GHA to buy and operate Rooke facility for elderly care 

The Gibraltar Health Authority will purchase the Rooke modular building and turn it into a publicly-run elderly residential and nursing care facility, with residents from Mount Alvernia, as well as long-stay patients at St Bernard’s Hospital and those in Cochrane Ward, expected to move there before the end of the year. 

The Minister for Health, Care and Business, Gemma Arias-Vasquez, and the Director General of the GHA, Dr Paul Bosio, announced the decision at a press conference on Tuesday after meetings with staff, patients and relatives. 

The Rooke facility has 170 rooms and capacity for 218 residents, with more than 200 people potentially moving into the building once the transfer is completed, freeing up acute hospital beds and reducing overall running costs for elderly care. 

The purchase price has not yet been disclosed because financing arrangements with a commercial bank in Gibraltar are still being finalised, although Mrs Arias-Vasquez said the construction cost had previously been put at around £38m. 

The final purchase price will also include the cost of fitting out the building and interest incurred during its development. 

“We know the figure, but we’d rather the lending be completely finalised before we actually announce a figure,” Mrs Arias-Vasquez adding, adding that further details would be made public later this month. 

The building will be bought from Rooke Holdings Limited, allowing repayment of financing initially provided through the Gibraltar Savings Bank to private entities linked to the company. 

The GHA expects to use around £5m a year currently allocated to repayments on the financing of St Bernard’s Hospital to service the new borrowing once the existing hospital arrangement ends this year. 

Mrs Arias-Vasquez stressed that the new facility would not be privatised and that existing GHA staff from Mount Alvernia and Cochrane Ward would transfer to the Rooke. 

The announcement was welcomed by Unite the Union, whose officials were briefed by the Government and the GHA earlier on Tuesday. 

The union said employees had been told the move would largely amount to a change of workplace, with further commitments given on filling vacancies within ERS. 

“This is really positive news and demonstrates an on-going commitment to maintaining public services and ensuring that these stay rooted where they belong, in the public sector,” said Stuart Davies, Unite’s national officer for Gibraltar. 

“There were a number of rumours and concerns that an announcement could have involved a private provider which would have been highly problematic so this significant commitment to and investment in the public sector is very welcome.” 

“There will undoubtedly be teething problems and issues that need to be worked through.” 

“Unite will be engaging with our members and the GHA to resolve any issues or concerns that arise, but broadly speaking the move to a new, modern facility will be positive for members, residents and their families.” 

“A number of reassuring commitments were received in our initial meeting and whilst the union recognises that there will be concerns and anxieties within the membership, we are confident that we will be able to work through these successfully via the regular and planned consultation with the employer.” 

PROJECT DELAYS 

The Rooke facility was initially announced in June, 2020, and used Chinese modular construction methods that, at the outset, were expected to significantly increase ease and speed of construction. 

But the project ran into problems, delays and mounting costs until its completion late last year, when it obtained its final certificates of safety. 

The facility, originally expected to be completed by 2023, was first intended to be privately operated and has been the subject of persistent Opposition scrutiny on transparency of financing and operational arrangements, and its impact on existing ERS residents. 

As recently as January this year, Rooke Holdings Ltd invited expressions of interest from private operators for the running of the facility and, at the time, Mrs Arias-Vasquez assured Parliament that “no resident of Mount Alvernia or any Elderly Residential Service facility will ever be compelled to leave their home against their wishes”. 

But responding to questions during the press conference, Mrs Arias-Vasquez dismissed any suggestion that it had proved a messy project. 

“It's a construction project, and in all my experience with construction projects, and I've had significant experience in my previous life, every construction project comes up against obstacles, especially when you throw in a pandemic and everything else,” she said. 

Asked whether that assessment applied even to a modular development intended to simplify and accelerate construction, Mrs Arias-Vasquez said both public and private projects had experienced delays during the same period. 

She focused instead on the finished facility and the response from patients’ relatives who had visited it. 

“I think there might have been delays, but the finish is absolutely fantastic,” she said. 

The original plan had been for the Rooke to be privately operated, with the GHA effectively paying a private provider for elderly care.  

Dr Bosio said an options appraisal carried out after he took up the post of Director General late last January had instead led him to recommend that the GHA should operate the facility itself. 

He said the assessment considered financial, clinical, staffing, industrial relations and long-term resilience issues, including the difficulty of transferring experienced public-sector staff to a private operator, which would likely have created significant practical and industrial relations issues. 

“Having appraised what the GHA actually had, putting all of this in place and having a resilient solution for the population of Gibraltar, it was my recommendation that the GHA could and should do this for a number of practical reasons,” Dr Bosio said. 

CLINICAL BENEFITS 

From a clinical perspective, Dr Bosio said bringing elderly residential and nursing care into one building under the GHA would allow standards to be monitored and developed as part of the authority’s wider work. 

