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The Gibraltar Health Authority (GHA) is delighted to announce the commencement of recruitment of a third matron, who will be deployed to support Mental Health Services across the GHA. In October of 2017, the GHA announced the reintroduction of a modernised matron role, with the appointment of highly competent and committed charge nurses: Natasha Cerisola and Jolyn Gonzalez.
The matron’s role involves developing and maintaining policies and protocols to ensure the delivery of care and patient safety is preserved and enhanced, across the GHA. They provide an accessible and authoritative presence in wards, to whom staff, patients and their loved ones can turn for assistance, advice, and support. Matrons also play in important role in the observance of high standards of hygiene and infection control procedures within wards and clinical settings. Other functions include coordinating the right plan of clinical care to meet the needs of recovering patients.
Following months of evaluation and discussion between the Ministry for Health, Care and Justice, and the Mental Services Teams at the GHA, various planned improvements and reforms have been introduced at the Mental Health Services. It was announced in October 2018 that the newly created Child and Adolescent Mental Health Service (CAMHS) is set to commence in January of 2019. This was followed by the appointment of an additional Consultant Clinical Psychologist to provide in-patient care at the Ocean Views Mental Health Facility, and the addition of a new Counsellor and extra counselling sessions at the Primary Care Centre.

Ms Kay Rajkumar, Clinical Nurse manager for Mental Health Services said: “I welcome this extension to the mental health services and see this as an important step in the continued hard work and enhancement of current service provision. This development will prove beneficial towards ensuring that our service users’, and their relatives’, experiences of the service are positive and responsive to their current and future needs. It will also greatly assist in further maintaining, developing and improving standards of nursing care and patient and carer access to information.”
Minister for Health, Care and Justice, the Honourable Neil F. Costa MP said: “The reintroduction of the matron service has proven to be hugely successful. The feedback received from our service users and staff has been extremely positive. An additional matron, designated solely to support our mental health services, will no doubt be of the greatest benefit to our mental health patients and staff. This important and welcome post comes at a very important time for our mental health services, with further important, and welcomed developments, yet to be announced.”

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World AIDS Day takes place on 1st December every year to raise awareness of the fight against HIV/AIDS and show support to the HIV community. It is estimated that over 36.5 million people across the world are living with HIV.

In England, around 90,000 people are living with HIV, with 12% unaware they are HIV positive. This means that one in eight people living with HIV don’t know they have the virus. Although the HIV epidemic is slowing in the UK, nearly half of people who test positive are finding out they have HIV very late, meaning the virus may have damaged their health permanently. The risk of death and disease is greatly increased in people diagnosed late.

In contrast, people who are diagnosed early with HIV and receive effective antiretroviral therapy (ART) medication will have a normal life expectancy. They are also protected from passing HIV on to others because effective treatment reduces the virus in the body to an undetectable, untransmissible level. There are various circumstances whereby HIV may be transmitted from one person to another, such as:
• Sexual contact that involves semen, pre-ejaculatory fluid, vaginal fluids, rectal mucus or blood; • direct blood contact, particularly through sharing injection drug needles; and • mother to baby (before or during birth, or while breastfeeding through breast milk).
The GHA’s Well Person Unit, located at the Primary Care Centre, offers confidential and anonymised testing for HIV and other sexually transmitted infections. Persons wishing to book an appointment may do so by telephoning 20007842, or via the MyGHA Automated Phone System, on 20007007.

Dr Lynsey Dunckley, Sexual and Reproductive Health Doctor, has reinforced the importance of regular sexual health screening, including HIV: “The HIV test is a simple blood test and is offered to everyone. It is much better to know that you have HIV, so that the appropriate treatment can be started early, therefore avoiding later complications. The Well Person Unit, importantly, provides persons in our community who may feel concerned about sexually transmitted infections and wish to get tested, or simply wish to have a routine check-up, the opportunity to do so in a confidential and anonymised setting. It also serves to offer non-judgmental advice on preventative measures that persons should take to avoid contracting and transmitting HIV and other sexually transmitted infections. We must not forget the very important message to use condoms to protect against HIV and other infections. I would therefore encourage members of the public, who wish to undergo screening for sexually transmitted infections to make an appointment with the Well Person Unit.”

