Download Health Matters - Gibraltar Health Authority

Health Matters
Gibraltar Health Authority
Annual Report 2005
Health Matters
Gibraltar Health Authority
Annual Report 2005
Credits
PUBLIC HEALTH SECTION
Dr. Vijay Kumar, Director of Public Health (lead)
Miss M. Sene, Cancer Registry officer
Mr. J. Easter, Health Promotion Officer
HEALTH CARE SECTION
Dr. David McCutcheon, Chief Executive (lead)
Contents
Public Health in 2003
Vital Statistics
Immunisations
Life expectancy and mortality
Health Promotion
Infectious Diseases
What is Bioterrorism?
Response to Bioterrorism
SARS
8
8
8
9
10
12
14
14
15
Health Care in 2003 Gibraltar Healthcare Development Programme
Obstetrics and Gynaecology
General Medicine and Specialties
Paediatrics
Anaesthesia and Intensive Care
The late Dr. Andrew Correa - Obituary
Laboratory services
Speech assessment and therapy
Operating Theatre The New Hospital
Eye Care
ENT Services
Information Technology
Palliative Care
Clinical Psychology
Mental Welfare Services
Physiotherapy
Occupational Therapy
Nutrition and Dietetics
16
16
16
17
17
18
18
19
19
20
20
21
21
21
22
22
22
23
23
23
Dr. P. J. Nerney, Primary Care Co-ordinator
Dr. S. Higgs, Consultant paediatrician
Mr. M. Haroon, Consultant ophthalmologist
Mrs. C. Vinent, Senior Physiotherapist
Mr. A. Wink, Senior Occupational therapist
Ms. M. McLeod, Senior Dietitian
Mr. A. Montero, Laboratory Manager
Mrs. C. Macias, Sponsored Patients Officer
Mrs. G. Phillips, Head Pharmacist
Mr. E. Lima, Director of Finance and Information Technology
Mrs. E. Cervan, Medical Records Manager
PRODUCTION
Mr. S. Perera (graphic design & photography)
Mr. S. Escudero (photography)
Miss M. Sene (administration and proof reading)
Public Health 2004
Minister’s Foreword
The Hon. Ernest Britto, Minister for Health
The period covered by this report
culminated with the most exciting and
significant improvement to our Health
Services in many decades when we
inaugurated our new St. Bernard’s
Hospital at Europort.
This came as a result of many months of meticulous planning and hard work by GHA Staff throughout the preparations for the main move on 12th
February 2005. Some departments started to move into the new building during late 2004.
The opening of our new St. Bernard’s Hospital required a capital investment in excess of £55,000,000, including some £20,000,000 of new equipment. The
success story of the New Hospital is there for all to see and from the very first day it started to attract favourable comments, not only from patients and their
families, but also from visiting health professionals who compare it favourably with private hospitals of the highest standards in their own countries.
Gibraltar is indebted to all those who in any way either directly or indirectly helped GHA in the successful migration of all its patients in St Bernard’s
Hospital from its old location in the upper town to its new environment in the Europort area.
The migration went quite smoothly and all patients and essential equipment were moved within a 5 hour period. Without doubt, this would not have been
possible except for the understanding and co-operation of those who suffered the inconvenience of drastically reduced parking in the vicinity of both
hospitals as well as on the routes between them. Also noteworthy was the co-operation of the general public in avoiding the use of their vehicles during the
migration period. This eased the circulation of traffic and made it so much easier for the vehicles carrying patients to move between the two hospitals.
All members of the GHA Staff co-operated magnificently by their full attendance, the long hours worked and by carrying out the transfer so efficiently and
effectively. Last but not least, Gibraltar’s gratitude goes to the patients and their families for their forebearance and patience during the move and in the
subsequent period of adjustment after arrival at the new hospital. Their co-operation was fantastic and they helped to make the job of all those persons
involved with the move very much easier.
It would be foolish of me to pretend that as a result of the new hospital everything is now perfect in our Health Service, that there is nothing more to do to
continue to improve it, or that regrettable patient incidents and experiences will not occur from time to time. But the same is true of even the best medical
facilities in the world. To ensure that we learn from mistakes so that they do not reoccur, in September 2004 we opened the Health Services to greater
scrutiny. Not only is the GHA’s own internal complaints procedure more open, timely and transparent, but it now includes an external examination by an
Independent Panel from outside the GHA with very great powers of investigation.
Of course, the opening of the new St. Bernard’s Hospital has not just been the inauguration of a new building, impressive as it is. The wards are divided
into spacious and comfortable rooms with one, two, three or four beds in each and most rooms have their own bathroom. A total of 212 beds are available,
about 40 more than in the old hospital, and each bed is being provided with its own television and radio facility. There are three Operating Theatres, as
opposed to only one in the old hospital, as well as day-surgery facilities. There is a modern and enlarged Accident & Emergency Department, a dignified
and spacious Mortuary, an Endoscopy Suite and a Staff and Visitors Canteen. But as I said, the new building is not the whole story. More Consultants will
soon be recruited and new medical services, never provided before in Gibraltar, will soon be available here. The forthcoming arrival of a new Consultant
General Surgeon will help with the launch of the new concept of day surgery, as well as with the introduction of new techniques such as ‘keyhole surgery’.
Improvements will also be carried out in the coming months to our system of patients health records, to our procurement methods and to our IT and
Communications systems.
Continuing to look through to the future, we will be seeking to carry out further improvement to systems and practices at the Primary Care Centre
in order to provide a more patient friendly service. We are also in the initial stages of preparation to carry out a review and modernisation of mental
health legislation and facilities at the KGV Psychiatric Hospital. Without any doubt the major developments expected in the coming months will be the
inauguration, for the first time ever in Gibraltar, of a Dialysis Clinic, of a CT Scan and a Mammography Service.
This is the measure of our commitment to our health service and of the huge transformation that is being brought about. We shall continue to bring about
improvements where they are needed and possible because the health of our families is the most important thing for us and we will continue to deal with
our health service on that same basis.
Vital Statistics
Population
According to the Government Statistical
Office, the final results of the national
Census 2001 published this year showed the
resident population of Gibraltar to be 27,495,
representing a growth of 3% from the previous
census in 1991. These finally published
figures differ only very marginally from the
provisional figures originally published and
therefore the analysis presented in the public
health report for the year 2002 remains
largely valid.
Births
The number of babies born in Gibraltar rose dramatically in 2004 to
421, when compared to the relatively constant numbers in previous
years (around 360). Of these, 223 were females and 198 were males.
The proportion of these births attributable to the resident population
was 91.2%, that of the Forces population accounting for the rest.
The birth rate in the resident population rose sharply this year to
14.0% reversing the downward trend in local birth rates since 1992.
The birth rate in the Forces population is estimated to be 23.0, also
a significant rise.
The number of births to teenage mothers remained constant this
year at 23, but this year for the first time, a birth occurred in a mother
as young as 14. There was also one birth to a 15-year-old mother. The
overall number of teenage mothers each year has hardly changed in
recent years and continues to be a matter for concern. There were no
teenage pregnancies this year in the Forces population.
At the other extreme, there was a significant rise in births to
mothers aged 40 years or older – this year there were 16 births
(3.8%) in this age group as against 5 (1.5%) in 2003 and 8 (2.2%)
in 2002. The age of the oldest mother was 51, while the oldest
mother in 2003 was 43.
Life expectancy
Gibraltar enjoys a good Life expectancy in keeping with the
standards for western societies and the actuarial tables from the
Census 2001 show that a baby born in 2001 could expect to live up
to 78.5 years (if male) or 83.3 years (if female). The magnitude of
this change is dramatic considering that life expectancies were a
full ten years lower, barely 30 years ago (1970).
The mean age of death in the resident population was 77.3
years (males) and 80.6 years (females), slightly higher than in
previous years.
Deaths
During 2004, 111 females and 110 males died, giving a total of 221 deaths in the
resident population, a crude death rate of 8.0, again roughly similar to previous
years. A further fifteen deaths of non-residents were also registered in Gibraltar.
There were no stillbirths or early childhood deaths this year.
Once again, the differences in gender patterns for the age of death were pronounced,
but less striking to previous years. This year, the pattern for both men and women
showed similar numbers of deaths until the mid 60s, after which the death rate
for men rises sharply to peak at around 80, falling gradually thereafter, while for
women, the peak occurs a few years later, in the mid 80s. Only 13 men reached the
90s, the oldest dying at 96. In contrast 26 women reached 90, three women reached
a 100 and one woman survived to 104.
Heart Disease - this year with 49 deaths (22%) - used to be the most common
cause of death but this year has yielded its supremacy to Cancer, with 50 deaths
(23%). This phenomenon is not unexpected, as people are living healthier lives
through to older ages when cancer is more common. However, the actual numbers
of deaths from both heart disease and cancer were the lowest this year for the last
seven years.
The types of cancer causing deaths have changed this year. Prostate cancer was
responsible for the most deaths, followed by cancer of the pancreas. Although
lung cancer was the cause of only three deaths this year, it still kills young – it was
responsible for the second-youngest person to die of cancer, a woman of just 34.
Breast Cancer was responsible for 4 deaths this year.
As in previous years, 16% of the deaths occurred at home. Again as in previous
years, 25 persons (11%) who died had diabetes recorded as a contributory factor.
Details of the main causes of death and comparisons to previous years can be found
in the tables.
‘Premature’ mortality
Cancer
As in past years, a review of all deaths under 65 was made. This is usually taken as an indication
While counting deaths is useful as an outcome
Registry. Such instances are very rare and very few
indicator for the quality of care and services, it
cases should be lost.
is not a good reflector of causation, for which
Radiological cancers are the most significant of the
incidence data would be more useful. The
three groups, not only in terms of numbers, but also
Gibraltar Cancer Registry was set up in 1999
in the wider prevalence of some of these cancers.
to collect statistics on each case of cancer as
These are cancers which are primarily diagnosed
it becomes incident. Subsequently, incident
by xray and not by pathology – examples are lung
cancers for the year 1998 were added but further
cancer, some bone cancers, pancreatic cancer, etc.
addition of retrospective data will not take place
These constitute a significant number and the
landmark. However, this year the position appears to be more even.
