dermatology Linda Castro 3 Palliative care / District care team District Nurses / Dr Robles / SN Fawden Specialist clinics held and Dawn ward patients seen by colleagues within ocean views. Sept0 Clinic Professional Number of patients seen General Practitioner Dr Haider/ DR Marin 38 Physiotherapist Jan Wink 6 Dermatology Linda Castro 8 Palliative care / District care team District Nurses / Dr Robles / SN Fawden Elderly care services - Sunshine ward As described above, this report and the data within it represents not only the demographic details of patients but also the focus for this period of holistic needs for patients. As part of our on-going commitment to provide continued support and care for the elderly population, Sunshine ward have continued to enhance the services they provide. This has seen an increase for end of life care for patients and greater involvement in palliative and district staff. A number of patients have been seen and assessed by Physiotherapy and as a result has been provided with individualised wheelchairs in order to increase movement and comfort. The dependency of patients although it remains high for all, there is a noticeable change in needs and more patients are requiring help with mobility, diet and self-care. The main risks identified with this current client group are falls, difficulty in swallowing and mobility, with all 14 patients deemed as at P a g e

185 risk. To add this there are also 6 patients at risk of becoming aggressive towards others, usually as a result of their confusion and believe that people have entered their home. Alongside the day-to-day care, which is provided on the ward by the MDT patients also, have regular access to allied care professionals this data is presented below with respect to medic in-put which is provided by two visiting consultants from SBH. These consults are not only available when they visit the unit, but are also contactable by the full team in Ocean views during the week, for phone consultation and advice the latter is not represented in this data. Specialist clinics held and Elder care patients seen by colleagues within ocean views. July 20 Clinic Professional Number of patients seen General Practitioner Dr Haider/ DR Marin 40 Physiotherapist Jan Wink 4 Occupational Therapy On-going treatment 138 Palliative care / District care team District Nurses / Dr Robles / SN Fawden Specialist clinics held and Elderly care patients seen by colleagues within ocean views. Aug 20 Clinic Professional Number of patients seen General Practitioner Dr Haider/ DR Marin 26 Physiotherapist Jan Wink 4 Occupational Therapy On-going treatment 125 Palliative Care / district care team District Nurses / Dr Robles /SN Fawden Specialist clinics held and Elderly care patients seen by colleagues within ocean views. Sept 20 Clinic Professional Number of patients seen General Practitioner Dr Haider/ DR Marin 26 Palliative Care team Dr Robles / SN Fawden 4 District nurses Physiotherapist Jan Wink 4 Occupational Therapy On-going treatment 125 Monthly sessional attendance by patients to the ARC. The enclosed statistics show the patient contacts seen in the Arc. This includes both group settings and individual work facilitated either in the hospital setting or in the patients home or community. Averages of 14 patient contacts have been seen daily in the Arc. The majority of the patients seen P a g e

186 are from Dawn Ward as this is the rehabilitation ward and where they have most input. Activities completed per month by Arc for ward / community patients July to Sept 20 July Aug Sept Horizon Dawn Sunshine Community October to December 20 Introduction This quarterly report (Oct Dec 20) has been produced in conjunction with the multi-disciplinary management team. The report illustrates the work currently undertaken within the mental health services from a multidisciplinary aspect, identifying areas of practice and development. During this time the emphasis has been on improvement of the services through closer links with allied professional and outside agencies, in order to ensure holistic individualised care is provided. The mental health services have and will continue to adapt the care it provides according to the needs of the patients we care for. This is evident in the data presented below where allied professionals have provided clinical input to in patients. The report represents the work carried out in all departments of the mental health services (in-patient, community and the ARC). It presents the activities from some of these groups, the visits completed in the community by the multi-disciplinary team and the work which we hope to develop over the coming months. Community Mental Health Team (CMHT) Patient contact/staff activity. 186 P a g e

187 Axis Title GHA Board report July 20 to March 2017 CMHT - Patient Contact/ Staff Activity table Dr Segovia Dr Lillywhite Dr Diaz Dr Ruiz/ Dr Gandia Dr Marin Patients seen in Clinics Communi ty Visits Oct Nov Dec In-patient data and activities In-patient quarterly data Horizon / Sky 187 P a g e

188 Diagnosis on admission October to December 20 Section / appeals / outcomes Oct to Dec 20 Month Number of Number of Gender Outcome patients appeals / admitted on Section section Oct 20 6 patients 2 Male 1 Male admitted on withdrew Section 5 appeal 4 patients 1 discharged admitted on from hospital Section 6 before tribunal 2 patients admitted informally 1 patient on court order Nov 20 4 patients None admitted on Section 5 2 patients admitted on Section 6 5 patients admitted informally Dec 20 1 patients None admitted on Section P a g e

189 2 patients admitted on Section 6 4 patients admitted informally Other groups / activites held on the Horizon and Sky Arts and crafts x2 sessions every week Interactive games x2 every week Bingo x2 every week X2 patient meetings Ladies pamper groups Relaxation groups Rangoli / painting weekly Commuity escorted leave, these will be for access to social events and for collection of fortnoghtly benefits. Rehabilitation in-patient services - Dawn Ward Data The data provided in these charts represent the current monthly totals of patients on the ward per month and their current level of dependency and the identified risks (such as falls, aggression or self-neglect). 10 male and 3 female in Dawn ward 4 males in flat A 3 females in flat B 189 P a g e

190 Diagnosis of patients nursed Dawn ward and in the 2 flats Diagnosis Male Female Schizophrenia 4 3 Dementia 6 1 Mood disorder 2 2 including depression Learning 1 0 disabilities OCD 1 0 Elderly care services - Sunshine ward As described above, this report and the data within it represents not only the demographic details of patients but also the focus for this period of physical health needs for patients. The data below provides information risks identified as well as contacts patients may have at any time services to mental health. As part of our on-going commitment to provide continued support and care for the elderly population Sunshine ward have continued to enhance the services they provide. This has seen an increase for end of life care for patients and greater involvement in palliative and district staff. A number of patients have been seen and assessed by Physiotherapy and as a result has been provided with wheelchairs in order to increase movement and comfort. The dependency of patients although it remains high for all, there is a noticeable change in needs and more patients are requiring help with mobility, diet and self-care. 190 P a g e

