As long-stay patients move to Rooke, plans for new services at St Bernard’s Hospital

Around 70 elderly long-stay patients currently in St Bernard’s Hospital will be moved to the Rooke facility leaving empty beds and the GHA Director General Paul Bosio has plans to repatriate services to Gibraltar in this space.

The elderly patients account for around half the hospital bed space and their move to the Rooke will mean that St Bernard’s Hospital will function more as an acute hospital with plans to bring services such as advanced imaging, a women’s centre, pacemaker services, and to redevelop A&E, the outpatient’s floor and maternity.

“We are looking at an advanced imaging suite, more CT, more MRI, bringing all that in-house,” Dr Bosio said.

“At the moment, some of that is done with our partners in GibMed, and some of it is done in Spain. It's absolutely essential for me to bring that in-house.”

He added that the GHA is starting work on a dedicated women’s centre and will be modernising the maternity suite.

“A totally transformed experience for our mums, making it a lot more modern, but homely, in keeping with modern obstetric practise,” he said.

“We're going to redevelop A&E, specifically focussing not just on function, on efficiency, but also some of the waiting areas and aesthetics of A&E.”

“We're going to completely redevelop the outpatient’s floor, which is the first floor, not just in terms of facilities but also how it work in terms of where the doctors sit, how they sit, how they see patients. If you've ever been to the outpatients, it's on the first floor, there's no waiting area, it's kind of a long corridor.”

Dr Bosio said these changes will be worked on over the next three years and one of his main ambitions is to secure international recognition for the GHA in the form of accreditation, which would mean St Bernard’s Hospital would be assessed against a range of standards and need to continue to uphold those standards.

“We're moving 200 patients [GHA and Mount Alvernia], we're moving over 300 staff [to the Rooke],” he said.

“It's never been done in Gibraltar before, even when the old hospital moved here, it was much smaller.”

“But once we do that very successfully, which I'm extremely confident we're going to do, it opens up capacity in St. Bernard's for us to focus on what else can we do in St. Bernard's and other new services we can develop.”

Dr Bosio pointed out how data is important to assess the needs to the community and how this can be supported by the hospital.

He aims to repatriate services where there is sufficient need locally underscoring that, where cases are rare, there will continue to be a need for these patients to travel to receive specialised care.

For Dr Bosio, it’s a case of targeting surgical specialities with local needs, hiring the right doctors, and training nurses.

Assessing capacity is important at the hospital and Dr Bosio said one of the biggest challenges moving forward is to support families to look after the elderly at home.

“What we can't do is sustain the numbers,” he said.

“As soon as you get older, we put you in an institution. That sounds very cold, but we've got to make sure we don't sort of fall into the trap [of thinking] 'we'll just keep building Rookes'. It's not sustainable.”

Dr Bosio is looking at what support structures can be put in place moving forward, adding that a wider social discussion needs to happen in Gibraltar.

A challenge moving forward for the GHA, he said, will be improving on governance and ensuring processes are followed, and “consistency and fairness”.

Improving transparency is another goal for the Director General, in terms of what the hospital does well and also when there are issues.

“I'd like to be in a position where people are proud of the GHA. To do that, we also need to be seen to be fair and consistent and transparent,” he said.

“When things don't go right, we need to say, ‘actually, we didn't quite get that right. We need to do it better, especially for future patients’. That's very important in healthcare.”

Dr Bosio also reflected on his first six months in post and calling it a “steep learning curve” in understanding how St Bernard’s Hospital is run, adding that it is unique to any hospital he has worked in previously due to the demands on healthcare locally.

“I've worked in many different international spheres, as well as in the UK, and there's nothing like the GHA,” he said.

“I've learnt that we do a huge amount of amazing work, that we've got a very professional workforce and, given our size, it is really impressive. The GHA working very closely with the NHS, and sister providers in Spain. The work we do ranges and what is different for me, is that we do everything.”

“I'm very used to having different areas, different hospitals, different specialisms, covering different areas of healthcare. Here, it's us, and we have to cover absolutely everything.”

Dr Bosio has been away from Gibraltar for over 40 years and said it’s great to be back home, within a close-knit community, which has also given him a sense of purpose as head of the GHA.

He said Gibraltar’s expectations are “extremely high”, as is the intensity on social media at times.

“My most recent post was in Abu Dhabi where expectations are very, very high. I have to say expectations here from the ordinary Gibraltarian are even higher than the Emirati patient,” he said.

“I think it's just in our culture. I think we're very close in the community and healthcare is a very emotional thing to deliver. When you're affected, it's very personal.”

Dr Bosio said he has embraced the expectations as this drives up standards.

“Rather than complain about the expectations, it provides the right sort of drive for improvement,” he said.

He added that the GHA’s performance exceeds, “by a long way,” the UK with average waiting times reduced.

The average waiting time for a non-urgent GP appointment in the UK is four to six weeks, while in Gibraltar it is a same-day service.

A&E waiting times are less, as are surgical waiting times, he said.

A&E in Gibraltar sees around 30,000 patients annually.

“In very crude terms, it's almost every patient attends A&E a year at least once,” he said.

“That is unprecedented in any healthcare organisation. So that is all something that we contend with, but we embrace.”