Cancer continues to engender public anxiety despite the
fact that death rates from cancer in Gibraltar are still lower
than the UK or Spain. This is because of many reasons,
not all medical. Research evidence in Spain showing high
cancer death rates in Andalucia, the presence of nearby
industries such as the Refinery in Algeciras and a general
fear of radiation are some reasons. Also, in a small insular
community, as every event eventually touches everyone,
events that arouse fear such as cancer, even if rare, are always
remembered and the incidence will appear to be magnified.
as it is not possible to assure data quality. The
potential for data loss is real. The matter has been
Cancer Registry continues to register new cases
The cause of death in people under 65 is changing. In the past, deaths from heart disease in
Cancer and the Environment
pursued since the early days of the Cancer Registry,
of cancer.
people under 65 had frequently reflected patterns similar to the other age groups, but this year,
but the lack of a radiology information system
Grossly polluted environments can contain harmful agents
that contribute to cancer, but the actual contribution of the
environment to cancer is often overstated. The influences
of several other factors in human health - genetic, lifestyle,
dietary and other - often dwarf that of the environment,
particularly in communities where air, water, food and soil
are regulated.
The Cancer Registry draws its data primarily from
meant that such data was practically impossible to
the reports of pathology department as almost all
retrieve after the event. Efforts are under way to use
diagnoses of cancer are made there. Protocols are
notification procedures in the new hospital, with its
now established for the notification, collection
more sophisticated radiology information system.
and quality control of the data originating from
It is intended to carry out an audit of data quality
this source and work well. There are however
in the following year. A summary of the cancer
some cancers that may fail to be notified through
notifications from 1998 to 2004 as stored in the
these means and these fall into the following
Registry is presented in the tables.
of “premature” mortality, assuming that a key health goal for all Gibraltar residents is to achieve
survival to at least 65 years, which is still 10 years below average life expectancy.
Of the 221 people who died this year, only 21 (9.5%) were under 65 years, a fall from the usual
proportion of around 18%, which is a very encouraging development.
In previous years the gender contrast has been striking, with premature mortality being a
much bigger problem with men, than with women. For example, last year, only 11% of women
died before their 65th birthday, whereas 23% of men (nearly a quarter) failed to reach this
the fall in overall heart disease mortality is matched by an even greater drop in the under 65s
– only two people died of heart disease. However, more than half of these people died of cancer
(52%) but it was not possible to identify a specific type of cancer as being more contributory.
The resident population
of Gibraltar is 27,495,
representing a growth
of 3% from the previous
census in 1991
The following are the chief influences in the Gibraltar
environment.
• By far the most strongly proven cause of environmental
pollution is tobacco smoke, which directly and intensely
pollutes the inhaled air of both the smoker and those
exposed passively. The attributable risk from this one factor
dwarfs all other factors, for those who are affected.
• The biggest cause of general air pollution in Gibraltar
is traffic. Peak hours and frontier queues result in large
numbers of stagnant vehicles burning fuel inefficiently,
sharply raising levels of hazardous gases and particles in the
air. There could be number of localised areas of air pollution,
the most obvious example being the Dockyard, with low-level
smoke from generators and aerosolised industrial paint.
• Other contributors are relatively insignificant.
The Refinery is often blamed, but the dilutional effect of
wind forces and distance reduce this risk considerably,
provided the plant as a whole is adequately regulated.
Drinking water pollution is not a problem because of
desalinated production. Bathing water in the beaches
is more affected by sewage pollution, but this is
intermittent.
Trends in mortality
It is difficult to make a statement about trends in mortality as the numbers fluctuate fairly
widely, albeit within a narrow margin. It is safe to say that the total number of deaths this year
(221) is the second lowest in the past seven years.
However, when the causes of death are examined for trends over the past seven years (1998
to 2004), it is striking that the number of deaths from Heart disease show a clear downward
trend while the levels of other causes remain more or less the same. This is encouraging and
although it is too early to judge the factors behind this trend, it is at least likely that advances in
surgical and medical treatments, together with the messages about smoking reduction, weight
reduction and healthy lifestyles may be having an impact.
Cancer Registration
There is very little food manufacturing in Gibraltar and
environmental food pollution issues are few. Imported
problems (such as mercury pollution of swordfish) are
addressed as they arise.
Soil pollution has not been greatly investigated, but a
recent geological study by a local student showed some
heavy metal residues from the military past but not to a
great concern.
The conclusion is that apart from tobacco smoke, there
is at present no identifiable and serious environmental
carcinogenic threat operating significantly at a
population level. Analysis of the cancer registry database
may yield further hypotheses.
categories:
Cancers investigated and diagnosed by overseas
pathology departments (e.g. Royal Marsden
Hospital) are not always notified to the St Bernard’s
Hospital Pathology department and efforts
“Eating fruits and
vegetables every day
prevents cancer”
are being made to improve coverage. Cancers
diagnosed privately (in Spain or elsewhere) may
only reach the Registry if the patient returns to
the public sector and a copy of the pathology
report is forwarded to the laboratory.
Inoperable cancers (eg. some head and neck
cancers, vascular sarcomas, etc.) are sometimes
not investigated pathologically, but this is rare
and when this happens, there are now agreed
notification procedures with the general and
ENT surgeons to notify such cases to the
Infectious Diseases
Laboratory confirmed notifiable infections
Again this year, there was a small rise in infectious disease notifications (199) compared to the previous
year (184), but still below the large numbers regularly seen before 2001 (over 230).
There was a sharp fall in the number of cases of food-borne infections such as Salmonella and
Campylobacter, which again accounted for most of the fall in notifications. There were 90 cases of
Salmonella as opposed to 129 last year, and 32 cases of Campylobacter infections this year as opposed to
24 last year. The continued reduction in Campylobacter infections seems to suggest that the standards of
public hygiene may have improved.
There was a small outbreak of salmonella infection among some long stay residents of KGV hospital. The
cause of this was identified to be delays between the cooking and serving of the food to the residents.
Measures were taken to minimise this delay and it is hoped that the situation will improve even more
under the new catering facility set up by the Authority.
There were no cases of meningococcal infection during 2004.
Multi-Resistant Staphylococcus
Aureus (MRSA)
During 2004, 33 cases of infection due to MRSA
(multi-resistant staphylococcus aureus, an
organism resistant to most antibiotics) were
reported. This was an unusually large number and
warranted further study. An audit was carried out
of all MRSA infections ever recorded.
It was found that between 1994 (when the first case
of MRSA was isolated in St. Bernard’s Hospital) and
1998, MRSA isolations were relatively rare, around 2
to 3 per year. Between 1999 and 2003, the incidence
increased to around 13-15 infections per year. This
period coincided with a huge upsurge of MRSA in
several countries of the world (including UK and
Spain) and nearly half of all cases could be clearly
identified as having been imported by patients
returning from overseas hospitals. Despite stringent
measures adopted, a certain number of homegrown
and hospital acquired MRSA infections also began
to make an appearance. It is also possible that the
increased interest and attention to MRSA led to
more cases being investigated and identified.
Against this background, the finding of 33 cases in
2004 was still unprecedented. On closer analysis, it
emerged that the number of cases acquired from
abroad was falling and was the lowest since 2001.
Thus imports could not be blamed for the rise,
but instead increases were observed throughout
every other category. There were also some
freak occurrences, such as an unrelated cluster
of long stay residents, two septicaemias and an
unexplained large group of persons with intrinsic
infection, all of which may have inflated the figures
without providing a cohesive explanation. Thus, the
audit did not pinpoint any single factor responsible
for the unusually large number of MRSA infections
in 2004.
It is of course possible that this was an aberrant
year, the figures being no more than a statistical
oddity. Only future years will tell whether this rise
will dissipate, or be sustained, indicating a greater
endemicity of MRSA in line with the UK and
elsewhere.
Other infections
Following the admission of a patient with UK
acquired scabies infection, several ward staff who
reported with itch symptoms were reviewed by the
specialist dermatologist but no scabies was found.
There was a rise in chlamydia isolations, from less
than 3 a year in previous years to 8 this year. This is
more probably an indication of greater awareness
among health professionals rather than any abrupt
increase in incidence.
Immunisation
Routine immunisation programmes continued to be carried out during 2004 as per schedule. The annual winter Influenza vaccine campaign also continued
this year.
However, the key event of the year in immunisation was the introduction of the Five-in-One vaccine. The Five-in-One vaccine (or more correctly known as DTaP/
IPV/Hib vaccine) is a new vaccine that replaces three vaccines that are normally given to all children separately - the old Triple vaccine, the Polio vaccine and
the Hib vaccine. The new vaccine had been used in the routine childhood programme in Canada since 1997 and was introduced in the UK in early 2004. It
produces very effective immunity to five serious diseases of babies and small children : Diphtheria, Tetanus, Pertussis (also called Whooping Cough), Haemophilus
Influenzae B infection (also called Hib) and Polio.
When compared to the existing vaccines, the new Five-In-One vaccine offered four major areas of benefit:
• It uses inactivated (killed) Polio virus, as opposed to the live virus in the old vaccine, thus abolishing the slight
risk of causing vaccine-associated paralytic disease.
a model lung, which attempted to illustrate the damage smoking causes to
our body. Materials purchased ran out quickly and more should have been
purchased to cover St. Bernard’s hospital and other departments such as the
youth and social services. The late arrival of campaign resources from the UK
presented difficulties for the timely dissemination of posters, stickers, banners
and leaflets to schools and other public places.
The No Smoking Day campaign’s effectiveness at population level depends on
achieving wide reach, particularly among individuals most likely to respond
positively. The public response to the campaign was reasonably good. A few
individuals approached the table for information on how to quit smoking. The
campaign must continue to keep awareness levels high in order to ensure that
smokers have the opportunity to respond.
Radio Gibraltar reported the event in an early morning piece preceded by a
series of talks on Healthfile. GBC TV covered the event on the day and screened
the interview on Newswatch. A series of articles were published in the Gibraltar
Chronicle before and during the campaign, covering such areas as smoking in
young people, smoking in the workplace and passive smoking.
It was not surprising that, as on so many past occasions, the majority of people
who visited the displays wanted to know when smoking cessation clinics
would be set up. The development of smoking cessation services is essential
and pressing.
