Wider challenge with aging population for GHA bed management

Gibraltar aging population has brought complex challenges where at the GHA there are around 60 to 70 elderly long-stay patients in St Bernard’s Hospital.

This has led to concerns from the GSD over bed management, which the GHA has said is under control and capacity is within the upper end of the ideal operating range.

The issue of an aging population is a global issue, and Shadow Minister for Health Joelle Ladislaus highlighted anecdotal evidence of bed shortages in the GHA from patients and Gibraltar’s growing population.

GHA Director General Dr Paul Bosio, who has been in post for five months, said the GHA operated at an average of 89.9% capacity between July 2025 and July 2026, which he described as being at the upper end of the normal operating range for hospitals.

He said hospitals should ideally operate between 80% and 90% capacity, allowing a buffer to deal with unpredictable increases in demand.

The hospital has a core capacity of 147 beds, excluding maternity and paediatrics. If that capacity was reached, he said additional beds could be opened in those areas, taking capacity to 174, which the GHA hasn’t had to do.

“If you go above 90% when you get peaks in activity, which are unpredictable, you'll have bed shortages, you'll have a crisis in terms of how to deal with, manage patients and where to put them,” Dr Bosio said.

“If you're operating below 80% to 75% then you probably have a lot of empty beds, that's very expensive in terms of staffing, in terms of maintenance, and it's not very efficient.”

Dr Bosio said that he was “pleasantly surprised that despite the narrative”, the numbers show the GHA doesn't really have bed capacity issues.

“I've been here for five months, and I haven't had one day where we've had a crisis.”

He stressed that an average did not mean the hospital did not experience periods when it approached full capacity.

“There are days when we're reaching almost 100%,” he said.

Dr Bosio said the GHA had rescheduled 11 patients for surgery between July 2025 and July 2026, out of a total of 4,269 procedures.

He said the figure represented rescheduled rather than cancelled procedures, with patients subsequently given another date for surgery.

“That is remarkable,” Dr Bosio said.

“That is very good. And I say that with pride, not because I did it because I've only been here five months, but that's actually really good performance.”

Dr Bosio said the GHA's surgical waiting lists also compared favourably with the UK.

“On average, I think are about five and a half weeks and it ranges from a couple of days or a week for ENT to nine weeks for orthopaedics.”

He said the NHS target was for 92% of patients to receive surgery within 18 weeks, although that target had not been achieved for more than a decade.

The GHA's main capacity issue relates to long-stay patients, particularly elderly people occupying acute hospital beds.

“What we do have is way too many elderly patients, long-stay patients in acute beds, which is not ideal for the patients, and not ideal for an acute hospital,” He said.

Dr Bosio said Cochrane Ward had 22 beds specifically designated for elderly residential nursing care, while other long-stay patients were distributed across the hospital.

“At the moment anywhere between 60 to 70 patients are long-stay patients in the hospital getting whatever they need within the hospital.”

He added that not all of those patients would necessarily be suitable for residential elderly care, as some continued to require active acute or more advanced hospital care.

Dr Bosio said the issue reflected a wider challenge facing ageing populations.

He said people were living longer while family structures had changed, with more family members working full-time and fewer households able to provide the same level of care for elderly relatives.

The issue raised wider questions about whether resources should be directed towards residential care, community support or helping families care for elderly relatives at home.

“It's a challenge,” Dr Bosio said.

“There needs to be a discussion as a society how we look after elderly where do you want to put your resources do you want to put them in homes and institutions or do you want to put them in the community.”

He added: “It's a big discussion that one I don't have the answers to.”

He said Gibraltar had seen a significant increase in elderly care provision over recent decades, including Mount Alvernia, the John Mackintosh Wing, Hillside and dementia units under the GHA, and “half the hospital”.

He added that when it comes to bed management the issue caused by long-stay patients is that if the GHA “wants to develop the hospital and more acute services that's a limiting factor.”

Mrs Ladislaus said she has continued to receive reports of patients waiting for beds and spending prolonged periods in A&E.

“I've heard about bed shortages,” she told this newspaper.

“Bed shortages keep coming up and I keep being told that there's no issue. But there are issues and they are obvious, especially to patients who are having to wait in A&E three hours or twelve hours.”

Ms Ladislaus said she had been told of cases involving elderly patients receiving end-of-life care who had been admitted to A&E overnight.

“Some are admitted into A&E and I've had in the past, not just months, in the past few years, I've had people who are already in palliative care, who are on end of life care, having to be admitted for cancer, having to be admitted to A&E overnight, an elderly person, because there's no beds.”

“So it is there, it is happening and it is obvious.”

Ms Ladislaus said the issue was persistent rather than being limited to seasonal pressures such as winter flu.

She added that long-stay patients were a significant factor in bed availability, while noting that some patients could have complex medical needs that meant they could not simply be transferred to residential care.

Ms Ladislaus also raised concerns about whether staffing and bed capacity had kept pace with population growth.

She said comparisons based only on the total number of nurses or other staff could be misleading without accounting for population growth.

Mrs Ladislaus said freeing beds occupied by long-stay patients would help the GHA.

“The beds that are taken up in the hospital need to be freed somehow,” she said.

“From my perspective, if they could free some beds, then I think that would go a long way within the hospital.”