The public deserves a Government that prioritises public services, not one that makes decisions based purely on finances. Lack of adequate spending on our Healthcare system is having a profound impact on the quality of the service, increasing staff stress levels, lowering morale, and can ultimately lead to the most dramatic of consequences - loss of life of service users. We champion the dignity and well-being of both staff and service users, and believe in a modern, well-resourced health service that stands the test of time and is equipped to withstand the challenges of Brexit.
Independent Regulator/Quality Commission
The lack of monitoring of care standards in Gibraltar as a whole is, at the very least, inconsistent, with differing care standards and training between the various agencies and Care Agency alike.
Together Gibraltar will address this by creating an independent regulator for health and social care in Gibraltar. Unlike the current Clinical Governance model, it will be independent from Ministerial influence and not include the Medical director/CEO on its board. It will regulate care service providers, using data, evidence, information and feedback to help reach judgements and conclusions. The findings will be published and acted on when services require improvements and will ensure those responsible for poor care are held accountable.
Domiciliary Care for the Elderly/Meals on Wheels
In many elderly care homes, stress, isolation and depression are all too common. For these service users, low levels of social integration and loneliness can significantly increase mortality rates. We have identified that most of our elderly would prefer to be cared for in their own homes. However, due to waiting lists for existing care homes and the lack of space to provide more, access to elderly at home is limited. We will:
Expand on Domiciliary care, assisted living and community teams, in order to provide improved, person-centred care.
Introduce a “meals on wheels” service.
In the long term, elderly residents will be housed in community support systems amongst the other estates so that they can continue to have a good standard of care with dignity and not be pushed away from their community. This will be the basis of our policy with extra care provided so they can continue to be supported.
Rehousing of patients with domiciliary care needs will be expedited and the process made more efficient. We will place more investment in care packages to keep patients in their own homes.
Care Agency Choice
There are inconsistencies in the standards of care that the different subcontracted agencies provide. Personal bonds between carers and service users are often broken on the basis of remote managerial and administrative decisions. We will:
Empower patients with choices. Together Gibraltar is all about choice and this will be extended to your choice of carers. Once eligibility has been established, each service user will have the choice to use the Government approved agency they wish, based on their affordability and the rating given.
With the creation of a Quality Commission, all registered agencies will be consistently rated and verified consistently.
The Gibraltar health and social care sector employs thousands of people. These workers often receive different kinds of training for the same qualifications, which impacts on the cohesion of the service they provide. Together Gibraltar will introduce recognised qualifications with pathways to other roles, like nursing. To ensure that all required training courses are observed, a central bank of training providers will be created.
Register for care workers
Staff members from one care provider are being dismissed for acts of gross misconduct, only to be re-employed soon after by other providers. Just like the nursing profession, a register will be created to ensure that all workers in this sector meet the highest standards of training and vetting.
Communication and interdepartmental links
Communication between the PCC and departments within the GHA appears to be lacking. We will centralise the database of these areas to improve efficiency all round and eliminate repetition and unnecessary delays in patient treatment and care.
Consistency and nepotism
Health workers lack a consistency of goals and leadership. Managers interpret similar general orders differently. This lowers morale in the workforce and impacts negatively on the quality of service provided. We will consult with healthcare professionals to implement up-to-date guidelines for service protocols and staff management so that there is seamless consistency between departments. This will ensure that staff are treated fairly, help install a solid work ethic and raise morale.
Investment in People and staff morale
Healthcare workers are given short-term contracts that are not conducive to productive, healthy working environments. These contracts are cut abruptly, making workers go about their lives without knowing if they will have a job the next day. Disproportionate fees go to intermediaries (agencies), which do not provide value for money for the taxpayer or optimal care for the patient. This needs to be addressed with investment in staff and creation of better-quality employment. We will:
Standardise flexibility in working hours and arrangements throughout the health sites in consultation with management and according to business needs.
Address uncertainty about contract renewal and implement organised and structured succession planning.
Standardise supervision throughout the health and social care department, by a dedicated unit that will provide individual assessment of staff. This unit shall provide pathways for workers to provide feedback and complaints without fear of retribution.
Encouraged appraisals and incentives for innovation and excellent working practices, with promotions being meritocratic and based on sterling staff appraisals and standards of work – no more nepotism and “enchufes”.
Prioritise mandated training for all staff, with provisions for those in need of cover to attend.
Long-Term Staffing Plans
We want the nursing school to work with career advisors in schools to inspire suitable students and provide them with dedicated training, both in their homeland and abroad. Healthcare pathways can be offered from 16 onwards, including mature students wishing to switch careers. We have an excellent nursing school run by highly experienced professionals that can be expanded into specialised areas.
Junior doctors for Understaffed Areas
The A&E night shift currently only has only one doctor. This causes unnecessary waiting times, overcrowding and is potentially dangerous. This problem exists in many other departments. Junior doctors should be employed in A&E and other suitable areas as is the practice with anaesthetists (paed, gynae, ortho etc).
We will take steps towards St. Bernard’s Hospital becoming a teaching hospital for junior doctors completing the foundation year of their specialist training, an experience that has proved successful in the past. It will bring home grown talent back earlier and provide suitable staffing levels to understaffed areas.
24hr, Hospital-based Paediatrician and Gynaecologist.
We will ensure a Paediatrician and Gynaecologist will be available 24h in the hospital, and not on call as per the current system.