• It uses acellular pertussis vaccine instead of whole-cell pertussis vaccine, thus reducing the risk of neurological side effects.
• It has no Thiomersal (mercury) in the vaccine, thus reducing allergic skin reactions
• The combining of the vaccines means fewer injections and clinic visits for the baby.
The switch-over went smoothly and without incident.
Sun Awareness Campaign, summer 2004
Gibraltar’s sixth Sun Safety Campaign took place on 12th June 2004 with
the now regular beach visits. Some hot weather ensured that the campaign
was well timed.
Bioterrorism
Bioterrorism continues to remain a matter of importance in the wider
political scene and the local preparedness in the face of the smallpox threat
was described in last year’s report. A key deficiency identified was the lack
of awareness and training on bioterrorism in health care professionals and
in February 2004, the department organised a Seminar on Bioterrorism
with the support of the Civil Contingency fund. It was inaugurated by the
Minister, delivered by the foremost experts in the field from the UK and
attended by a large number of local doctors and health care professionals.
The resources included lectures, discussions, a simulation exercise, an
inter-services workshop and study materials. Participants as well as faculty
judged the Seminar to have been a great success.
The health service responded to two Suspect Package Incidents during
the summer, involving white dust falling out of letter packets. These were
analysed by the hospital laboratory and revealed a white, gritty, crystalline,
organo-chemical substance, which was proved not to contain anthrax.
Although no harmful substance was found, circumstantial factors suggested
a malicious intent and the matter was taken up by the Police.
The Miss Gibraltar contestants’ help was again invaluable and they did
tend to focus on promoting sun safe behaviour to the adolescents. Newall
Holdings Ltd kindly sponsored the event supplying T-shirts for the
campaigners with the message ‘Keep the sun off your back’ on the reverse
to create a uniform look, bottles of sunscreens for use throughout the
campaign and refreshments for the campaigners. A campaign bus and
driver were hired.
Articles were published in the Gibraltar Chronicle, Insight Magazine, and
the Panorama. A radio piece was aired for the GBC Healthfile slot. The
Health Promotion
Leaflets ‘The Sun & you’ were re-printed for the campaign and distributed
at the beaches. They were also distributed to all pharmacies, the post office,
supermarkets and other public places such as bars. The successful A5 flyer
Health Promotion
As has been the case in recent years, the year 2004 continued
to be a very active and busy one for the Health Promotion
department. The delivery of the department’s campaigns,
literature production, organisation of events and leading
initiatives still continues to be shouldered by a single Health
Promotion Officer, a situation that has become stretched.
The multi-agency collaborative Health Promotion Group has
continued to meet regularly throughout the year.
The following is a summary of the campaigns, events and
developments that have occurred in the field of health
promotion during the year.
No Smoking Day, March 2004
Wednesday 10th March 2004 was Gibraltar’s fifth consecutive No Smoking Day. The
Day’s combination of highly visible public displays at the Primary Care Centre and
media involvement intended to intensify and widen awareness, with the ultimate
aim of fostering a supportive environment for smokers wanting to take steps
towards quitting.
‘Be Sunwise’ featuring the character ‘Sunny’ and aimed at preparing the
children to be ‘sun wise’ during the summer break was distributed to
all schools and nurseries again this year. Posters were also printed and
distributed to the above establishments.
It however seemed that the public reaction to the campaign was not as
positive as in previous years. It is possible that the campaign has become
jaded with repetition and a different angle will be explored next summer.
The ‘Be Sunwise’ campaign promotes high-factor protection
Coronary Heart Disease Awareness Day 2004
The third Coronary Heart Disease Awareness Week took place on 8th - 12th November 2004 at the Primary Care Centre. Information was displayed as usual,
aimed at both heart disease patients and well people, but in addition there were themed displays on ‘women and CHD’ and ‘men over the age of 40’. The
Cardiac Nurse Specialist kindly monitored and managed the resources throughout the week.
Banners carrying information on CHD in Gibraltar were hung around the foyer of the PCC (main area) and were very noticeable. The new leaflet ‘Looking
after your heart’ produced by the Health Promotion Group specifically for the event was distributed within Primary Care. Articles on CHD were written and
submitted in the Gibraltar Chronicle during CHD week. The Chronicle also provided the front-page headline “Gibraltar’s Biggest Killer Revealed”, which
stimulated public interest. Insight Magazine also published an article. An interview was broadcast on GBC TV on the campaign and the importance of
CHD awareness in Gibraltar.
There was quite a lot of positive feedback from the public. Several health care professionals in Primary Care also expressed appreciation for the campaign
in this important area.
There were many different posters on display, a wide variety of leaflets and even
10
11
The GOOD Health Award scheme has been in operation now for two years. Coronary Heart Disease (CHD) is one of the biggest killers globally as well as locally and
the prevalence of overweight and obesity is rising in the local community in adults and children. The Scheme is intended to encourage restaurateurs and caterers
to promote healthy eating in the community. By taking part in the scheme and gaining the award, caterers can make a positive contribution towards safe dining
and healthier living.
Trying to motivate restaurateurs onto the scheme has not proved to be easy as there are many commercial disincentives. However, the work of the Tourist Board in
promoting the award-winning restaurants is a valuable asset.
The current Awardees are listed below:
Gold Award
Silver Award
Bronze Award
The Rock Hotel
Airside Services
Bunters
Rooke Officers Mess (MoD)
WO + Sgt’s Mess (MoD)
Devils Tower Camp (MoD)
Carpenters Arms
Little Rock Café
Kowloon Chinese Restaurant
The Clipper
Paradiso
Chez Nous
Just Desserts
Café Boheme
Bug Busting
There is still a lot of public confusion on the proper
approaches to address the head lice problem with calls
to bring back the ‘nit nurse’. This is a misunderstanding,
as this old-fashioned resource, while being expensive has
never really delivered the expected results. The best place
to address the problem of lice infestation is the home,
not the school or the doctor’s surgery. Regular parental
attention and care is the only approach that will rid the
child of head lice.
With this in mind, the department organises Gibraltar’s Bug
busting campaigns regularly scheduled for 1st February and
1st October every year. The purpose of these is to provide
parents, schools and childcare establishments a unified and
synchronised focus for lice disinfestation, thus reducing
opportunities for re-infestation. Supportive leaflets on head
louse infestation and its management were produced by the
Health Promotion Group and distributed to the children by
the education department. Additional posters were created
and placed in the Primary Care Centre waiting rooms and
in the schools. Professional advice to teachers and parents
was also made available. The literature was updated this
year to clarify the roles of professionals, to provide useful
advice in managing difficult infestations and eradicate the
harsh unnecessary practice of child exclusion.
Health Promotion Group WebPage
Perhaps the most exciting event in the Gibraltar Health Promotion Group’s calendar this year
was the launch of its website, developed with the aim of providing an information service for
the public as well as for health professionals. The site was developed with help and suggestions
from a number of health professionals who focused on creating a site that would be an
informative yet friendly resource bank.
The website address is www.health.gov.gi
The website has broadly been constructed around a main page describing the work of the
Group, with information on contacts, listing of events and links to download leaflets. There are
also sub-sites for parents and carers (focusing on positive parenting, with a useful section on
nutrition of children), for teenagers (youth zone) and for younger children (with quizzes and
fun stuff evolved around a health theme).
The whole process of publishing the site, from the
storyboard through construction to launch has involved a
huge amount of work, including a detailed review of the
literature and professional assistance from graphic and
web designers. However, knowledge does not stand still
and it is hoped that users will contribute to keeping the
site updated and accurate.
While such a resource can be very useful, care has been
taken to point out that the website is not intended to act
as a substitute for personal medical advice, but aims
to provide generic information on a variety of health
issues. Personal advice should always be sought from the
appropriate health professionals.
Bus stop posters
One of the innovative approaches that the
Health Promotion Group has introduced is
the use of bus shelters to disseminate health
promotion messages. The Claims Centre very
kindly provide space at no cost and the Group
has produced a number of posters on various
topics, including: Sun Safety, Smoking and
The GOOD Health Award Scheme, all of which
were displayed at several points during the
year and rotated. Posters under development
include Promoting fruit and vegetables ( 5 a
day), protection against STDs and HIV/AIDS
awareness.
Involvement with other agencies
The Department, through the Health Promotion Officer, is also involved in collaborative work on promoting health with several
local groups such as the Department of Education, the Sports Development Unit and the British Forces Health Promotion Group
Press and Media Relations
The Health Promotion Officer continues to contribute regularly to Radio Gibraltar’s “HealthFile” slot at monthly intervals. The
purpose of these interviews is to raise awareness on a variety of health-related matters and to encourage individuals to adopt a
healthier lifestyle. It is also used to publicise forthcoming campaigns.
Health advertising on television (“infomercials”) has great potential but past experience has shown that commercial production
is prohibitively expensive and amateur production is unreliable. Nevertheless the efforts continue. Radio infomercials are also an
important medium for health promotion and requiring a lesser technical approach to the construction of the product, seem more
attractive. Key issues to tackle would be smoking, obesity and sun awareness.
To put things into perspective, it should be emphasised that
although people find them repulsive, head lice are not really
a medical problem, as they do not spread disease. Even the
symptoms (such as itch) only arise because of the body’s
intolerance of the parasite and does not occur in everyone.
Better understanding can prevent a lot of unnecessary
hype, anxiety and overreaction.
12
13
Mount Alvernia
A PCC GP visits Mount Alvernia four times weekly for 3 hours at a time. Full
emergency cover is provided at all times.
Health Care in 2004
Home Help Pilot Scheme
This has been a source of considerable help to many elderly people living at
home without adequate family support. It is an important means of enabling
elderly people to remain in the community rather than having to admit them
to hospital.
PCC Nurses
Primary Care
General Practitioners
The GP complement has been held at 16 .
Continuing Professional Development (CPD):
• The process of in house performance Appraisal has begun with a visit and
initial assessment of trained GP Assessors from the UK. All GHA GPs have been
appraised and a suitably tailored programme of CPD developed.
• There are continuing fortnightly CPD sessions for all PCC GPs. These are
dedicated to practical general practice issues and case presentations. They are
organised by the GP group.