191 Specialist clinics held and Elder care patients seen by colleagues within ocean views. October 20 Clinic Professional Number of patients seen General Practitioner Dr Haider/ DR Marin 34 Physiotherapist Jan Wink 4 Occupational Therapy On-going treatment 111 Palliative care / District District Nurses / Dr 4 care team Robles / SN Fawden Chiropodist 8 Specialist clinics held and Elderly care patients seen by colleagues within ocean views. November 20 Clinic Professional Number of patients seen General Practitioner Dr Haider/ DR Marin 26 Physiotherapist Jan Wink 4 Occupational Therapy On-going treatment 125 Palliative Care / district District Nurses / Dr 8 care team Robles /SN Fawden Chiropodist 0 Specialist clinics held and Elderly care patients seen by colleagues within ocean views. December 20 Clinic Professional Number of patients seen General Practitioner Dr Haider/ DR Marin 30 Palliative Care team Dr Robles / SN Fawden 4 District nurses Physiotherapist Jan Wink 140 Occupational Therapy On-going treatment 9 Chiropodist Monthly sessional attendance by patients to the ARC. The enclosed statistics show the patient contacts seen in the Arc. This includes both group settings and individual work facilitated either in the hospital setting or in the patients home or community. Averages of 14 patient contacts have been seen daily in the Arc. The majority of the patients seen are from Dawn Ward as this is the rehabilitation ward and where we have most input. 191 P a g e

192 Activities completed per month by Arc for ward / community patients July to Sept 20 Oct Nov Dec Horizon Dawn Sunshine Community January to March 2017 Introduction This quarterly board reports represents the months of January to March 2017 and includes a number of new initiatives across the service that have either already been introduced or are planned in the coming months. Horizon ward have introduced more ward based activities, community outings and improvement in the liaison work they already do with colleagues from SBH and outside the organisation. Dawn ward are providing more outreach work, jointly working with colleagues from the ARC and community teams in order to facilitate careful discharge planning to patients who have been in hospital for more than 13 years. Alongside this, they have also improved the links with other professionals from SBH, ensuring that patient s physical wellbeing is addressed also. Sunshine ward continue to develop and lead on policy guidelines for elderly dementia patients, exploring with SBH aspects of falls and care of the dying initiatives. CMHT, there are plans in the very near future to implement further outreach / crisis components to the service, this will be reported in more details within the next quarterly report. Mental Health Act implementation, as a service we have been tasked with the rolling out and cascading of information on the new act. Mandatory training continues high on the agenda and further staff have been trained as in-house trainers in order to facilitate staff and service needs. 192 P a g e

193 Section one monthly activity Community Mental Health Team (CMHT) Patient contact/staff activity. 193 P a g e

194 In-patient data and activities Horizon - Sky / Dawn - Flats / Sunshine / ARC In-patient quarterly data Horizon / Sky 194 P a g e

195 Section / appeals / outcomes Jan Mar 2017 Month Number of Number of Gender Outcome patients admitted on section appeals / Section January Male Section February Male 1 Female upheld 2 section appeals withdrawn by patients 1 section 195 P a g e

196 March No appeals upheld by tribunal 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 fortnoghtly benefits. Rehabilitation in-patient services - Dawn Ward Data Presented in boxes below are: (1) the patient transfers within the service, 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. 196 P a g e

197 In March one patient started extended overnight leave from the ward, during which the staff facilitated up to 2 Outreach sessions a week. This outreach from the ward included visiting the patient in their home, ensuring they are safe, clean, taking medication and dealing with any needs or support needed, as well as monitoring physical/ mental health and observing for early signs of relapse. Also in March through a joint government and mental health service initative we obtained a community flat for two patients to encourage rehabilitation back into living independently in the community as part of their discharge package. Preparing this next stage in patient recovery and discharge from hospital has entailed not only the prepartion of patients, but also the flat itself which electrics/water etc, furniture deliveries and safety checks, plus instalation of Fire safety equipment. We are currently offering Outreach to two patients living in the community twice a week, for up to 4 hours per session. We have achieved this through close liasion with our community colleagues who hve also played a part in the outreach and who will be incresing their in-put in the near futher. 197 P a g e

198 At the end of April we will be withdrawing the outreach to once a week as CMHT will take over one of the days as we plan for discharge into care of CMHT. We currently have one patient residing in the Community flat (Kent Hse) twice a week, where we offer Outreach for Twilight period and 8-10am. This is to ensure safety and wellbeing of the patient, monitor medication and monitor for early relapse signs, due to this being the first leave from the ward on their own in approx. 13 years. We plan to introduce leave for the other patient on alternate days in the next few weeks, with the same plan for outreach being offered, as this patient has also had approx. 13 years with no overnight leave on their own. When introducing them both to over night leave on the same days we will ensure they are supported through the use of staff being at the flat for the full night period initially with view to this withdrawing within a few nights and continuing only with the Twilight and morning Outreach. Dawn ward staff work very close with the ARC team who also 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 depts. We continue to offer 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. We have several patients who we will be looking to offer Outreach to in the very near future once needs are met with housing or stabilising physical/ mental health concerns. Alongside the rehabilitation activities (described above) Dawn ward staff have also reviewing the physical care needs of the patients. Outlined below are a few of the clinics and professionals Dawn ward patients see, demonstrating the holisitc nature of the care provided and the importance of a healthy balance of physical and mental wellbeing. Specialist clinics held and Rehabilitation patients seen by colleagues within ocean views. January 2017 Clinic Professional Number of patients seen General Practitioner Dr Haider/ DR Marin 9 Physiotherapist Jan Wink 0 Outpatient Appointments Various depts.. 4 to SBH Patient outings Variety of social 7 activities Chiropodist 6 Specialist clinics held and Rehabilitation patients seen by colleagues within ocean views. February 2017 Clinic Professional Number of patients seen General Practitioner Dr Haider/ DR Marin P a g e