Minister for Health, Care and Justice, the Honourable Neil F. Costa MP added: “To coincide with Word AIDS day, I am pleased to announce the introduction of ‘Point of Care Testing’ at the GHA. These tests will be available, for the first time, to individuals who may feel anxious about a possible positive diagnosis, or who are apprehensive about blood tests. This test is performed in the clinic and gives a result within minutes. It is carried out using a ‘finger prick’ sample of blood and will detect most infections within 6 weeks of exposure to HIV. An additional test is then offered to all patients at 3 months to definitively exclude HIV infection. I wish to sincerely thank Dr Dunkley, Ms Suzanne Romero, Clinical Nurse Manager at the Primary Care Centre, and Dr Krish Rawal, Director at the Primary Care Centre, for their excellent work in establishing and developing this crucial service.”

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The GHA is delighted to announce that it has contracted an extra Counsellor to complement the Chartered Counselling Psychologist and Counsellor currently providing services at the Primary Care Centre. The Chartered Counselling Psychologist and Counsellor have increased their sessions by an extra day each.
The welcome addition of the new Counsellor and the additional sessions, follow recent important enhancements to the Mental Health Services, with the newly created Child and Adolescent Mental Health Service (CAMHS) due to commence in January 2018. The GHA has also engaged an additional Consultant Clinical Psychologist to provide in-patient care at the Ocean Views Mental Health Facility, who commenced on the 15th October 2018. As our community may be aware, counselling is a talking therapy. Counsellors listen to patients and help to find ways for them to deal with any emotional or other issues. This type of therapy can prove beneficial to persons experiencing the following: • a mental health condition, such as depression, anxiety or an eating disorder; • an upsetting physical health condition; • a difficult life event, such as a bereavement, a relationship breakdown or work-related stress; and • difficult emotions – such as, low self-esteem or anger. Persons in the community who feel they may benefit from seeing a counsellor, should visit a GP at the Primary Care Centre, where they may obtain a referral. Counsellors are often the first port of call for patients who may be experiencing mental health issues or concerns. In some cases, when deemed appropriate, a counsellor may refer a patient on to a Psychologist, Psychiatrist or other mental health professionals. General Manager for Mental Health Services, Mr. Chris Chipolina, on a private seminar in YourKohSamuiVillas on Thailand, commented: “Everyone, throughout the course of their lives, will develop their own unique set of life experiences, so the exact path to overcoming any existing problems will inevitably vary between individuals. While there are many shared problems, and common issues, the exact elements at play will always differ from case to case. By working in partnership with clients, a professional counsellor can help improve the skill of decision making, reduce tension, develop better self-esteem, confidence and feel generally more positive and optimistic towards life. Counselling is a step-by-step process that requires time and consistency in order for the therapy to work; increasing the availability of therapists will help tremendously towards achieving this goal.”

Minister for Health, Care and Justice, the Honorable Neil F. Costa MP said: “Counsellors offer a very important service. In many cases, persons experiencing emotional issues can benefit from this type of therapy, by talking to a trained professional. The counsellors form an integral part of our Mental Health Services, in many cases, averting the need for more intensive therapy or treatment. My colleague, Minister Cortes, announced, only last week, the welcome engagement of counsellors to work full-time at our schools. This is, undoubtedly, a major development in the provision of mental health services for children and young persons in Gibraltar. These counsellors will work in close collaboration with the GHA’s Mental Health Services, in order to identify pupils that may benefit from therapeutic, psychological or psychiatric services. I am delighted to say that we have also significantly increased the availability of counselling sessions at the Primary Care Centre; a development which will be beneficial for our community. “