• Intercalated with these sessions are fortnightly Multi-disciplinary sessions of
wide interest to all GHA medical, nursing and PAMs staff. These are held in the
PCC on alternate Wednesday afternoons, are organised by Dr J Negrette and are
well attended.
• Five GPs have attended week long refresher courses in the U.K.
• Hospital based Basic Life Support refresher courses are now organised for all
PCC medical/nursing staff.
We have continued to develop the concept of PCC clinic nurses
working together in small groups providing support for small
groups of GPs and their patients. Instead of spending time in
the GP clinic helping the individual GP as required the nurses are
based outside the clinic. They will have an increasing range of
responsibilities some of which will be clinical e.g. triage, history
taking, blood pressure and blood sugar monitoring. In this way
we expect that the nurses role will become more pro-active, more
responsible and more useful. The nurses will not simply be GP’s
assistants but will also have a developing independent role.
One Clinic Nurse is now in charge of cryotherapy sessions
– previously a GP’s remit. She also assists in the visiting
Dermatologists clinic which is now held in the PCC.
The two Nurse Practitioners are now established and carrying out
an absolutely invaluable task covering many aspects of what was
previously considered a Doctor’s role.
Operational Changes
Emergency Team arrangements
Demand continues to rise and the emergency Clinics of both GPs
and Nurse Practitioners remain over-pressed.
We are now running regular, Specialist GP supported, Dermatologists’
clinics in the PCC with notably reduced waiting times and greatly
improved educational content.
Some GP clinics times are now staggered allowing appointments
over lunch time and ensuring a GP presence in the PCC at all times.
Computerisation
Electronic Appointment System
In the past year we have developed a PCC IT Network well supported
by Mr Heath Watson.
This system has been operational since Summer 2003. It has been
regularly updated and developed in response to circumstance and
has certainly allowed us to offer a better service than with the old
paper based system.
Many more PCC staff now have basic Computer support. All of the
PAMs departments, all Admin areas and most of the GPs have PCs.
In all there are about 40 PC s in the PCC. These PCs are linked to the
PCC server.
It is now much easier than before to make an appointment by ‘phone’.
However considering that 400 appointments on average are made
daily at the PCC it is clear that it will never be possible to guarantee
instant ‘phone’ access. There is a deluge of phone calls to the pcc
between 8 and 10 am which creates problems at that time.
We all now have access to the e British national formulary. The GPs
have in house, amateur clinical database software and access to the
central PCC appointment system. However, we still lack a networked
professional clinical system and this is a major weakness in the PCC
set up. It severely limits our ability to provide a high quality service.
The failure to re-register patients has also prevented many positive
developments.
Each patient is now given a definite appointment time rather than a
block booking time shared with other patients. Most GPs now offer
14
seven and a half minute appointment. Each GP in a normal clinic
sees an average of 16 patients per session.
15
Report of the Paediatric
Department 2004
Altogether 7010 children were seen at the Child Welfare Clinic, of which 583
were examined by the paediatrician, 971 assessed by the Health Visitirs, and
299 by Dr Vasallo (2 years assessments)
The Paediatric Department continued to extend its service
The Child Welfare Clinic Staff and School Health nurses provided an excellent
and dedicated service throughout the year
during 2004, both in hospital and in the community.
Child Protection
Hospital
The Child Protection Team headed by the paediatrician comprises the child
welfare staff, midwives, social workers, general practitioner, accident and
emergency staff and the Director of Public Health. The team has met at intervals
to discuss providing an intact system to identify and manage children at risk.
The ‘at risk’ register is kept up to date and communication between the various
disciplines is good. A protocol for management of the ‘at risk’ child (protection
policy) is being drafted.
There were 888 patients admitted to Rainbow Ward during
the year of which. 447 were Medical, 79 Surgical, 238 dental,
44 orthopawedic, 90 ENT, 9 Gynaecology, 8 Plastic Surgery, 3
Opthalmology.
In the General Outpatient Clinic 620 children were seen by
Attention is being given to acquiring further child protection training to all
staff involved.
the Paediatrician.
School / Department of Education
escalated as a result of meeting the need for early or urgent
The visits of Dr Philip Jardine, Paediatric Neurologist from Bristol at 6 monthly
intervals ensures that all Special needs children are seen annually. These visits
have been of immense help in identifying the complex diagnoses in these
children and focusing specific treatment and management programmes. The
paediatrician individually assesses the children on weekly visits to St Martins
School in preparation for the neurologist’s visit.
referral allowing children to be seen within 2 or 3 days of
referral. Altogether 497 children were seen.
The Allergy Clinic has become the busiest clinic of all.
Children are investigated for their allergies by the Allergy
The input from the special needs teachers, speech, occupational and
physiotherapists working with these children is deeply appreciated. The
centralisation of these services ensures a comprehensive service, which is
second to none.
Team, including skin testing and blood tests. The two
lead nurses continue to contribute to the care with their
expertise.
incorporating individual counselling by Sr Mary Sene,
Newborns
regular checks and a visiting service by Dr Ahmed Massoud,
The fruits of the distance-learning course in 2003 paid off in the form of better neonatal
nursing care through the year of 2004.
Paediatric Endocrinologist from Northwick Park, London.
The use of insulin pumps is being investigated in line with
modern trends. Sr Sene attended a workshop in this respect
A number of sick newborns and preterm infants were managed in the unit, obviating
transfer of the newborns to the Intensive Care Unit in Malaga. Throughout the year a total
of newborns/premature infants were transferred to Malaga.
Constant communication and sharing of knowledge occurs
With the opening of the new hospital and in particular the Neonatal High Care Unit,
more sick infants will be able to be managed locally. The new CPAP machine for noninvasive ventilation will enable infants with mild respiratory distress to be treated
without transfer.
between the consultant and the nursing staff mainly on an
The nursing staff is to be congratulated on their fine record of care.
informal basis. It is hoped that a formal continuing education
Altogether 377 infants were born in the Unit. The caesarean section rate was 23%. There
were no stillbirths or deaths.
in London recently. Adolescent counselling has received
priority in order to improve control in this difficult group.
programme will be possible in 2005 when the consultant will
have more time on the ward for teaching.
Sr Sene and her staff are to be congratulated for their
dedication, excellent standard of nursing and holistic
approach to patient and parent care.
Mothers were transferred to Malaga in premature labour and 1 was transferred after birth
for intensive care.
The BCG immunisation programme after birth was launched in April 2004. The
Paediatrician received training in administration and was able to train all the midwives in
the intradermal technique. All infants under the age of 3 months were included at the start.
The success of the campaign and any reported side effects are being monitored.
Finally a second Paediatric Consultant will be appointed
in 2005 which will enable one paediatrician to focus on
the paediatric ward an d neonatal and emergency service,
and the second to develop the community service further
(Child Welfare, liaison with the general practitioners, child
protection, learning disabilities etc)
16
This caters for children with learning problems assessed by Mr Freddie Trinidad,
Principal Educational Psychologist, who need medical evaluation and possible
medication. This service has developed rapidly throughout the year and Mr
Trinidad and the Paediatrician meet regularly to discuss common patients and
their management. It is hoped with the advent of a second paediatrician that
the Clinic can be expanded further, doing justice to this important aspect of
ambulatory paediatrics. The paediatrician met with the teaching community
at Bleak House to discuss the medical aspects of management of the Attention
deficit Syndrome, raising the level of awareness in the schools for this
condition.
A significant move forward is the appointment of a clinical psychologist with
experience in children. Dr Cantos will commence work in February 2005 and
the wide gap in the psychological service for children will be closed.
The new St. Bernard’s Hospital
The Paediatric Department will move to the new hospital in February 2005.
The number of children seen in the Rapid Access Clinics
The paediatric Diabetic service develops steadily,
The Learning Disabilities Clinic
Community Paedriatrics
The presence of the paediatrician at the Primary Care Centre for 3 clinics per week has
forged closer links with the general practitioners. The assistance of those with a special
interest in Paediatrics is greatly appreciated: Dr Vasallo (2 year assessments), Dr Risso
and Dr Pinto (Paediatric diabetes), Dr Penrice (child protection) and Dr Thoppil (general
paediatrics).
The Rainbow Ward will have 20 beds, of which 2 are high care and 5 are isolation.
In addition there is provision of 2 adolescent beds in private wards. Adolescents
are increasingly being incorporated into paediatric care. Children under 16
years will be included. Staff is being briefed in the care and management of
adolescents, presenting a new challenge in the care of this age group.
On the newborn side there will be a high care unit with better monitoring and
the facility of non-invasive ventilation.
A dedicated area for paediatric patients in the Accident and Emergency is
planned which will improve the assessment and management of children.
Department of Anaesthesia and Critical care
Substantial progress has been made in bringing the department up to agreed worldwide standards and above and preparing for the move to the new hospital.
The department is a consultant led service providing expertise in anaesthesia, critical care, resuscitation (in and out of hospital) acute and chronic pain, and
transfer of the critically ill. It has been focal in the education and training of staff in the recognition of the critically ill, cardiac and trauma life support, with
Dr Roberts continuing as an Advanced Trauma Life Support Instructor in the UK The appointment of permanent members of staff have helped to stabilise the
transition to the new hospital with many new multidisciplinary guidelines and protocols being introduced and bringing up to date evidence based medical
treatments and techniques. Dr Rebello has been appointed as the lead in chronic pain bringing with him a wealth of experience and skill. Dr Svendsen brings with
him from Sweden a great deal of experience in cutting edge Anaesthesia and Critical Care will be taking a lead in theatres All critically ill patients are now treated
by consultants with recognised training in Intensive Care and with improved multidisciplinary working has enabled the GHA to provide a more comprehensive
care package to the population of Gibraltar.
As the department continues its proactive role within the GHA it looks forward to a bright and dynamic future in the new St Bernards
Department of Ophthalmology
A final report of our work at the old St Bernard’s Hospital before we said
goodbye. The Ophthalmology Service has progressed to a very high standard
in the Primary and Secondary care aspect during this year.
The Ophthalmic nursing staff, Optometrist and Orthoptist have contributed a
great deal to expand the Ophthalmic Primary Care Service. In addition to their
routine work, nurses provide vital emergency ophthalmic care. A total number
of 385 emergency treatment was offered by the nursing staff.