199 Physiotherapist Jan Wink 2 Outpatient Appointments Various depts.. 11 to SBH Patient outings Variety of social 2 activities Chiropodist 0 Specialist clinics held and Rehabilitation patients seen by colleagues within ocean views. March 2017 Clinic Professional Number of patients seen General Practitioner Dr Haider/ DR Marin 9 Physiotherapist Jan Wink 2 Outpatient Appointments Various depts.. 5 to SBH Patient outings Variety of social activities 4 Chiropodist 0 Elderly care services - Sunshine ward Sunshine wards Identified risk Jan-Mar There have been a number of patient changes to Sunshine during the period represented in this quarterly board report, with a number of initiatives and ward based activities being implemented. Staff within the department taking on lead roles in order to champion change, support staff through implementation and ensure evidence based, good practice continues. These roles have included work around; falls, palliative care and physical assessments. The joint working with SBH colleagues continues, with results that improve patient quality and dignity whilst an in-patient. There has also been some design changes to the environment with a patient wet room being installed to facilitate personal hygiene again leading to greater dignity and respect for patients. Specialist clinics held and Elder care patients seen by colleagues within ocean views. January 2017 Clinic Professional Number of patients seen General Practitioner Dr Haider/ DR Marin 25 Physiotherapist Jan Wink 4 Occupational Therapy On-going treatment 120 Palliative care / District District Nurses / Dr 11 care team Robles / SN Fawden Chiropodist P a g e

200 Specialist clinics held and Elderly care patients seen by colleagues within ocean views. February 2017 Clinic Professional Number of patients seen General Practitioner Dr Haider/ DR Marin 20 Physiotherapist Jan Wink Occupational Therapy On-going treatment 100 Palliative Care / district District Nurses / Dr 3 care team Robles /SN Fawden Chiropodist 3 Specialist clinics held and Elderly care patients seen by colleagues within ocean views. March 2017 Clinic Professional Number of patients seen General Practitioner Dr Haider/ DR Marin 15 Palliative Care team Dr Robles / SN Fawden 0 District nurses Dermatology 3 Occupational Therapy On-going treatment 110 Chiropodist 0 Other Dressing / medical outpatients / Eye dept 3 Monthly sessional attendance by patients to the ARC During this period, the ARC department have continued to facilitate groups and activities to meet the needs of our patients. These have included community skills groups, lunch cooking groups, arts and craft groups and relaxation groups. We strive to change the groups as necessary to meet client needs. We have established good links during the past year with the housing department and the benefits department, which has helped to support our patients with accessing relevant care and support. We aim to strengthen these links to continue to provide support as needed to the patients accessing these services. The ARC continues to work closely with the three wards at Ocean Views, to provide assessment and treatment to the patients. This has included individual sessions providing community support to enable the clients to work towards discharge or supporting their functioning and independence. During the coming year, we hope to further establish our links with the wards and community support (e.g.cmht and clubhouse) and continue providing a full programme of groups and activities to meet the needs of the clients. 200 P a g e

201 The ARC also provides relaxation sessions for the Drug and Alcohol service (Bruces Farm) and the Cardiac Rehab service. These sessions will continue to benefit these clients. Activities completed per month by Arc for ward / community patients January March 2017 Jan Feb March Horizon Dawn Sunshine Community Respectfully submitted Chris Chipolina UGM Mental Health Services 201 P a g e

202 5.10 Director of Information Management & Technology July to September 20 Information Technology During the third quarter of 20 the increase in the number of calls to the IT Helpdesk has remained. This is despite the fact that GHA staff can now submit tickets directly and avoid calling the helpdesk directly. This continues to be due to a greater number of users actively using the computer systems and a greater need for constant availability of computers and the underlying systems. After the successful pilot of the Patient Wi-Fi network it has now been rolled out across all hospital patient areas. The system is working well and is currently being utilised by a large number of our patients. Activation of the new door access system is now expected during the last quarter of 20. The technical infrastructure has been completed for some time and the changeover is awaiting the contractor and GHA administrative staff to complete the administrative element of the project and then schedule in the works to switch systems. The department has been closely involved in the introduction of the new Chemotherapy Unit. All IT infrastructural requirements were completed in All IT and telephony equipment was installed during the first weeks of September in preparation for the opening of the unit later in the month. The programmed replacement of the aging hospital CCTV system with a modern IP network based system has been completed. The remaining analogue system has now been decommissioned. Work in the Pathology Department continues, assisting in expanding the computerization to a point where the suppliers of the main Laboratory Information System are using the installation as an example of cutting edge implementation of their systems. The department is currently assisting with the computerisation of Microbiology. Migration from our two aging file servers onto the new GHA file server, with greater storage capacity and much improved performance is almost complete. The remaining server is still awaiting an upgrade to the latest version of the Sidexis software used for dental x-ray imaging before migration can be finalised. The replacement hardware for the GHA system has now been purchased. The installation/configuration of this new system is currently underway. Migration to the new system is expected to commence in the next quarter. 202 P a g e

203 The replacement Telephone System has been ordered and is expected to arrive and be installed during the next quarter. As stated in the previous board report the current GHA telephone system is this year reaching what is called End of Life. This essentially means that by the end of the year it will no longer be supported by the manufacturer and any failure could result in considerable down time of the entire GHA telephone systems. A large number of the GHA servers currently operating are in urgent need of replacement due to the lack of availability of security patches and manufacturer support. Maximum use is being made of the funding available and as many as possible will be replaced during the course of this financial year. It is planned to replace the remaining servers during the next financial year and then adopt a rolling replacement programme going forward. The redesigned internal GHA Intranet site has been received well. The newly introduced ability for individual GHA departments to add and manage the content pertaining to their area themselves is working well and is ensuring that information is kept as up to date as possible. Development of a similar content management interface for the GHA website is on-going and expected to be ready for testing before the end of the next quarter. This will empower departments to keep content as up-to-date as possible without having to ask for changes to be made by the GHA webmasters. The Backup/recovery system continues to function well on a technical level. However an increase in the amount of data stored by the GHA is putting pressure on the storage capabilities of the backup system. Backup retention times before being overwritten by a newer backup are having to be reduced so that the backups can fit on the existing storage systems. This reduces the capability to go back to a specific point in time and increases the risk of not being able to recover lost files or go back to a point before data corruption occurs if the loss or corruption is not discovered within a couple of days. A replacement, fully consolidated, backup solution has been purchased and is expected to arrive in October. This will enable the GHA to again adopt best practise in our backup solution and to maximise our Disaster Recovery abilities in the case of server failure or data loss. This new solution is also fully scalable so can be expanded to match the growth of data being held by the GHA as and when needed. The Dementia Day Care Facility network infrastructure has been configured, installed and commissioned. This allowed online systems within the building to be commissioned and brought online prior to hand over of the building. All IT and telephony equipment has been purchased and configured ready for installation on site in October. 203 P a g e