Investment in Staff
Morale levels amongst staff are low, with workers lacking basic amenities capable of providing proper working conditions. Shift workers are having to eat at sinks, and basic needs such as pumping rooms, chairs and resting areas not being provided. Rest rooms will be provided on each floor and the canteen divided in half so a general restroom can be built. Defined and timed breaks for all staff will be implemented.
Improve Guidance and support for Sponsored Patients
Sponsored patients often find themselves in need of help when abroad. We will expand the helpline to provide better support and guidance, proactively contact patients and their families to enquire about their situation, as well as liaise with foreign Health authorities and Calpe House to facilitate logistics. Other accommodation options will be facilitated when Calpe House is unable to cater for peaks of demand.
Chief Executive Officer
We will restore proper management structure and introduce a Chief Executive Officer in order to guarantee the independent and balanced management of the Health Authority.
Specialised nurses (diabetes, respiratory or cardiology specialists) can be trained to lead departments. This provides a quicker and more efficient service and reserves the consultant for more specialised cases. We would also look into implementing a triage system, with nurse consultants providing out of hours services for semi emergencies and a nurse led phone advice line.
New options and services to be introduced:
Baby friendly hospital accreditation
Move back to community midwifery- where mums feel safe to ask questions in their own environment and midwives can assess the home environment and flag concerns.
Triage for midwives separate to the ward.
Hotline for queries and concerns.
Active bank of neonatal trained nurses that can be called upon if a baby needing assistance is born.
Provide neonatal care by having a larger area and training for nurses to work with the current paediatrician who is also specialised in neonatology.
Have the current Paediatric unit on the fourth floor as a separate converted area for babies needing extra assistance and in between to the Rainbow Ward.
Conduct a comprehensive review of existing policies relating to the provision of government funded contraceptive services, including the provision of vasectomies and elective sterilisation.
Invest in training specialist GPs and have them act as the bridge between GPs and secondary care consultants.
Physiotherapists can be used to improve numerous health conditions, but the service is currently congested, and the referral list is considerable. The department will be expanded to include a 1st stage physiotherapist to complement the current service.
Dedicated physios for rehab, dedicated nurses will promote self-management of conditions, functional training for healthy bodies and lifestyle choice improvements. There will be an investment to create a fit for purpose rehabilitation ward to ensure safe management of the members of our family that have been in hospital. Lack of resources
Recycling facilities will feature in all suitable environments. With a segregated waste stream management, up to 30% of all waste can be reduced, as well as stericycle sharps management to reduce landfill waste. We will propose operating theatre- single use device reprocessing and medical waste minimisation. There will be no single use plastics to be used in the hospital or canteen. LCD bulbs will be incorporated and a “Switch off” policy will be introduced throughout the building.
Telecare and Telehealth
Community outreach and care will be introduced to provide better patient care and less impact within the hospital. Community outreach to be provided with sustainable vehicles i.e. electric bicycles. A paperless booking system and interdepartmental communication will be brought in.
Introduce a dedicated SHEF and FRMO team to ensure staff and patient safety with programmed regular testing.
Healthy Lifestyle Choices
As a health authority, it is important that we are proactive in setting social standards for healthy eating and lifestyles. This will allow us to help prevent the negative health effects of poor lifestyle choices. We will:
Install vending machines that only provide healthy products.
Deliver healthy lifestyle workshops, open to those who have chronic health conditions, allergies, diabetes etc
Employ a health coach to provide online feedback and motivational exercises and goals.
Deliver family life workshops to tackle childhood and adult obesity, making it fun to be active and eat healthy - with the additional bonus of family bonding.
Introduce a 24 hour canteen for staff and patient relatives, with a variety of healthy food options.
We will set up an evidence-based alternative therapy centre which is strictly controlled and capped.
We will introduce a secure whistle blowing policy so that staff who report failings will be guaranteed to be treated with respect and no risk of losing their posts. Whistle blowers will be protected in law.
Efficiency procedures and standardisation with across the board productivity to negotiate for pay review for health workers. We need to compete with the specialist medical market to ensure high standards of care.
Increase compliment for health visitors and back to community in line with multi-disciplinary team.
Breastfeeding is the first line in healthy eating. Babies that are breastfed have a reduced incidence of childhood illnesses, childhood obesity, diabetes and hospital admissions. A support service will be offered for all families that wish to breastfeed. We will:
Offer training in breastfeeding for midwives, nurses and all health professionals to support and refer breastfeeding families.
Create Baby friendly areas throughout all provided services, as well as unisex baby changing areas.
Introduce professional lactation consultants to properly administer these services.
Medicinal Use of Cannabis
Legalisation of Cannabis for medicinal use by Government is long overdue. Some cannabis products have already been legalised, but these are very limited, and are a far cry from a comprehensive list of cannabis-based products needed to combat various ailments. As an intermediary step towards the medicinal legalisation of cannabis, we would impose a framework that sees local patients being able to attain CBD products via prescription.
For both the points above, we will implement the following:
Licensing of local cultivators and manufacturers for hemp and cannabis-based medicinal products.
A "Medicinal Cannabis Authority" to oversee the entire industry, from seed to sale, to ensure that stringent standards are observed.
Licensing of local patients for the consumption of medicinal cannabis.
A Medicinal Cannabis Programme which sees patients being able to access the particular type of cannabis medication they need, under recommendation from specialist medical practitioners, GPs nominated to deal with the licensing recommendations of patients.
We aim to create a Medicinal Cannabis programme which is inclusive of all patients' needs, instead of relegating law-abiding citizens to the black market for their medication.