The Optometrist, in addition to her routine work, also supported the cataract
waiting list initiative by performing post-operative assessment and refraction
for 178 patients in 23 Clinics from January to February.
Optometrist routine work involves post-operative refraction, refraction for
children and adults, diabetic retinopathy screening clinics, glaucoma screening
17
clinic and a joint clinic with the Consultant Ophthalmologist. The total number
of outpatients seen by the Optometrist during this year was 1502. Waiting
time for diabetic retinopathy screening is currently 8 months, for routine adult
refraction 14 months and for children 2 months.
There is urgent need for a low visual aid service for the visually handicapped
and we are exploring ways to free some sessions for the Optometrist to establish
and run this Service.
A Diabetic Retinopathy Screening Service is a very important public health
project. Our Optometrist cannot single-handedly run this Service. We need
to look into the possibility of involving the other ophthalmic staff such as
ophthalmic nurses and Orthoptrist. (Cont.)
Routine refraction needs to be directed to the Main Street Optometrists. We are
exploring this possibility.
The cataract waiting list initiative had a tremendous impact on the waiting
list. Over 192 patients cataract extractions were performed by the external
team commissioned by the GHA during December 2003. There were many
shortcomings of this project due to poor organisation but overall it made a
significant impact on the waiting list.
The new phaco machine leased for the waiting list initiative and the usage
of disposable cataract packs for surgery have doubled the cataract surgical
throughput. Eventually the new phaco machine was purchased and it is a great
asset to the Unit. I am glad to report that we don’t have a surgical waiting list
problem in our Department. Patients were operated within 4-6 weeks from the
day of listing for surgery. I think it is a great achievement.
During this year we carried out 300 phaco-emulsification cataract surgeries
with excellent visual outcome and patient satisfaction.
cataract surgery. This year we have performed 315 major ophthalmic surgeries,
most of them cataract operations. We have done 69 minor ophthalmic surgical
procedures.
We offer ophthalmic laser treatment, particularly for retinal vascular
problems such as diabetic retinopathy. We carried out 158 ophthalmic laser
procedures this year.
Most of the workload is in the Outpatient Department. We held 151 general
Ophthalmic Clinics this year and roughly 4500 patients attended these Clinics.
Tertiary referrals to Moorfields Eye Hospital in London are the patients who
need vitreo-retinal surgery, corneal grafting and some required second
opinions. These referrals are few in number. The statistics are not available
for me to present.
There was some disruption to the Orthoptic Service due to the maternity leave
of our regular Orthoptist. Locum cover was provided by Mrs Diana Owen who
did a good job to continue the Service until she resigned the post due to medical
reasons.
Introduction of an Orthoptic Service in Gibraltar has tremendously improved
paediatric ophthalmic care. We manage to control and treat amblyopia
effectively and the incidence of surgical correction of squint in children is
reduced to the minimum.
The old St Bernard’s Hospital has served the community extremely well,
though with its limited resources. We, in a limited space, managed to provide
a comprehensive Ophthalmic Service. We performed the latest small incision
cataract surgery in a very small room in the Outpatient Clinic with results
comparable to modern units anywhere in the world.
We perform a wide range of ophthalmic surgical procedures that include phacoemulsification cataract surgery, glaucoma surgery, strabismus surgery and
various other minor surgical procedures. The bulk of our surgical workload is
By the end of 2004 we are mentally prepared to venture our future in the new
St Bernard’s Hospital. There are many challenges ahead of us. Our aim is to
achieve a patient focused modern Ophthalmic Service to our people and we are
ready to work towards realising this goal.
Physiotherapy Services
Students
Continuing Professional development - CPD
Physiotherapy training for 2006
4 students are undertaking Physiotherapy Degrees in the UK. Due to qualify in
2005. Students will then complete 2-year post–graduate Junior Rotations in the
UK before applying for posts in the GHA.
Courses undertaken as per Personal Development Plan:
Individual Physiotherapy Professional Development as per Personal
Development Plans:
Bank Staff
• Angie Fortuna: 8 day Spinal Mobilisations course UK
Human Resources
Physiotherapy staff
• Caroline Vinent- Superintendent II / PAM Co-ordinator
• Eddie Linares - Deputy Supt. / Manual Handling Co-ordinator - In-patients
• Carole Williams: Senior I -Special Needs / Paediatrics
(Maternity Cover -Gail Smith)
• Angie Fortuna: Senior I -Out-patients
• Janice Wink: Senior I -Community Adults
• Lynne MacDonald: Senior II -Rotations (returned from Maternity
Leave July 04)
List of Registered Bank staff available to cover sick/annual leave.
Total of 8 weeks cover was provided (resident Physiotherapist), allowing
the service to remain operational in critical areas, whilst providing the local
physiotherapist with additional experience/maintaining /building skills
following post-graduate rotations in the UK.
New Staff
• Janice Wink: 2 days Normal Movement UK/ Certificate in
Management Course
• Caroline Vinent: (PAM Co-Ordinator) 4 days 360 Appraisal and
Executive Coaching UK
• Eddie Linares: Managing Safely IOSH 4 days
MDT GHA courses attended
• Orthopaedic Seminar -Physiotherapy contribution by Angie Fortuna
• International Nursing Conference 2 days
• Tosca Figueredo: Physiotherapy Assistant
The recommendation from the Orthopaedic review was for a further 2 Outpatient Physiotherapists.
No increase in Physiotherapy staff complement during 2004.
2004//5 Estimates: New Hospital In line with new Services:
• Tanya Gilson: Physiotherapy Assistant appointed Sept. 2004*
• Hydrotherapy – Physiotherapist and Assistant
• Building a Patient Safety Culture and Managing Risk Seminar 1 day C.Vinent
• Samantha Victor- Junior Clerical Grade
• In-patient Physiotherapist
• BLS Update of all staff
*Replace existing posts
• Community Physiotherapist/out-patient Physiotherapist
• Manual Handling Update of all staff
• Cathy Pons: Senior II Rotations
• Amanda Danino: Senior II Rotations appointed Sept. 2004*
• Rehab Clerk
• Module in Rehabilitation Practice: 5 days E Linares, L Macdonald, A Danino
• ALS 2 day course Janice Wink
• Phototherapy Update
• ITU Update
• Paed Orthotics
• Obs and Gynae
• Assessment and Treatment of Stroke patients
Service requirements
• Mandatory training in BLS / Manual Handling / Agenda For Change
• Hydrotherapy Course pre-requisite for New Service
• Physiotherapy management of the Psychiatric patient.
• Management Courses for Senior staff
Development of Services - GHA wide
• Physiotherapy in Occupational Health
• MDT Pain Management
• MDT Stroke Management
• MDT Spinal Protocol and Study Day/Conference- Shadowing in the UK
• MDT Management of the Low Vision Patient
18
19
• Generic Clerical /Reception staff and facilities inadequate
• Protocols/Blanket referrals for Orthopaedics not in place.
• Hydrotherapy Pool – identified problems with build.
• Rehab Stroke Unit: deferred until new Hospital. MDT Management of the stroke patient essential to improve service in this clinical area.
• Appropriate Training for Hydrotherapy and ‘Housekeeping’ required.
After a busy year of preparations our plan was put in place for move to the
new Hospital.
Patient services
Out-Patients:
• Knee specialist and Scoliosis Clinic held in August 04.
No Physiotherapy input brought about numerous complaints re on-going Physiotherapy treatment.
• MDT Intermediate Care Services package for the Elderly not resourced.
Adult Community
Focus for 2005-Assisting patients to be treated and supported within their own
homes:
• Early Supported Discharge Scheme
• Rapid Response Service for elderly and frail seen in A/E
• Falls clinic
• Joint Spinal Clinics with Mr. Malik continued throughout the year.
• Improvements within Psychiatry Services.
• Increase in Appointments times has allowed the physiotherapist more direct patient contact time and Documentation time.
Special Needs Paediatrics:
• DNA Policy was more rigidly enforced.
Service improvements 2005:
• Multi-Disciplinary Backpain Protocol - Research-based management of Back Pain.
• MDT Pain Management Service.- pending recommendations from the Audit 2001.
• Review Triage and Assessment of Musculo-skeletal conditions on
waiting list.
• New methods of MDT working with the appointment of 2nd
Orthopaedic Surgeon.
In-patients
• Difficulty with planning of Physiotherapy services as Orthopaedic surgery fluctuates.
Paediatric Referrals for the Orthotist are 1st screened by the Paed.
Physiotherapist.
Orthotics and Prosthetics
Patients Appliance Policy and Operational Policy reviewed and financial
assistance increased.
Data
for 2005
Staffing Whole time
equivalent
New
patients
Review patients
Out-Patients
2.9 WTE
1577
5464
IN-Patients
1.7 WTE
485
Community
1.5 WTE
284
786
Special needs/ Paediatrics
1.2 WTE
58
560
Groups
411
• The 2nd Orthopaedic Surgeon was not appointed delaying improvement in MDT services.
Individual Performance Reviews
• Foot Audit commenced for Paediatric Orthotist referral.
• Staff appraisals including Personal Development Plans carried out.
• Are out-patients being over treated? Audit.
• Professional Portfolios encouraged.
• Best practice and evidenced based working integrated into working practice
• Reviewed Guidelines for Referral for In-patients to
Community Physiotherapy.
through Weekly In-service Training Programme, sharing of skills and use of Library/ Internet service at Bleak House.
• Senior Staff have consolidated responsibility for Objective setting and peer reviews within their own clinical area.
Health Professions Council
All Physiotherapists have current registration with HPC.
Clinical Governance Framework workstreams
Further work during the year centred on:
The New Hospital facility has seen the creation of a proper Occupational
Therapy Department with facilities in which we can begin to carry out full O.T.
assessments of our patients. This will result in an increase in the quality of our
interventions with our clients. We are not fully settled in however; nevertheless
the benefits of having moved down are palpable already. The department
structure is included in the service distribution map included on the right...
Points to Note.
• Request for Discretionary points pending since 2000.
• The Paediatric OT is working single-handedly.
• Request for Clerical post upgrade to AO post and P& P pending.
• The need to develop the O.T. helper role within the department. This would maximise treatment slots for patients, with tasks such as cleaning, delivery and collection of equipment being undertaken by a helper.