“We have now a purpose-built, state-of-the-art facility which meets all the requirements, and as the minister said, as much as Mount Alvernia fulfilled an amazing function for Gibraltar and has a legacy for Gibraltar for many years, we had to move on,” Dr Bosio said. 

As a clinician himself, Dr Bosio was clear the new Rooke facility would enable the GHA to “take residential and nursing care to a different level”, not least because a lot of the facilities, amenities and space available at Rooke “simply are not there” in current facilities. 

Mrs Arias-Vasquez and Dr Bosio took reporters on a tour of the building, which is equipped with spacious, airy rooms filled with natural light and large common areas with views of the bay, as well as nursing stations on each floor, a fully-fitted commercial-scale kitchen and a large outdoor terrace that will be developed with greenery and amenities for the residents. 

A key factor too is that the Rooke facility is centrally located, making it easier for relatives to visit frequently and help maintain cognitive functions crucial in elderly care. 

“If you think about the facilities that are on offer, if you think about the location, if you think about the quality of life that this is going to offer, simply based on location if nothing else, you have a facility for elderly care that's right beside the hospital, you have a facility that's right in the centre of town where you can go take out your relatives to parks and – the Director General doesn’t like me saying this – churros again,” Mrs Arias-Vasquez said. 

She added: “As far as the GHA and the ERS are concerned, we have a fantastic product which we're offering free to users for the benefit of families in Gibraltar, in a central location at a time when, globally, elderly residential care is under intense scrutiny and intense private costs.” 

“What we're able to offer, in my view, is groundbreaking and I am very proud that this Government is doing that.” 

LOGISTICAL CHALLENGE 

Dr Bosio acknowledged transferring residents would be a major logistical operation involving more than 310 staff, but added that the GHA was confident the move could be completed before the end of 2026. 

The transfer will include 129 residents currently at Mount Alvernia, residents from Cochrane Ward and long-stay patients at St Bernard’s who are waiting for free capacity at Elderly Residential Services. 

Dr Bosio said around 85 patients were currently waiting at St Bernard’s for elderly care, occupying close to half the hospital’s adult acute bed capacity. 

Moving them into the Rooke facility would therefore release acute hospital beds while reducing costs. 

He estimated the new facility would cost around 25% less to run than the GHA currently spends across its Elderly Residential Services sites, largely because residents and staff would be brought together on one site and because acute hospital beds are significantly more expensive. 

Dr Bosio said the GHA expected the cost of care at the Rooke facility to work out at around £90,000 per bed each year, slightly higher than the cost charged by some existing private providers in Gibraltar. 

He attributed that difference to the more complex needs of the patients who would be cared for there, with fewer than 10% of the elderly patients currently waiting for residential care fully independent. 

The Rooke facility will provide both residential and nursing care rather than standard residential care alone.  

Dr Bosio added that, when compared with the cost of similar levels of care in the UK, the projected figure was “in the same ballpark”. 

“It’s cheaper for the GHA to put them in a residential and nursing environment, and it’s also better for the patient,” Mrs Arias-Vasquez added. 

“The patient and the future resident should not be in an acute medical setting.” 

“We need to get the patients out of the acute medical setting as quickly as possible, so it's more beneficial for the resident to be in a nursing or care home than it is for them to be in the hospital setting.” 

Residents at Mount Alvernia will be asked individually whether they wish to move and Mrs Arias-Vasquez said the Government expected the vast majority, “if not all”, to agree. 

She pointed to positive feedback from residents and their relatives who had already visited the new building. 

But she acknowledged too that Mount Alvernia and the Rooke facility could not be operated simultaneously if some residents decided not to transfer. 

“The conclusion is that we'll look for what options are available, so we'll look to see what we can do,” she said. 

“It depends on the numbers that we're talking about, so if we're talking about minimal numbers, we'll have to look at other options. We won't be able to run the two concurrently.” 

Dr Bosio said contingency arrangements could involve transitional care elsewhere, most likely at St Bernard’s Hospital, but he did not expect those plans would be required. 

It is not clear at this stage what will happen to Mount Alvernia after the move. 

The building is owned by the trustees of the John Mackintosh Trust and Mrs Arias-Vasquez said discussions with the trustees would take place once the immediate focus on residents and their transfer had been addressed. 

“This isn't about real estate, this is about the residents,” Mrs Arias-Vasquez said. 

The new Rooke facility is expected to be close to capacity immediately, but Dr Bosio said the move would form part of a wider strategy aimed at helping people remain independent and at home for as long as possible against the background of increased longevity and an ageing population. 

“I think what we need to plan is an integrated model of care that takes through not just institutional care, for which this is going to really tick the box, but actually addresses all the other things that we talked about,” he said. 

Public open days at the Rooke are planned for next Monday, Tuesday and Wednesday, with the Government encouraging people to visit the facility before the first residents move in later this year.