Technology key to streamlining GHA and boosting efficiency, Arias Vasquez says

The GHA has all the elements needed to become a hugely successful healthcare institution on a par with top NHS trusts, Gemma Arias Vasquez, the Minister for Health, said, as she outlined ongoing work to bolster services and streamline systems to further improve efficiency and patient care.

In an interview with the Chronicle, Mrs Arias Vasquez spoke of the importance of data and technology in that process, revealing that artificial intelligence was already being trialled to speed up some administrative tasks.

And she praised the work of the organisation and its staff, adding the GHA “isn't very good” at communicating the positive work carried out across multiple services, and is more often in the public eye for negative reasons.

“The important message in the GHA is that there is a plan and we know where the weaknesses are, and there is nothing integral to the provision of the service, which is the great thing,” she said.

“We have the assets, we have the doctors and we have the finance available.”

“It's about streamlining that and making the service more efficient.”

The GHA has been at the centre of a political row in recent weeks over nursing staffing levels, with the Opposition highlighting concerns that staff are overstretched and risk burnout.

In the run-up to summer, that message was underlined by staff themselves in public protests.

And yet, according the Government, the GHA’s nursing workforce has increased by 193 since the 2011/2012 financial year, growing from 389.5 nurses to 582.5, including 38 supernumerary nurses.

The Government says too that it spent over £10 million last year on additional agency and bank staff to ensure full-service continuity and provide cover for any vacancies, with clinical posts requested by the GHA during budget planning approved and filled either permanently or through locum or agency staff.

Vacancies are sometimes held to allow newly qualified Gibraltarian nurses to enter the system each September, but those vacancies are covered by bank staff.

“I am assured at every point in time that there are no issues of patient safety,” Mrs Arias Vasquez said.

“There may be a vacancy, but there is someone covering that vacancy.”

Mrs Arias Vasquez confirmed that a recently completed nursing acuity review was now under discussion internally with GHA managers and will guide the organisation going forward.

But issues such as staffing levels cannot be looked at isolation because the GHA is a multi-faceted organisation that requires each element to work in unison with other parts of the healthcare system to deliver the best possible service.

“The hospital is a fascinating ecosystem because everything has to work together in tandem in order to get the best possible result,” she said.

That means that alongside the introduction of new facilities and services, there must also be focus on the basics underpinning the organisation including administrative processes, harnessing technology wherever possible.

In primary care, for example, the minister pointed to a pilot programme using AI transcription tools designed to reduce the medical secretarial workload and speed up referrals.

These tools are part of a broader strategy to reallocate administrative staff toward more patient-facing roles.

The system, which is widely used by GPs in the UK and is being trialled here, “slims down” the work of medical secretaries, enabling administrative staff to be more patient facing.

“As a result of that GP appointment, there'll be an awful lot of admin tasks that have to be done and a lot of things have to be coordinated,” Mrs Arias Vasquez said.

“So it's about how you coordinate that in the best possible way.”

“The staff at the GHA ordinarily works flat out, so it's about giving them the tools to be able to work more efficiently so the resources can be redirected to where we want them.”

Other digital upgrades include a check-in kiosk system at the Primary Care Centre, expected to go live in September, which will notify doctors automatically when patients arrive.

Mrs Arias Vasquez said the aim was to allow doctors to maximise their 10-minute consultation windows.

Efforts are also underway to address concerns over GP appointments and administrative efficiency. Ms Arias Vasquez acknowledged public frustration with the appointment system and said improvements have already been implemented, with daily tracking of appointment availability.

“To get an appointment with a doctor, if you call at 8am, you will get one — although it might not be with your preferred GP,” she said.

“I'm obviously biased, but I think the system is much, much better now.”

Mrs Arias Vasquez acknowledged challenges faced by the GHA, particularly around entitlement checks and access to services, but said the overall goal was to provide an efficient, well-resourced, and sustainable health service for Gibraltar.

In reconfiguring and streamlining the GHA and its services, a new internal audit department plays a critical role.

“If I've got an internal audit department that's looking at absolutely everything that's going on in the hospital and looking at ways that we can make that more efficient, every single penny that you spent on internal audit is worth it,” she said.

Technology is also allowing for a data-driven approach to decision making to best target resources.

The data and the GHA’s analysts “importantly tell you the trends and the direction of travel and where you should be aiming your expenditure”.

“We live in an age where data is at our fingertips and that data has to be used,” she said.

“So we have to drive the hospital on the data that we receive and the money that we have.”

Throughout the conversation, Mrs Arias Vasquez underlined the range of services offered by the GHA despite its size, including access to world-class multi-disciplinary specialists both in and out of Gibraltar.

She highlighted too new facilities at St Bernard’s Hospital such as the cath lab, which has been performing emergency procedures since going live with 24/7 on-call coverage, and the oncology suite, expected to open in the autumn.

Ms Arias Vasquez said the new oncology unit will be equipped with an aseptic suite, allowing chemotherapy drugs to be prepared in Gibraltar using NHS supply chains, significantly reducing costs by tapping into the NHS’ UK-wide purchasing power.

“The oncology suite is an example of how you better the patient experience,” she said.

“Cancer is always going to be horrendous, but you make it that little bit better. You give people the option of staying in Gibraltar and bring down the price.”

From bed occupancy levels to waiting times at the Primary Care Centre, Mrs Arias Vasquez keeps tight tabs on indicators that could point to trends in healthcare, or to brewing problems across all areas of the organisation.

But she insists her eye is on the bigger picture and that it was healthcare professionals who were in control on the ground.

“The health minister's role is to make as efficient as possible the service, so you have to understand a level of detail in order to understand where it's going, where the expenditure is going and how to make it work better,” she said.

“You have to understand the detail in order to be able to hold someone to account, but ultimately decisions are always going to be guided by the professionals.”

“The professionals are in charge. I just control the budget.”

“But in order for me to ensure that the Gibraltarian is getting the most effective and efficient service possible, I have to understand what's going on.”

“It's a fine balance, but my job as minister is to make sure that the budget that we're spending is going to be spent as efficiently and as properly as possible.”

And she added: “I don’t get involved in fixing the problem. But if I see a waiting list going up, I will call the medical director and ask what is happening.”

Ensuring that the GHA delivers the best possible service in a sustainable manner is vital as people live longer lives, as is the promotion in parallel of healthier lifestyles that will ultimately help reduce the healthcare burden.

For Mrs Arias Vasquez, it is about improving the organisation while also recognising its worth and the work of its staff.

“I think that everybody in the GHA is somewhat downtrodden by the constant negative feedback that they're getting,” she said.

“The problem is that 90% of the time [the GHA] is amazing, and people are actually amazed by the service that is delivered in the GHA.”

“But you only hear about the negatives, you only hear about when things haven’t gone to plan.”

“I'm not saying by any stretch of the imagination that every single service is perfect, because remember, the GHA offers a huge variety of services and there are some things that need improvement.”

“And there are some waiting times that need to be looked at and need to be improved.”

“But we also need to stop and think that, actually, there are a lot of things that they do that they do remarkably well.”