• Request for part-time status made -remains pending.
• Discharge Planning
Hospital Migration
• Orthopaedics- TKR Protocol
Risk Factors:
• Improvements relating to Clinical Governance work-streams.
• Change of date caused some uncertainty.
Quality Improvement Programmes
20
Outstanding issues
Occupational Therapy Department
• Staff resources with regards to New Hospital Services and actual build up to the Move considered inadequate. All the work done in-house.
Physiotherapy Services are regularly audited with respects to improvements
both in clinical practice and Service standards, egs of which:
• Central Stores arrangements not known
• Orthopaedic Joint Replacement Audit.
• Portering arrangements not known
• Documentation Storage not known
• The department covers all the broad spectrum of services you would expect from a district service in the UK
• The Mental Health OT post role has changed slightly to allow for more time to be available to community patients. It can be considered as two distinct 1⁄2 posts one-half covering KGV and the other covering community mental Health.
• Changes from last year include an 0.5 OT post moved from the community setting to the hospital service to provide continuing care needs of patients discharged into the community. It is also a service, which is used to offer
21
support to the needs of palliative care patients wishing to be discharged home.
Classification
2004
2003
2002
2001
2000
1999
There has been a slight increase in the waiting list, it has in fact gone up slightly. We are attempting to respond, as time allows, use quieter periods in hospital
referrals to attend to community referrals in an endeavour to reduce the community waiting lists. The community Team uses a triage system to ensure the most
urgent cases get seen quickly. Service throughput remains at the same levels, though these are provided in spacious and modern surroundings. The O.T. department
has submitted it’s operational strategic plan for evaluation by the Executive Board.
By location
Outpatients
1468
1214
1226
832
869
857
Inpatients
573
910
902
360
296
334
New contacts
722
806
766
547
Not available
Follow ups
1319
1318
1362
645
Not available
Children (<18)
266
190
219
211
218
222
Adults (>18)
1775
1934
1909
1053
1029
969
Total
2041
2124
2128
1192
1165
1191
Special Thanks
By caseload
By age group
We rely on the help and cooperation of a wide cross section of professionals and individuals to be able to provide the best care possible for our clients especially
those out in the community, too many people to highlight all of them individually. I would like however to take this opportunity to thank the following personalities
from outside the GHA: Carole Sharrock from the Red Cross; the Building & Works OT section; Staff from the Social Services Department; the members of the Housing
Allocation Committee
N.B. Cheryl Figueras was appointed in February 2002.
Expectations for 2006
1. The improvement of our data collection procedures to exploit the advantages afforded by the new technology provided.
2. The submission of a business case for a full intermediate care service.
3. The creation of a support service network as proposed in our operational plan.
Laboratories Service
Sponsored patients
Staff changes
Sponsored Patients is a very busy dynamic
department, which is involved in a variety of levels
of a patient’s tertiary care. We are made up of one
Executive Officer Mrs Carmen Macias and four
Administrative Officers, Joanna Ferrary, Jenny
Chipolina, Jay Schembri and Sabrina Viales.
No staff changes occurred during 2004, although for operational reasons, several locum tenens
were engaged from June onwards. The staff complement remained as follows:
4. Job evaluation and a capacity study in the OT services.
5. The creation of an equipment provisioning criteria.
1 x Consultant Histopathologist
6. Improvements in the Information regarding our service available to our users.
1 x Public Analyst/Chief MLSO
1 x Deputy Chief MLSO
Department of
Nutrition
& Dietetics
The Department of Nutrition &
Dietetics continues to provide a
wide variety of services to the
hospital and the community.
2004 saw an increase in the
number of outpatient clinics due
to an increased waiting list. The
5 clinics weekly now include 4
general clinics and 1 paediatric
clinic. The total number of
patients that the department
is able to consult has remained
saturated for the past 3 years
indicating our limitations for
expansion. The majority of
consultations for outpatients
are related to weight reducing
and diabetes whereas the
majority of inpatients seen are
for nutritional support e.g. tube
feeding, intravenous feeding.
The department is also involved
in health promotion, education
and training of other health care
staff, cardiac rehabilitation and
catering issues.
22
4 x Senior MLSO
3 x MLSO1
5 x JMLSO (including one part-timer)
3 x Clerical Officers
1 x Laboratory Operative.
It was hoped that our request for additional staff in 2005 would be favourably met.
Courses
Mr Alex Menez attended an Olympus Users Conference in Ireland. There was the opportunity
to discuss problems that are common to other users, as well as to assess the new Olympus
Immunochemistry Analyser and the OLA Pre-analytical module. This course was sponsored
by Olympus Optical Spain.
Two MLSO’s entitled to attend courses during the year under GHA sponsorship, were unable
to do so.
Service
We continue to participate in the UK National Quality Assessment Schemes for Clinical
Chemistry, Haematology and Blood Transfusion Serology, and plan to extend this to
Microbiology in 2005. More extensive internal Quality Control work was carried out in
Coagulation, and it is envisaged that we will have facilities for similar, increased QC work in
Haematology.
Changes introduced to improve the Blood Transfusion service are detailed by Ernest Gomez
in the sheets appended.
A total of 351 patients are on anticoagulant therapy and most regularly attended our
Department to have their INR monitored. This number represents an increase of approximately
30% over the previous year.
An offer by Palex Medical to provide us with a Tosoh AIA-1800 Immunochemistry Analyser
and a Labotech analyser that would automate our ELISA techniques, was readily accepted.
The AIA-1800 will take over the workload of the AIA-21 allowing the latter to remain as a
back-up.
Equipment that had been ordered for the new laboratory arrived and was stored ready to be
moved and installed. Towards the end of the year, a date was set by which the new hospital
would be operational. Planning the actual move then commenced in earnest
The nature of our work involves us making the
travel arrangements for a patient and their escort to
attend their appointments, liasing with the family
to complete the necessary financial assessment
prior to their departure which, enables us to
provide the vital paperwork they need to take with
them. We also deal with the day to day emergency
transfers, which can occur throughout a 24-hour
period. This involves the officer on call liasing
with the Doctors and nurses from our hospital and
the receiving hospital, be it in UK or more often
Spain. Again we need to prepare the fundamental
paperwork and arrange the Ambulance so the
patient is transferred according to their medical
needs and in an efficient style.
We need to prioritise our work and deal with the
task in hand in a methodical way. This ensures that
the patient and there family are aware throughout of
what is happening which helps them in this stressful
situation. We also deal with the reimbursement of
travel and maintenance allowances to the patients
and escort on their return to Gibraltar. Once a week
we also work paying the nursing escorts who do the
essential transfers to Spain their allowances.
This department’s workload has grown significantly
over the last twelve years as shown below. One of the
obviously changes over these years is the increased
volume of patients visiting the Spanish Hospitals in
the Andalucia area.
23
In conclusion the year 2004 to 2005 has been a busy year for the department with a growing amount of referrals to UK and Spanish hospitals. The work has however
been consistent and with the usual emergencies throughout the year. The team in Sponsored patients works very closely both internally and externally to ensure
the demands of the patients are met no matter what the workload.
Pharmacy
1. Highlight of this year is successful move to new Hospital which has
provided us with a much better working environment
2. Services provided are principally the same, except now both surgical and
• medication for our Haemophiliac,
• new drugs (pain relief-eg durogesic patches and psychiatric-eg risperdal
consta inj)
• increase in demand of wound dressings
both medical wards are issued their medication on a named patient basis
• increase in demand of feeds for dietician
3. No change in staff compliment – stores assistant still on roll-over
• increase in demand of expensive iv antibiotics (as set out in new policy)
contract
• increase in demand of i. v fluids
4. Major overspend on allocated drugs budget (Budget £950,000, actual
• increase in demand of anaesthetics / pain relief theatre
spend £1,444,409) This increase in spend is attributable to various factors;
• increase in demand of drugs for intensive care .
• opening of new hospital
• increasing demand of drugs by new doctors introducing new policies and
• new vaccination programme (BCG, 3 in 1, 4 in 1 an 5 in 1 vaccines),
procedures (eg pain clinic)
• vaccination for all grades hospital staff, emergency services (Fire brigade,
• two extra floors of ECA (patients from Lewis Stag and Lady Begg ward)
RGP,Prison,customs etc),ECA staff, students
• drugs for major cataract initiative
Information Management &
Technology
In February 2005, with the move into the new hospital, the Authority IMT
Department turned a new page in its application of technology towards the
improvement of healthcare in Gibraltar. It has worked towards achieving
the overall strategic aims of the Authority to improve clinical outcomes and
corporate performance. The focus was given the following development
themes:
• Improving and making maximum use of the physical infrastructure
• Maintaining ordered and well-planned Networks and services
• Creating working relationships with Government Departments & agencies
• Promoting the use of Science and Technology in Health Care;
• Increasing the number of PC’s throughout the GHA
• Providing clinical and other areas with support required
• Developing software to enhance the patient experience
• Developing software to assist clinicians and management
• Working towards an electronic patient record
• Leading in the development the European Health Insurance Card
Major investment has been made, and continues to be made, at many levels
to enable the delivery of dramatic improvements to customer service, quality,
24
operational effectiveness and value for money.
At the beginning of the year external consultants were commissioned to
advise on a Health Care IMT Strategy. This entailed a comprehensive review
of existing health systems and existing practices. The consultants also made
recommendations on the structure and development of the IMT Department.
The report contains recommendations that include the introduction of
modern and efficient standards of health care process and regulation as well as
functional programmes for the new hospital.
The Government and the Authority have accepted the recommendations of the
report and the Authority will now be seeking proposals, on an EU wide basis, to
assist the Authority in achieving these aims.
Technology is growing at an aggressive rate within the GHA. Developing a
sound relationship with public sector resources is crucial to the future delivery
of healthcare. Mutual co-operation with public sector resources not only
makes economic sense but is recognised as a prerequisite to our success. The
Government Information Technology & Logistics Department (ITLD) and
Gibtelecom have proved great partners to achieve the delivery of the first phase
of works. We have every confidence that this will continue well into the future.