204 IMT Helpdesk GHA Board report July 20 to March 2017 Our helpdesk continues to be at the core and central to our department. GHA staff are now able to submit support tickets directly into the system which has reduced the number of calls received but they continue to handle approximately 600 support calls per month. The reduction in calls does not signify a drop in the number of support requests it just shows that the additional step of making a call before ticket creation is no longer needed. The number of requests has grown in comparison to the same period of the previous two years. This continues to demonstrate the GHA s increased use of IT systems and the reliance that our clinicians and administrative staff now have on these systems in order to fulfil their duties. As can be seen in the first table below, the number of calls received has remained high whilst it is slightly lower than previous years. This is primarily due to the installation and troubleshooting of the EMISweb EPR systems which subsequently impacts on the helpdesk s ability to respond in a suitable time frame. It can also be seen, in the second table below that the number of support tickets created has risen from under 200 per month to between 350 and 600 per month, up to a 200 per cent increase in support requests. 204 P a g e

205 Patient Entertainment System A solution for replacement of the existing patient TV decoders and screens has been identified and enough units to conduct a pilot in one ward have been ordered and are expected to arrive in October. Once a successful pilot is completed further units will be purchased and installed across the remaining wards. As stated in the previous board report, the movement of many TV channels to HD Video is resulting in the gradual loss of channels as the broadcaster migrates to the better quality format. Eventually all channels will be moved to HD Video. 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. General Regular backups of our main servers and databases continue to ensure the integrity and safety of our data. The growth of data stored on our servers is still putting pressure on our capability to back up all of our data and comply with recognised industry standard intervals. Replacement of the backup systems is planned and will be undertaken in the next quarter. Our on-call staff are alerted of any equipment issues, alarms, faults via pager, SMS and avoiding any delay when taking action. 205 P a g e

206 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 Work continues on this project. The planned pilot phase was carried out in February 20. The pilot went very well with a small number of suggestions and requests for minor modifications made by the stores staff. These were implemented shortly afterwards. Statistics for the usage of pantry items are now available to management and a specific report was requested by procurement staff in order to assist with planning for the pantry budget. This has been implemented. A number of operational difficulties within the stores and procurement departments has meant that progression beyond the pilot to a user portal and inclusion of a full product catalogue has still not been possible. These same difficulties have meant that the use of the pilot system that was halted in mid- June has still not restarted. The software development team still have this on hold pending further involvement from the stores and procurement teams. Human Resources System Following successful demonstrations and training sessions the first phase went live on 27th July. The system currently consists of an employee database and is used to manage manning levels, vacant posts, employee movements between posts, etc. Certain actions automatically trigger notifications to salaries, (e.g. new joiners, staff members leaving GHA, extensions to termination dates) ensuring they are kept aware and are able to carry out necessary actions on their end. The IS team are now working on subsequent modules and will bring them online as and when they are complete. Some of these additional modules would be a Special Leave module, a Contracts database and a Locum database with many more as and when required. GHA User Account online requesting The pilot of a replacement for a paper based user account request and IT systems access request form is still on-going with the Medical HR department. It is planned to implement across the whole organisation once all of the departments concerned are engaged and ready to use it. 206 P a g e

207 Cancer registry patient management system This continues as previous. There still might be an opportunity to also populate this register with the introduction of new systems in pathology and radiology but there has been no further development in this area. The commercially available software CanReg5 is still being considered as a replacement by the Public Health Department Pathology System ( Vitropath ) The pathology department has asked that we look at implementing this as an interim solution whilst a solution from the EPR programme is being developed. Discussions are still on-going regarding the feasibility of this. Sponsored Patients This in house developed system continues to work well. Additional requirements and improvements are constantly being identified by the sponsored patients department as they use it in their day to day work. Enhancements to Screening application Re-development of the screening application is still on-going, providing additional features and functionality in a rolling programme. It is currently used for Colorectal and AAA screening programmes. As other screening programmes are introduced these will be incorporated as and when needed. Also, additional functionality for recall management and general screening programme is being developed. Working with EMIS/Ascribe teams As Phase 1 of the EPR project draws to a close there has been a need for a great deal of interaction leading into Phase 2. The Phase 2 PID has been approved and sets out what is to be achieved for the next 18 months. Several issues have been identified from this document and discussions are taking place to find possible solutions. Due to the intricacies of some of the existing systems, such as the GHA Health Card printing functionality, the IS team s involvement is and will continue to be relatively high leading into Phase 2. This is to enable the EMIS Group s developers to fully understand what is being replaced and to ensure that they develop and provide the same degree of functionality if not more. There are regular meetings between the EPR programme management teams and the IS team and a good relationship of cooperation and team work has been fostered between all. 207 P a g e

208 Replacement of Technical Services Systems A solution to replace the existing CAFM facilities management software and the Building Management System is currently being looked at. This solution will tie into other IT service offerings, such as the ticketing system, aiming to reduce and streamline current workflow and increase functionality of currently used products. The replacement of the existing CAFM facilities management software is currently being reviewed and is to be replaced either by an in-house solution or by the use of a customised Open Source Facility Management software package which is currently being tested and showcased to see if it meets the organisational needs. The use of an open source software package is being considered as it would reduce development and deployment times and the GHA could also take advantage of its additional features such as: Space & Asset Inventory Facility Maintenance Logistic Management Economic Management Energy & Environment GIS & BIM support Being open source there would be no associated acquisition costs but there are support and maintenance options which can be purchased. Staff Recertification Database A module to record and maintain re-certification and qualifications of GHA staff was requested. This was completed in the 1 st Quarter of 20. However, in order to avoid staff having to enter all of the data regarding all staff that require recertification, it was decided, now that the HR system is live and being used, to restructure the Recertification system to link into the HR system and pick up all of the existing staff details from there. This development is on-going and should be completed before the end of the next quarter. Computerisation of the GHA Estimates Process The development of the estimates submission system is now underway. The system is currently being written and the complex coding structure that is used in the estimates process is currently been set up for the users to test. The development team are currently observing the existing manual estimates process as it progresses towards submission so as to observe the way the current system functions so as to further grasp the current work practices and 208 P a g e

