Over the last 12 months, the GHA has launched several new initiatives and programmes to improve and modernise surgical services and maintain bed resiliency. This has included increased staffing in key areas and the appointment of specialists to develop new services within the GHA.
The appointment of a new colorectal surgeon has seen the introduction of a ‘keyhole bowel surgery programme’ for the first time in the GHA, meaning less invasive surgery and shorter hospital stays for patients. The new service is being supported by an enhanced recovery programme, which aims to optimise patients before surgery and ensure rapid return of normal bowel and body function. This programme involves targeted input from dieticians, physiotherapists, intensive care nurses and anaesthetists. Patients will receive the most up to date anaesthetic and pain control techniques, to ensure they are comfortable and able to get up and about within a very short time of their surgery.
The GHA has also appointed an upper gastro-intestinal surgeon twelve months ago and has launched two new surgical programmes. The first of these is weight loss surgery, (bariatric surgery), which again is mainly being done via the key hole approach. Patients entered into this programme are prepared for surgery via a programme of coordinated care, involving the surgeons and dieticians. The surgical and anaesthetic techniques being used allow patients to recover rapidly from their surgery and go home after a few days. The second programme is upper gastrointestinal surgery, also new to the GHA. This has seen new types of key hole and open stomach, spleen, liver, pancreas and gall bladder operations being performed in the GHA for the first time. Only this week, a second upper gastro-intestinal surgeon has commenced work at the GHA, she also has a special interest in Breast Surgery, having completed a fellowship with the Royal Marsden Hospital Specialist Breast team.
As the public may have read in the UK press, the NHS is regrettably in the midst of its worst winter crisis, with many hospitals without even a single free bed since the middle of November. UK newspapers have noted, that the lack of beds have meant that ‘boarding’ patients on trolleys was common, with some A&E departments running out of corridor space. It has been quoted in the Guardian Newspaper that “23 trusts were already 99% full and two trusts 100% full”. “Tens of thousands of patients are having their surgery cancelled”, with patients being warned that the ban on operations may have to be extended until the end of February 2018.
￼￼Gibraltar is also, currently experiencing a surge in winter influenza and other flu-like illnesses, which is similar to the pattern that is being seen in the UK. The St Bernard's Emergency Department has seen a total number of 500 attendances from the 22 December to the 27 December 2017, and the wards have had increased admissions from just before Christmas
Welcomingly, however, the GHA has had no operation cancellations, due to non-availability of beds since 9th January 2017. Notwithstanding the surge in A & E attendances, there has been bed capacity throughout this period, with average bed availability at 32 beds every night. The Chief Minister’s mandate to integrate Health, Elderly Services and Care Agency, has been key and instrumental, in order to coordinate care between hospital inpatients, Elderly Residential wards and the community. There is now an active and robust multi-disciplinary team approach to be able not only to look after inpatients, but also to ensure discharged patients are cared for in the community with adequate packages of care.
The Medical Director of the GHA, Dr Daniel Cassaglia, commented that: “my medical colleagues have confirmed that the numbers of patients being seen and admitted with Influenza is the highest they have seen for many years and mirrors what is being seen in other European countries this winter. So far we have been able to cope with this surge in admissions, and GHA staff will continue to work very hard to ensure optimal bed availability at St Bernard’s Hospital”.
The Director of Nursing Services, Ms Sandie Gracia, said: “The Nurse Management Team, alongside Medical Staff, Allied Health professionals and Social Services who all form part of a multi-disciplinary team, are working flat out to cope with the additional seasonal pressures to ensure all patients receive the best possible Care and elective services are not disrupted. We will continue to plan and make provisions to always try to ensure bed availability, so that patients receive their elective Surgery as scheduled as the pain and discomfort caused by people’s health conditions cannot be put aside”.
Minister for Health, Care and Justice, the Honourable Mr Neil F Costa MP said: “I am immensely proud, to see how our surgical services has expanded over the past twelve months, which will definitely have a positive impact on improving the service that we deliver to our patients. My amazing bed management team at the GHA have been working extremely hard over the last few months to plan for the winter surge in hospital admissions and I am happy to announce that beds have always become available to cater for patients. This improved service has also been due to the GHA having a Social Worker permanently based at St Bernard’s Hospital, who has been crucial in order to monitor and manage packages of care for individuals who need it. It also gives me enormous, personal satisfaction to learn that no operations were cancelled due to bed shortages since February 2017 given the various reforms introduced. I would like to thank, from the bottom of my heart, all GHA staff for their professionalism and dedication in meeting this winter’s increased demand. They truly represent the best of Gibraltar and are a credit to their profession”.