The Authority has maximised the use of the high capacity link installed by the
Government, under the auspices of the ITLD, and this has provided quality
connectivity between, for example, St Bernard’s Hospital and the Primary Care
Centre. The overall objective of the initiative is to improve the quality, efficiency,
25
and effectiveness of the healthcare services with real savings and cost-effectiveness.
Advantages
Within the space of a few months, the GHA has tripled the number of PC’s and users that have access to email and internet services. Doctors now have direct internet
access to critical services like poison centres and other online information sources. Communication throughout the organisation is faster and more efficient.
• Almost 300 individual lines have been disconnected and now run under a call managed operation;
A bed management system was developed in house and is already in use widely. This enables in-patient tracking and bed usage statistics. A history of admissions
for each patient is being stored electronically. On-screen ward layouts are available in all wards and Accident & Emergency, with room and bed distribution,
showing where patients are located in each ward, what phone extension the patient is at, and which bed is available in any given ward. In order to assist the families
of the patients with their queries, some of this information is readily available to the staff at reception.
• GHA has invested in a long term switching hardware, software and network that allows for future expansion and converging of data and voice services thus making the carrying of these services more economical and efficient in-site and of-site.
In a move away from the traditional paper list, and as an extension of the system that has been in operation at the Primary Care Centre for over a year, a GHA wide
appointment and scheduling system is already in place with appointments for clinics being made electronically.
The Radiology Department now operates powerful digital imaging equipment where X-rays, scans and other images are stored electronically on servers. These
images will soon be available for doctors to view on screen at their clinics.
Similarly, tests conducted by the pathological laboratories will soon be available to clinicians electronically.
Information Technology will enhance healthcare in Gibraltar. The seeds have been sown. The move towards the Electronic Patient Record has begun.
Telecommunications Report
At the old Hospital Site GHA operated a Centrex phone system for internal
• GHA now has the ability to deliver and monitor Patient services as well as providing statistics on things such as appointments etc.
• Monitoring and access control tools available on the PBX have reduced GHA’s overall phone bill amounts.
• The transitional over-haul of the entire numbering strategy has significantly assisted the production of a telecommunications policy for the “New GHA”.
Records Department
This year has seen major changes and improvements to the Medical Records Department
following the move to the New Hospital. The first challenge faced was the migration of the
Medical Records Department from old St Bernard’s to the New Hospital while causing the
least disruption to the general public and staff. I take this opportunity to thank all the staff
that made this possible for their unconditional support.
The department in keeping with its strategic objectives, has carried out a role re-design
exercise, which resulted in splitting of the functions of appointment scheduling from that of
medical librarianship. This entailed moving appointments scheduling to first floor reception
near the Out Patients clinics whilst keeping the Medical Library at Ground Floor level.
service users , and Gibtelecom service on outside lines. All incoming/outgoing
internal or external GHA calls were routed and switched individually from
the Gibtelecom, System X exchange into the GHA across Gibtelecom’s copper
network. Gibtelecom owned and managed all the communications equipment
We have also extended our services by providing an administrative officer in the
Ophthalmic Department Reception to cater for all service requirements & queries in
this Unit. This has been possible due to the increase in staff compliment by a further
five administrative officers.
necessary to implement PBX facilities and would sell services to the GHA. The
main number for the GHA and St. Bernard’s Hospital was (and still is) 79700,
and the service was manned by Hospital Attendants. GHA also rented individual
Centrex lines for use as exchange lines to and from the Primary Care Centre in
Secondary sites i.e. Johnston’s Passage and Bleak House also operated
Weekly Audit reports on performance by the Records Department show an increase in
compliance of availability of medical folders. In addition, the Gibraltar Health Authority has
contracted the services of Micro Business Systems Ltd to undertake a process of weeding and
bar coding of all patient medical files in Records library.
on Centrex.
This exercise commenced in March 2005 and is being carried out as follows:
Background
phone services and extensions directly from Gibtelecom and individual
• All files are being labelled with name, date of birth, reference number and barcode and
entered in a patient database. This will lead to the introduction of files electronically tracked
using bar code readers.
on-site phones as required. Individual phone lines had to be ordered from
• Weeding of non-active files for the last five years and archiving in Records Stores.
Gibtelecom, and the company would install individual line to site and to the
the new established call-centre / Helpdesk. For general undirected access and
• Colour coding all files. This will enable efficient and accurate retrieval and filing of
Patient files.
quality call management the GHA intercepts calls in this call centre during
We envisage that this exercise will be completed within the next couple of months.
the main operating times and this allows for porters to avail themselves for
prompt that requests the extension required.
FrontDesk, the new computerised appointment system introduced in the Primary Care Centre
in the summer of 2003, has also been introduced very successfully at St Bernard’s Hospital
in August 2005. This has given us the opportunity to be able to follow patients’ history from
primary to secondary care and provide a much enhanced service to the public.
The PBX is providing the GHA with cost saving and service advantages over
Reception
the previous outsourced operation. This has included bulk reduction in paid
A new front of house service was created with the addition of the role of Helpdesk/Telephonist.
The new system became operational in February 2005, in order that it coincided with the
opening of the New Hospital facility. This new role was to include the manning of the main
reception desk from 08.00 to 20.00 Monday to Friday offering a new front of house professional
approach in the welcoming of patients and visitors to the hospital. The service as well as
providing a telephone and helpdesk service at the main reception counter, also includes the
manning of the Hospital communications centre. The centre provides the 24hrs monitoring of
the Building Management Systems as well as the Fire Prevention Systems. The Helpdesk staff
at St. Bernard’s are integrated into the Primary Care Advanced Appointments telephone lines
in order to assist Primary Care in dealing with advance appointments, and thereby improve
the service provided to our clients.
the ICC to communicate internally and with the rest of the authority in order to
save on local call charges.
GHA before inaugurating it’s new Hospital traditionally purchased all
final it’s location. Gibtelecom would submit charges for all telephone moves,
additions, and changes. This type of service had worked fairly well for the
GHA with the previous building and operational strategy. However, the costs
of lines, moves, additions, and changes became increasingly expensive as the
organisations communications requirements grew, and the systems became
outdated and incompatible with the technological requirements of a modern
healthcare facility.
As part of its telecommunications strategy for the New Hospital the GHA
purchased a state of the art internal phone system, a PBX (private branch
exchange) manufactured by Northern Telecom using traditional voice and
Internet voice protocols. As part of the construction programme the building
was pre-wired with approximately 2500 structured wiring points capable of
delivering both data and voice. The facility being spread over six server rooms
across the hospital.
26
• GHA has reduce significantly high charges for moves, additions, and changes of any telephone lines and services;
direct patient services. An additional system available to incoming traffic is an
automated or through dial system for personal or indirect traffic. This is a voice
up lines, with a total disconnection of over 300 previously rented lines. With
the multiplexing of traffic on PRI (Primary Rate Interface) links to Gibtelecom
and the commencement of Voice over IP service for converging telephony and
data over existing links to sites like Primary Care Centre has saved on past
individual links for all the different services. A large number of “internal”
extensions operate with specific features and control for professional Patient
The approach has been to use some of the existing operationally required
orientated quality call management services. Some of the end-user features will
external direct numbers routed through 2 PBX PRI links. These are large
improve communications and mission-critical functions at GHA, including,
capacity telephony cables carrying 30 simultaneous calls each in and out of the
roll-overs, hunt-groups, multi-call ringing and broadcast messages through
GHA and delivered to the required extensions either automatically or through
voice-mail etc.
27
Valedictory 1567-2005
This year, St Bernard’s Hospital was transferred to the new building in Europort. This is
an important, forward-looking move, which should transform the delivery of medical
care in Gibraltar – truly a hospital for the new millennium!
But before we advance starry-eyed into the future, let us for one nostalgic moment
look backwards at the building we have left.
Yes, the old hospital, with its jumbled architecture, its crumbling infrastructure, its maze of corridors. But how
many generations of Gibraltarians were cared for there? It was founded in 1567, when Shakespeare was a toddler!
For four hundred and thirty eight years, it looked after Spanish inhabitants, sailors, soldiers, and for the last 190
years, it served us, the Gibraltarians. And, with all its perceived deficiencies, it served us well.
Here is a brief timeline, to give us a feel for the venerable history of the building:
1567-1591: Founded by Juan Mateos, a retired innkeeper, to treat sick sailors (Don’t ask!)
1591-1704: The Hospital de San Juan de Diós, run by monks, for the treatment of infectious diseases.
1704-1756: After the capture of Gibraltar, it was used as a hospital for soldiers and sailors, until the Old Naval
Hospital was completed in 1746. After that it became the ‘Garrison Hospital’.
1756-1815: The building was converted into a barracks – the ‘Blue Barracks’.
The Company of Military Artificers (the forerunners of the Royal Engineers) was formed here in 1776. The building
was severely damaged by bombardment during the Great Siege, and remained in a ruined state for over 30 years.
1815-1889: The Civil Hospital was built on the site by General George Don, the Lieutenant Governor. This was the
first hospital for the whole civil population for over 100 years. It was divided into Catholic, Protestant and Jewish
sections, each managed by a committee from the respective community.
1889-1963: In 1889, the management was taken over by the Colonial Government, and it became the Colonial
Hospital.
1963-2005: St. Bernard’s Hospital
The new St Bernard’s Hospital has many sophisticated facilities which were not available in the old building.
But these will serve for little if those working in it do not follow the shining example of old Juan Mateos, who
consecrated his life to caring for the sick, and of the many devoted doctors and nurses who followed him over the
centuries, and of forward-minded administrators like George Don.
The new hospital, I fear, does not lack for carping critics: It will thrive, in spite of its malingers, if it takes action
where criticism is justified, but for the latter, it can do no better than to adopt as its motto the phrase that old
George Don was fond of quoting to the recalcitrant inhabitants of Jersey, his previous posting, when they opposed
his reforms.
“Je vous ferais du bien malgré vous!” (“I will do you good, in spite of you!”)