209 identify any efficiencies that can be introduced into the computerised equivalent. Medical Registration Board System A new feature was requested that allows the Medical Registration Board to export their data from their in-house electronic system to their public facing website. This is necessary in order for the MRB to provide details to the public on medical professionals registered to practice in Gibraltar. The current system was redeveloped to incorporate this new requirement and is now being used by MRB personnel. Web-based HTTP Paging (Emergency / On-Call Bleepers) In 2007 an in-house bespoke system was setup allowing GHA call centre staff to send pages (bleep), via their computer terminal, to GHA staff issued with pagers from the Gibtelecom paging service. This was a vast improvement at the time as it provided very quick access / response from teams paged via this facility when compared to the previous method which required the call centre staff to individually dial in by phone for each pager. Whilst this setup continues to provide a robust service to date, recent proposed changes in the Gibtelecom systems has required that the project is revisited. The changes being made to systems by Gibtelecom has meant that a completely new solution needs to be developed. The existing system will continue to run until the new one is developed, tested and made available to users. Currently the project is in the early planning phase from a software perspective. October to December 20 Information Technology During the final quarter of 20 the high number of calls to the IT Helpdesk has remained. This is despite the fact that GHA staff can now submit tickets directly and avoid calling the helpdesk directly. The primary cause of this is the increased leveraging of technology to aid clinicians in providing patient care. This results in a greater number of users actively using the computer systems and a greater need for constant availability of computers and the underlying systems. The department has been closely involved in the introduction of the new Chemotherapy Day Unit. 209 P a g e

210 All IT and telephony equipment was installed during the first weeks of September in preparation for the opening of the unit later in the month. The focus for the department is now supporting the additional unit in the same manner as for all existing GHA units and departments together with managing any teething problems that will arise as is expected with a brand new service provision. Work in the Pathology Department continues, assisting in expanding the computerization across all pathology disciplines. The department is currently assisting with the computerisation of Microbiology and the Anticoagulation clinic. The suppliers of the main Laboratory Information System continue to use the installation as an example of cutting edge implementation of their systems Migration from our two aging file servers onto the new GHA file server, with greater storage capacity and much improved performance, is almost complete. The remaining server is still awaiting an upgrade to the latest version of the Sidexis software used for dental x-ray imaging before migration can be finalised. The installation/configuration of the new GHA system is currently underway. Migration to the new system has been delayed due to other project priorities but is expected to commence in the 1 st quarter of Pending preliminary infrastructure works being completed. The replacement Telephone System (PBX) has been delivered. Installation and configuration has commenced with migration across from the old system scheduled to be completed during the second week of January As stated in previous board reports, the current GHA telephone system needed to be replaced as it was reaching what is called End of Life. Once a system reaches End of Life it is no longer supported by the manufacturer and any failure could result in considerable down time of the entire GHA telephony systems. As previously stated, a large number of the GHA servers currently operating are in urgent need of replacement due to the lack of availability of security patches and manufacturer support. Maximising use of available funding, a solution has been purchased which utilises advanced and cutting edge technologies to replace a large number of these servers. The use of these technologies enables us to replace many more servers than would normally be possible but with the same costs. The equipment is currently being tested and installation will commence once preliminary infrastructure works have been completed. It is planned to replace the remaining servers, using the same technologies, during the next financial year and then adopt a rolling replacement programme going forward. The internal GHA Intranet continues to function well. The ability for individual GHA departments to add and manage the content pertaining to their area 210 P a g e

211 themselves, that was introduced earlier in the year, is working well and is ensuring that information is kept as up to date as possible. Development of a similar content management interface for the GHA website is on-going and expected to be ready for testing before the end of the next quarter. This will empower departments to keep content as up-to-date as possible without having to ask for changes to be made by the GHA webmasters. The Backup/recovery system continues to function well on a technical level. However, an increase in the amount of data stored by the GHA is putting pressure on the storage capabilities of the backup system. Backup retention times, before being overwritten by a newer backup, are having to be reduced so that the backups can fit on the existing storage systems. This reduces the capability to go back to a specific point in time and increases the risk of not being able to recover lost files or go back to a point before data corruption occurs if the loss or corruption is not discovered within a couple of days. Purchase of a replacement, fully consolidated, backup solution was approved and has now been delivered. It is scheduled to be installed and configured once preliminary infrastructure works have been completed. This will enable the GHA to again adopt best practise in our backup solution and to maximise our Disaster Recovery abilities in the case of server failure or data loss. This new solution is also fully scalable so can be expanded to match the growth of data being held by the GHA as and when needed. Prior to the opening of the Bellavista Dementia Day Care Facility in October all IT and telephony equipment was configured and installed on site. Now that the site is operational focus for the IT department is now on facilitating the later opening phases and supporting the additional site in the same manner as for all existing GHA sites and facilities. As a result of the severe rainwater flooding of the Primary Care Centre at the beginning of December the department had to react rapidly so as to alleviate any potential damage to IT equipment across affected areas. This required the removal of equipment from the entire Dental Department, 3 GP Clinics, the yellow area reception and the entire District Nurse s Office. During the course of the following days this equipment was redeployed in temporary offices and clinics in reallocated space across the centre together with the installation of necessary network infrastructure. Once repairs have been affected to the roof areas all of the equipment will be moved back to the original locations. IMT Helpdesk Our helpdesk continues to be at the core and central to our department. GHA staff are now able to submit support tickets directly into the system which has reduced the number of calls received but they continue to handle approximately 600 support calls per month. The reduction in calls does not signify a drop in the number of support requests, it simply demonstrates that the additional step of making a call 211 P a g e