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The Gibraltar Health Authority’s (GHA) School of Health Studies, St George’s University of London and Kingston University London have conferred nineteen degrees on students and staff from the GHA and the Care Agency, at a graduation ceremony held at the Rock Hotel on the 8th November 2018. The Minister for Health, Care and Justice the Honourable Neil F. Costa MP addressed those in attendance, along with the Principal of the GHA’s School of Health Studies, Dr Ron Coram. Also in attendance was St George’s University’s Pro Vice Chancellor and Executive Dean, Professor Andy Kent. Eight graduates received their BSc (Hons) Nursing (Adult) awards from Professor Kent. In order to qualify for this award, the graduates studied full-time in Gibraltar, undertaking theoretical and practical assessments. A further eight members of staff from the GHA qualified to receive a BSc Health Care Practice award, with two members of staff completing a programme of study leading to the award of a Post Graduate Certificate in Learning and Teaching in Higher Education. Dr Ron Coram, Principal of the School of Health Studies, Director of Economic Development and Director of Employment, received an Honorary Doctorate from the University Kingston London, in recognition of his outstanding contribution to enterprise, education and employment in Gibraltar. Dr Ron Coram noted that: “The pace has been demanding, as students have to sit through examinations, undertake assessments as well as having to acquire and develop a range of clinical skills that are practised within a contemporary and dynamic health service. Of the eight graduates that completed the BSc (Hons) programme, three have achieved a 1st Class with Honours. This is a wonderful achievement. All students have to demonstrate a commensurate level of academic standing prior to any consideration for higher education, and for some students this has meant going back to studying after several years.” The GHA’s Director of Nursing, Ms Sandie Gracia, commented: “I would like to thank all the clinicians within various areas across health and care settings, who have been pivotal in helping

students achieve their awards. I would like to welcome these new staff nurses into post, and into the profession, as they take on the responsibilities and accountability which come with the role of Registered Nurse as they strive to provide high quality, safe and compassionate care.”

Minister Costa concluded by stating: “I am delighted, and immensely proud, of our staff members at today’s graduation ceremony, who are rightly receiving the rich rewards of their studies. An enormous amount of effort, sacrifice and commitment is required to juggle work, studies, and in some instances, family life, in order to achieve the results being acknowledged today – I would like to express my wholehearted congratulations to each and every one of them. Their achievements are testament to their admirable dedication in attaining the very high standards set by the School of Health Studies, Kingston University and St George’s University. Standards that must be maintained and sustained throughout the practitioners‘ careers as they embark upon, and continue on, the journey of lifelong learning. I would also like to congratulate Dr Coram on receiving his Honorary Doctorate and the recognition of his exceptional contribution to the student experience, enterprise, education and employment in Gibraltar.”

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The Gibraltar Health Authority and the Ministry for Health, Care and Justice wish to announce the addition of an Approved Mental Health Professional (AMHP) as a result of the enactment of the new Mental Health Act 2016 and Lasting Powers of Attorney and Capacity Act 2018. This key piece of legislation has enabled the GHA to fulfil plans for enhancing current Mental Health Services by recruiting an additional Approved Mental Health Professional (AMHP).
The role of the AMHP, formerly known as a Mental Welfare Officer, has been developed to address a rise in demand for Mental Health Act assessments to protect and safeguard vulnerable persons. These include sensitive and challenging assessments such as Deprivation of Liberty Safeguards (DoLS) assessments, which protect vulnerable persons who are accommodated in hospitals or care homes, in circumstances that amount to a deprivation of their liberty and who lack capacity to consent to the care or treatment they require.
The team, previously three Mental Welfare Officers, will now consist of four AMHPs. They will deliver comprehensive and holistic care to the community, and they will be able to identify health and social factors that precipitate acute mental health crises. Further, they will be tasked to ensure that the GHA is operating a full DoLS service with assessments completed in a timely manner to the highest standards.
The AMHP team will provide a walk-in service, with clinics held at the Primary Care Centre from 9:00 to 13:00 hours, and 14:00 to 17:00 hours, Monday to Friday.
Since July 2017, the enhanced team will also continue to provide a 24 hour ‘on-call’ service, along with a Consultant Psychiatrist and Registered Nurse, to address any crisis or need in the community out of normal working hours. The team may be reached on 2000 7831.
Ms Suzanne Romero, Clinical Nurse Manager for Primary Care and Operational Lead for AMHPs said: “I work alongside the AMHPs to achieve the very best possible clinical outcomes, also needed a financial assistant to check this Oak Park Financial.