Sam Benady,
Retired Consultant Paediatrician
28
29
Statistics 2004
Public Health 2004
Births in Gibraltar by location (2004)
Location
Female
Male
Total
Percent
1
15
207
223
1
22
175
198
2
37
382
421
0.5%
8.8%
90.7%
100.0%
Home
Royal Naval Hospital
St. Bernard’s Hospital
Total
Births to mothers over 35 (2004)
Age of Mother
35
36
37
38
39
40
41
42
44
51
Total
Female
7
6
7
6
2
4
1
1
Male
9
5
9
3
2
4
3
Total
37
16
11
16
9
4
8
4
1
2
1
72
Female
Male
Total
1
12
203
4
3
223
5
187
5
1
198
1
17
390
9
4
421
Age at death
Female
Male
Total
<44
45-54
55-64
65-74
75-84
>85
Total
(%)
3
1
7
13
45
42
111
50.2%
2
2
6
25
48
27
110
49.8%
2
1
35
Births by birth weight (2004)
Birth weight
<1499g
1500-2499g
2500-4499g
>4500g
Unspecified
Total
Deaths by age and sex (2004)
Births by month (2004)
Month
January
February
March
April
May
June
July
August
September
October
November
December
Total
Female
Male
Total
20
17
21
17
18
14
22
15
24
18
19
18
223
21
16
12
15
18
18
13
5
21
16
20
23
198
41
33
33
32
36
32
35
20
45
34
39
41
421
Female
Male
Total
5
3
13
38
93
69
221
100.0%
(%)
2%
1%
6%
17%
42%
31%
100%
Births to teenage mothers (2004)
Age of Mother
14
15
16
17
18
19
Total
30
1
1
6
4
4
1
16
3
1
2
7
1
1
6
7
5
3
23
31
Deaths by place of death (2004)
Place of Death
St. Bernard’s Hospital
Home
Mount Alvernia
Jewish Home
Elsewhere
K.G.V. Hospital
Total
Female
87
13
8
2
1
Male
Total
94
11
3
1
111
1
110
181
24
11
3
1
1
221
Female
Male
Total
25
18
25
19
11
6
1
5
110
49
34
50
36
27
14
1
10
221
Cancer incidence: selected anatomical sites cumulative (1998 – 2004)
(%)
82%
11%
5%
1%
<1%
<1%
100%
Site
Deaths by cause and sex (2004)
Cause of Death
Heart disease
Cancer
Stroke
Respiratory diseases
Infections
Degenerative diseases
Accidents & Injuries
Others
Total
24
16
25
17
16
8
5
111
(%)
22%
15%
23%
16%
12%
6%
<1%
5%
Heart disease
Cancer
Stroke
Respiratory diseases
Infections
Degenerative diseases
Accidents & Injuries
Others
Total
73
59
31
29
11
5
10
23
241
1999
2000
Organism
100%
87
52
40
39
8
11
9
21
267
2001
90
60
18
15
6
23
9
12
233
75
53
18
24
6
18
3
18
215
Cancer deaths by site (2004)
Site
Prostate
Pancreas
Colon
Breast
Melanoma
Lung
Stomach
Pharynx
Kidney
Bladder
Brain
Occult
Uterus
Oesophagus
Ovary
Myeloma
Parotid
Lymph
Biliary
Liver
Total
32
Female
Male
Total
N/A
3
3
4
1
1
2
1
0
1
1
2
1
1
1
0
1
1
1
0
25
8
3
3
0
2
2
0
1
2
1
1
0
0
0
0
1
0
0
0
1
25
8
6
6
4
3
3
2
2
2
2
2
2
1
1
1
1
1
1
1
1
50
2002
77
48
21
48
8
13
1
15
231
333
80
37
35
17
17
16
15
15
70
635
Laboratory confirmed infections (2004)
Trends in cause of death (1998 – 2004)
1998
Registrations
Skin
Breast
Uterus & cervix
Colon
Stomach
Bladder
Prostate
Oral cancers
Lymph nodes
Other cancers
All cancers
2003
62
66
37
23
13
17
6
7
231
2004
49
50
34
36
14
27
1
10
221
Salmonella
Campylobacter
Shigella
Giardia lamblia
Myco. tuberculosis
Cryptosporidium
E coli 086: K61
E coli 0111 :K58
Trichomonas vaginalis
Chlamydia
Bartonella (Cat scratch)
Mycoplasma pnuemoniae
Adenovirus
Rotavirus
Respiratory Synctitial Virus
Hepatitis C
Hepatitis B
Hepatitis A IgM
Total
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
NOV
Dec
Total
2
2
1
7
1
4
1
5
5
5
6
8
4
1
27
5
16
3
6
2
3
5
2
6
2
1
90
32
8
1
2
2
1
1
3
8
1
1
19
14
8
3
3
2
199
1
2
1
1
1
1
1
1
1
1
1
1
1
3
1
1
2
4
4
10
9
1
1
1
1
1
13
1
4
3
1
2
1
10
1
12
12
14
38
33
1
1
6
3
1
1
14
9
19
15
Trends in MRSA infections by probable source (1994 – 2004)
Source
Imported
Community
Intrinsic
Hospital Acquired
ECA
Indeterminate
Total
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
All years
1
2
1
1
2
1
3
1
1
7
5
9
3
2
2
2
6
1
4
4
4
1
1
4
18
1
15
13
10
6
2
1
3
1
1
14
3
9
4
6
5
6
33
40
32
8
18
6
13
117
1
4
3
4
1
2
(%)
34%
27%
7%
15%
5%
11%
33
(Cont.) PATHOLOGY Health Care 2004
PATHOLOGY 2004
323,477
8,293
376,906
9,387
25,223
22,275
2,454
602
1,969
487
830
636
Coagulation:
6,106
7,373
Samples
Gynae Cytology:
1,468
1,256
Cervical Smears
Histology:
1,247
2,712
477
1,217
2,496
1,050
Specimens
Deep cut requests
Extra blocks
100
1
62
0
0
4
1
0
0
0
7
0
0
92
6
84
2
4
4
1
9
2
0
2
0
0
PAS
PASd
ABPAS
ABPAS low pH
Mast
Retic
Grams
Perls
Giemsa
ZN
Unna Apap
EVG
MGP
0
1
0
12
3
2
Imprints
Decalcification
Dekeratinisation
181
8
0
3
1
7
9
8
144
8
3
5
1
5
8
3
0
45
18
5
5
5
0
2
3
10
32
14
4
1
51
9
2
4
2
1
3
8
16
13
13
0
Haematology:
Blood Group Serology:
Blood Donors:
Surgical Cytology:
FNAB: 0
34
2004
40
40
3
18
18
0
Microbiology:
4,801
3,089
1,430
610
388
58
81
92
3
3,941
2,914
1,185
632
259
38
42
53
3
Urines
Swabs
Stools
Blood Cultures
Sputum
Seminal fluid
TB Cultures
Mycology
Cerebrospinal fluid
Viral Serology:
6,647
6,553
Investigations
2003
Clinical Chemistry:
2003
Total investigations.
TSH
Samples
Group and Antibody Screen
Antibody Screen
Bled and Screened
Specimens
Ascites
Bronchial brushings
Bronchial washings
Buccal mucosa smears
Cyst fluid (NOS)
Cyst fluid ovary
Douglas Pouch fluid
Branchial
Breast
Lymph node
Parotid
Thyroid
Other
Hydrocoele fluid
Knee aspirate
Peritoneal fluid
Pleural fluid
Sputum
Urine
Other
Samples Referred:
Public Analysis
756
964
179
202
378
352
234
45
29
PAS
PASd
MGG
Doctor’s Laboratory
Arrimada’s Lab
Sheffield Children’s Hospital
PHLS/Northwick Park
Royal Marsden
2003
2004
Food and Drink:
205
273
Samples
Potable water, Civilian:
209
224
Samples
Potable water, MOD
306
577
Samples
Deionised water:
34
35
Samples
Sea water:
156
157
Samples
Swimming pool water:
33
79
Samples
Filtrations:
13
17
Samples
Atmospheric pollution, SO2:
728
728
Samples
GHA Expenditure 2004/05
Pay & Related
£23,117,859.00
Drugs & Pharmaceuticals
£10,059,172.00
Interest, Leases & Accommodation
£4,849,148.00
Sponsored Patients & Visiting Consultants
£2,196,319.00
Other Operational
£1,999,543.00
Dressings / Gases & Tests
£1,273,109.00
Non-GHA
£919,123.00
Insurance, Fees, Claims
£857,927.00
Med & Surg Appliances
£563,880.00
Elec, Water & Tels
£538,651.00
School of Health Studies
£204,964.00
Capital
£61,727.00
TOTAL
€£46,641,422.00
35
Notes
Sponsored patients
Amount of Patients
Financial Year
1992/93
U.K.
Spain
295
Total
295
U.K.
Spain
446
Total
446
1993/94
329
3
332
517
3
520
1994/95
372
5
377
599
6
605
1995/96
386
5
391
666
5
671
432
11
443
653
11
664
1997/98
480
27
507
763
45
808
1998/99
545
32
577
827
50
877
1999/00
566
58
624
889
70
959
2000/01
1996/97
573
69
642
1,034
115
1,149
2001/02
599
117
716
966
206
1,172
2002/03
631
185
816
1,090
393
1,483
2003/04
679
259
938
1,164
598
1,762
2004/05
753
291
1,044
1,252
644
1,896
Sponsored Patients number of referrals 04/05
Sponsored Patients number of referrals 02/03
UK Hospitals
UK Hospitals
Total
Total
St Mary’s Hospital
354
St Mary’s Hospital
341
Royal Marsden Hospital
291
Royal Marsden Hospital
266
Moorfields Hospital
81
Moorfields Hospital
85
Charing Cross Hospital
26
Charing Cross Hospital
31
Hammersmith Hospital
21
Hammersmith Hospital
27
Leicester Royal Infirmary
54
Leicester Royal Infirmary
27
The Middlesex Hospital
42
The Middlesex Hospital
26
Guys Hospital
64
Guys Hospital
24
Kings Healthcare
22
Kings Healthcare
24
Spanish Hospitals
Spanish Hospitals
Hospital Materno Infantil Malaga
Hospital Materno Infantil Malaga
75
Hospital Universitario Puerta Del Mar Cadiz 342
Hospital Universitario Puerta Del Mar Cadiz
74
Hospital de la Seguridad Social La Linea
137
Hospital de la Seguridad Social La Linea
30
All other Hospitals
424
All other Hospitals
Total
36
Amount of Referrals
40
1898
Total
242
1272
Notes