212 before ticket creation is no longer needed. If anything the number of requests has grown in comparison to the same period in previous years. This continues to demonstrate the GHA s increased use of IT systems and the reliance that our clinicians and administrative staff now have on these systems in order to fulfil their duties. The number of calls received has remained high. This is primarily due to the installation and troubleshooting of the EMISweb EPR systems which subsequently impacts on the helpdesk s ability to respond in a suitable time frame. It can also be seen, in the table below, that the number of support tickets created remains between 350 and 600 per month, up to a 200 per cent increase in support requests when compared to months before implementation of the EPR system. Patient Entertainment System The patient TVs that were ordered for the pilot installation in one ward have been delivered and the deployment of the units is planned for the 1 st Quarter of Once a successful pilot is completed further units will be purchased and installed across the remaining wards. As stated in previous board reports, the movement of many TV channels to HD Video is resulting in the gradual loss of channels as the broadcaster migrates to the better quality format. Eventually all channels will be moved to HD Video. 212 P a g e

213 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. General Regular backups of our main servers and databases continue to ensure the integrity and safety of our data. The growth of data stored on our servers is still putting pressure on our capability to back up all of our data and comply with recognised industry standard intervals. Replacement of the backup systems is planned for once necessary infrastructure works are required. Our on-call staff are alerted of any equipment issues, alarms, faults via pager, SMS and 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 A number of operational difficulties within the stores and procurement departments has meant that progression beyond the pilot to a user portal and inclusion of a full product catalogue has still not been possible. These same difficulties have meant that the use of the pilot system that was halted in mid- June has still not restarted. The software development team still have this on hold pending further involvement from the stores and procurement teams. Human Resources System A module for Special Leave has been developed and has been added to the main HR system. This now allows HR to record Special Leave submissions electronically and have the relevant documents, such as authorisation letters produced automatically. Work has started on the next module to be introduced to the HR system, namely one for managing Foundation Reports for staff. GHA User Account online requesting Following the successful pilot of this with the Medical HR team, it has now been launched across the whole organisation. 213 P a g e

214 Cancer registry patient management system This continues as previous. There still might be an opportunity to also populate this register with the introduction of new systems in pathology and radiology but there has been no further development in this area. The commercially available software CanReg5 is still being considered as a replacement by the Public Health Department Pathology System ( Vitropath ) The pathology department has asked that we look at implementing this as an interim solution whilst a solution from the EPR programme is being developed. Discussions are still on-going regarding the feasibility of this. Sponsored Patients A new module is being developed for the Sponsored Patients system. This new module will allow consultants to fill in an electronic form which will notify the Sponsored Patients Department of the requirement for a patient to undergo treatment at an external clinic. The system will also notify consultants when a patient is due to return to one of these external clinics for a follow up. The consultant will be able to formally approve this follow up or reject it, if the patient can instead be seen locally. This new module is being developed to the requirements laid out by the Medical Director and his team. It is planned for this to go live during Q Enhancements to Screening application Re-development of the screening application is still on-going, providing additional features and functionality in a rolling programme. It is currently used for Colorectal and AAA screening programmes. As other screening programmes are introduced these will be incorporated as and when needed. Also, additional functionality for recall management and general screening programme is being developed. Working with the EPR project team The IS Team continues to work with the EPR Project Team on an ad hoc basis. They are often required to review documents, plans & proposals related to the ongoing work of the EPR programme and to provide technical feedback on these. There are regular meetings between the EPR programme management teams and the IS team and a good relationship of cooperation and team work has been fostered between all. Staff Recertification Database Development of the module to record and maintain re-certification and qualifications of GHA staff has progressed well. 214 P a g e

215 In order to avoid data duplication of staff details, a link was created to the HR system. Development has been completed and the system is currently undergoing user acceptance testing ahead of going live. Computerisation of the GHA Estimates Process The development of the estimates submission system is now underway. The system is currently being written and the complex coding structure that is used in the estimates process is currently been set up for the users to test. The development team are currently observing the existing manual estimates process as it progresses towards submission so as to observe the way the current system functions so as to further grasp the current work practices and identify any efficiencies that can be introduced into the computerised equivalent. Study Leave Request - Medical On the request of the Medical Director development has started on a system that will allow clinicians to submit their requests for study leave in electronic form. Including the ability to submit expenses claims, travel details, etc. Once complete the project will replace several paper forms that currently need to be filled in by hand and submitted to the School of Health Studies in person. January to March 2017 Information Technology During the first quarter of 2017 the number of calls to the IT Helpdesk has remained high. This is despite the fact that GHA staff can now submit tickets directly and avoid calling the IT helpdesk support line. The primary cause of this is the increased leveraging of technology to aid clinicians in providing patient care. This results in a greater number of users actively using the computer systems and a greater need for constant availability of computers and the underlying systems. The installation of the replacement Telephone System (PBX) was completed and the system implemented in January as planned. Due to comprehensive preplanning and preparation the migration from the old to new systems progressed relatively smoothly with minimum downtime for the GHA phone lines. As stated in previous board reports, the GHA telephone system needed to be replaced as it was reaching what is called End of Life and was no longer supported by the manufacturer. In April we are due to launch the Pathology Results Mobile App and the notification by of Pathology Results being ready. This was developed in just 2 months as a result of close collaboration between the IM&T Dept, Pathology Dept. and Izasa (the suppliers of the Modulab pathology system). 215 P a g e

216 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 installation/configuration of the new GHA platform is currently awaiting infrastructure works being undertaken. These works should commence within the next quarter and once completed the new mail platform can be completed and implemented. As previously stated, a large number of the GHA servers currently operating are in urgent need of replacement due to the lack of availability of security patches and manufacturer support. The solution purchased in the last financial year will be installed and implemented once the infrastructure works mentioned previously have been completed. It is planned to replace the remaining servers, using the same technologies, during the coming year and then adopt a rolling replacement programme going forward. The current GHA website, developed and launched in 2013, is in great need of a redesign with a fresh look and feel, utilising modern functionality that is now common place on most modern websites. The department began work on a new website in November and, after just 14 weeks of internal development, it is now ready to be launched. The added functionality includes a content management interface. This will empower departments to keep content as up-to-date as possible without having to ask for changes to be made by the GHA webmasters. The Backup/recovery system continues to function well on a technical level but, as stated previously, is in need of upgrading to meet the increased demands of the increasing data sizes. A replacement, fully consolidated, backup solution was purchased in the last quarter and is awaiting installation. It is scheduled to be installed and configured once the infrastructure works mentioned previously have been completed. This will enable the GHA to again adopt best practise in our backup solution and to maximise our Disaster Recovery abilities in the case of server failure or data loss. This new solution is also fully scalable so can be expanded to match the growth of data being held by the GHA as and when needed. The opening of the additional floors in the Bellavista Dementia Day Care Facility is complete and all planned IT and telephony equipment has been installed and commissioned by the IT department. The department will now encompass this additional site within the support processes and structure of previously existing GHA sites and facilities. 2 P a g e

217 IMT Helpdesk GHA Board report July 20 to March 2017 Our helpdesk continues to be at the core and central to our department. GHA staff are increasingly submitting support tickets directly into the system which initially reduced the number of calls received but the number is now rising and approaching 700 support calls per month. This increase in calls reflects the growing usage and reliance on the IT systems by GHA staff. It can also be seen, in the table below, that the number of support tickets created has risen to between 450 and 600 per month, remaining at up to a 200 per cent increase in support requests when compared to months before implementation of the EPR system. Patient Entertainment System The deployment of patient TVs that were ordered for the pilot installation in one ward, has been delayed due to other demands on the department, but is now planned for the 2 nd Quarter of Once a successful pilot is completed further units will be purchased and installed across the remaining wards. As stated in previous board reports, the movement of many TV channels to HD Video is resulting in the gradual loss of channels as the broadcaster migrates to the better quality format. Eventually all channels will be moved to HD Video. 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 217 P a g e

218 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. General Regular backups of our main servers and databases continue to ensure the integrity and safety of our data. The growth of data stored on our servers is still putting pressure on our capability to back up all of our data and comply with recognised industry standard intervals. Replacement of the backup systems is planned for once necessary infrastructure works are completed. Our on-call staff are alerted of any equipment issues, alarms, faults via pager, SMS and 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 use of the pilot system that was halted in mid-june has been restarted. Once the pilot has been completed the project will progress to a user portal and inclusion of a full product catalogue. Human Resources System Work continues on the next module for the HR system. This new functionality will allow the managing of Foundation Reports for staff. Cancer registry patient management system This continues as previous. There still might be an opportunity to also populate this register with the introduction of new systems in pathology and radiology but there has been no further development in this area. The commercially available software CanReg5 is still being considered as a replacement by the Public Health Department Pathology System ( Vitropath ) The pathology department has asked that we look at implementing this as an interim solution whilst a solution from the EPR programme is being developed. Discussions are still on-going regarding the feasibility of this. Sponsored Patients 218 P a g e

219 A new module has been developed, to the requirements laid out by the Medical Director and his team, for the Sponsored Patients system. This new module allows consultants to fill in an electronic form which will notify the Sponsored Patients Department of the requirement for a patient to undergo treatment at an external clinic. The system also notifies consultants when a patient is due to return to one of these external clinics for a follow up. The consultant can formally approve this follow up or reject it, if the patient can instead be seen locally. The module has been completed and will be launched for the use of all clinicians in April. Enhancements to Screening application Re-development of the screening application is still on-going, providing additional features and functionality in a rolling programme. It is currently used for Colorectal and AAA screening programmes. As other screening programmes are introduced these will be incorporated as and when needed. Also, additional functionality for recall management and general screening programme is being developed. Working with the EPR project team The IS Team continues to work with the EPR Project Team on an ad hoc basis. They are often required to review documents, plans & proposals related to the ongoing work of the EPR programme and to provide technical feedback on these. There are regular meetings between the EPR programme management teams and the IS team and a good relationship of cooperation and team work has been fostered between all. Staff Recertification Database Development of the module to record and maintain re-certification and qualifications of GHA staff has progressed well. Development has been completed and the system is currently undergoing user acceptance testing ahead of going live. Computerisation of the GHA Estimates Process The development of the estimates submission system continues. The system is currently being written and the complex coding structure that is used in the estimates process is currently been set up for the users to test. The development team are currently observing the existing manual estimates process as it progresses towards submission so as to observe the way the current system functions so as to further grasp the current work practices and identify any efficiencies that can be introduced into the computerised equivalent. Study Leave Request - Medical 219 P a g e

220 Development of a system that will allow clinicians to submit their requests for study leave in electronic form is ongoing. Once complete the project will replace several paper forms that currently need to be filled in by hand and submitted to the School of Health Studies in person. Respectfully submitted, Heath Watson Director of Information Management & Technology 220 P a g e

221 221 P a g e

222 July to September School of Health Studies The first year cohort of the BSc (Hons) (Adult) Nursing has successfully completed the first year of study and has moved into their second year. The second years are fully completed and have now moved into their final year of study. Clinical and academic evaluations are currently being analysed. The current cohort of pupil nurses (one student has been removed from the programme of study) are progressing well as they enter the final six months of their programme. Portfolio work is continuing in a timely manner. External evaluation of several elements of our provision has occurred over the summer period. The outcome of the BSc (Hons) (Adult) Nursing has now been published; this was successfully revalidated by St George s Kingston University of London and Kingston University London (SGULKUL). The SHS was commended by the visiting delegation with no conditions to meet and one recommendation pertaining to SGULKUL. Pearson Edexcel visited the SHS and has undertaken an assessment of the QCF level 2 and QCF level 3 programmes with both programmes receiving outstanding feedback from the awarding organisation. Complimentary comments recognised the work of clinicians in supporting pupils as well as the work that is undertaken by staff in the SHS. The External Examiner (University of Chester) along with the Liaison Officer SGULKUL visited the SHS to undertake external examiner duties for the BSc (Hons) Nursing (Adult). The Examiner met with students and clinicians as well as sampling a range of academic work, she concluded that the work of the SHS is akin to and in alignment with other UK HEIs who offer a similar programme of study. The External Advisor (University of Salford) for the EN/QCF programme met with pupils and clinicians who support pupils in their work based learning programme and she was complimentary of the standard of work produced and the development of the programme. The Head of School visited SGULKUL to attend the Board of Examiners in order to progress the Gibraltar undergraduate students. It was noted at the Board of Examiners that there is parity with student progression in the UK. One module, as part of the Continuing Personal and Professional Development (CPPD) portfolio (multidisciplinary), has been run with students registered on the module. Student achievement is yet to be determined. The SHS are currently recruiting to a Work Based Learning Module. Recruitment is also in progress for next QCF/EN programme commencing end of October 20. We have hosted a number of students from the UK over the summer months as well as a student nurse teacher from Germany as part of their elective study. 222 P a g e

223 October to March 2017 School of Health Studies The SHS continues to offer range of multidisciplinary study days and accredited learning modules at various academic levels these are offered in response to organisational need. Staff from the operating theatre, for example, are undertaking second module Surgical First Assistance, this second module builds on learning from the first module and has helped in ensuring that patients requiring surgery receive their surgery in a timely fashion. A second Work Based Learning Module has commenced. This approach to learning in the work place is ideally suited to practicing clinicians and up take has been very good with staff from a number of areas participating. These clinically focused education/practice updates have been provided as a result of service development activity, they assist in ensuring that staff are equipped with the knowledge and skills required to continue to offer a service that is safe, evidence based, effective and responsive to need. The SHS support education and training needs from a wide multi-disciplinary base. The third cohort of pupils nurses concluded their training in February 2017 with 14 students successfully completing this programme, all have been registered with GNMHVRB. These successful candidates come for the health and social care sectors. An awards ceremony will take place for these Enrolled Nurses and other recipients QCF/NVQ awards. Recruitment processes have been undertaken to recruit a record 20 pupils to the 4 th Enrolled Nursing programme that commenced in February 2017, these pupils come from the health and social care sector. The group is progressing well. The 2 nd year BSc (Hons) Nursing programme continues, two students have self-deferred from this programme citing personal reasons for this. The 3 rd year BSc (Hons) are now on their final clinical placement all have progressed and are predicted to successfully receive their award and make an application to the GNMHVRB for registration. The Pearson/Edexcel External Verifier made an annual quality assurance visit to the SHS to consider the QCF aspect of the level 3 work; she examined portfolios, met with the pupil cohort and A1 assessors. The External Verifier provided complimentary feedback to the team at the SHS suggesting that the programme was defendable and is being delivered in a competent and confident manner. This programme is fit for purpose and fit for practice. The SHS continues to receive a number of requests from international health care organisations to act as host and to support students and staff undertaking elective periods of study. These elective periods of are always well evaluated. The GHA has agreed to deliver an MSc Leadership and Management for health care Practice through the SHS and with University of Salford. This programme will commence in September Students and academic staff 223 P a g e

224 in the SHS continue to publish work in a variety of health care journals as well as a range of text books. Respectfully submitted Professor Ian Peate Head of School 224 P a g e

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226 Volume of Complaints/Enquiries 5.12 Complaints The Complaints Handling Scheme Office has received 766 complaints/enquiries during the last two years of operation since it opened office in April 2015; 347 from 1 st April 2015 to 31 st March 20 and 419 from April 1 st 20 to 31 st March Table 1, showing Complaints/Enquiries received at the CHS from 1 st April 2015 to 31 st March 2017 Table TOTAL Months Complaints/Enquiries Complaints/Enquiries April May June July August September October November December January February March TOTAL * *20 The Statistical Information shown below pertains from 20 figures. 226 P a g e

227 GHA Departments (1 st January 20 to 31 st December 20) The trend of Complaints/Enquiries at the CHS has continued similar to last year, once again the same departments comprise the Top Five in respect to all the complaints/enquiries we have received against the Gibraltar Health Authority in 20, the only difference is that they are in different order to last year. This year the Surgical Unit tops the list with 50 complaints/enquiries, the Orthopaedic Department follows closely with 48, the Medical Investigations Unit has 44, the Primary Care Centre 39, and closing the Top Five is the A&E with 34; see Chart 1 below. Other GHA Departments with complaints/enquiries under double figures such as Physiotherapy, Neurologist, Records, Tertiary Unit, Sponsored Patients, Facilities, Victoria Ward, Dudley Toomey Ward, Pain Clinic, Pathology, Urologist, Ambulance, Elderly, Maternity Ward, Dermatology, Paediatrics, Stores, Mental Health, Spinal Clinic, Accounts, Call Centre, Cancer Screening, Diabetic Clinic comprise the remaining P a g e

228 complaints/enquiries against the GHA. Classification of GHA Complaints (1 st January 20 to 31 st December 20) There were 399 Complaints/Enquiries in 20 out of which 244 were speedily resolved, i.e. fell under the classification of Immediate Resolution. One quarter of the complaints/enquiries were investigated thoroughly by the CHS team as it involved examining more complex issues (serious allegations brought by the Complainants and their respective actions taken by the staff at the GHA) that demanded presenting letters to the GHA. 17 (4%) Complaints were also passed on to the Ombudsman for further investigation as the majority of these cases warranted clinical advice. Full investigation reports are carried out and included in our Annual Report. See Gibraltar Health Authority, Page (3%) were closed as outside jurisdiction, another 13 were classified as 228 P a g e

229 Insufficient Personal Interest and 6 were withdrawn soon after the complaint being submitted at the CHS. Nature of GHA Complaints (1 st January 20 to 31 st December 20) There were a number of situations where the basic standards of healthcare were not met, at the very least at an administrative level, with excessive waiting times for appointments and treatment, these amounted to 33% of all complaints/enquiries received in 20. In one instance there was a Complainant unhappy that he had to cancel his son s dental appointment due to important mock exams and the only availability was 6 months later. Another patient was waiting to be seen at the Spinal Clinic and according to Orthopedics there was a 7 months waiting time and last but not least a patient was told that he could not get his biopsy carried out due to the Consultant/Specialist that was treating him had recently retired so he had to wait a couple months uncertain as to what would happen 229 P a g e