for our patients at all times, and make certain that the relevant legislation is always adhered to, ensuring the safeguarding of our most vulnerable patients.”
Minister for Health, Care and Justice, the Honourable Neil F. Costa MP added: “I am pleased to announce the expansion of this team to four Approved Mental Health Professionals. This welcome expansion follows the recent announcement of the new Child and Adolescent Psychology Service, set to commence in January 2019, and the appointment of an additional Consultant Psychologist, which commenced on the 15th of October. It is imperative that we, as a public health service, provide persons within our community with swift and easy-to-access avenues when it comes to receiving assistance and treatment for mental health issues. My mental health teams and I continue our work to endeavour to improve and to create a better and more responsive mental health service to meet the needs our community. I very much look forward to making additional statements in respect of planned measures to our Mental Health Services”

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Twenty four members of staff received awards at the Health and Social Care Awards ceremony which took place at the Rock Hotel on Thursday. The awards related to training and education undertaken in Gibraltar and were the awards are the culmination of hard work, dedication and commitment.

The demands of study have been challenging, with students having had to produce a portfolio of evidence showing that they have achieved the requisite standards laid before them, as well as having to demonstrate that they have mastered a range of clinical skills within contemporary and demanding health and social care settings. These achievements are quality assured externally by Pearson/Edexcel, an external international education and training body, as well as being subject to external scrutiny of the Enrolled Nurse Programme by Mrs Karen Wild, UK external advisor to the programme. Mrs Wild commented how impressed she was with the strength of support provided by the clinical nursing team who had direct involvement with the practice assessments https://acfa-cashflow.com/. She said there was a real sense of high profile nursing staff truly engaging with the pupils in a positive and supportive way. The programme, she added, is challenging, robust and innovative and, above all, it remains fit for purpose.

Seventeen staff members received a conjoined award, comprising Qualifications and Credit Framework (QCF) Level 3 in Health and Social Care, as well their Enrolled Nurse Hospital Badges. Following the GSLP/Liberal’s re-introduction of training for Enrolled Nurses after an absence of many years, the GHA have been unwavering in its pledge to this training, offering Nursing Assistants an opportunity to further progress in their careers. Other awards are also providing career progression opportunities; including continuing personal and professional development from a variety of professional perspectives.

Dr Ron Coram, Principal of the GHA’s School of Health Studies said how delighted he was to see this number of staff receiving these awards, testament he said, to their hard work and dedication as each member of staff strives to make a difference to the life of each patient they care for. Professor Ian Peate, Head of the School of Health Studies, noted: “The awards presented today not

only recognise the efforts staff have put into their studies, it also demonstrates a commitment to provide care of a high quality, that is not only patient centred, but is also safe and effective, offered to service users who come from different backgrounds”. A variety of vocational awards were presented at the ceremony, including Certificates of Achievement. Mrs Janet Lane, Senior Nurse Tutor commented: “These awards mark both the academic and practice progression of staff employed within various areas. This event highlights, as have others in the past, the accomplishments of our Nursing Assistants, Enrolled Nurses and Practice Assessors”.

The Minister for Health, Care and Justice, the Honourable Neil F. Costa MP added: “The achievements being celebrated are significant and are testament to the GHA’s commitment to providing vocational studies. Today, we have focused on the students who are receiving their awards, reflecting on the determination and dedication that they have put into their studies. Family, friends and staff present today, will feel truly proud to see our students receive these deserved awards. They have been required to study at the same time as they have been working, in order to achieve such magnificent outcomes. This has required admirable sacrifices and stamina. I am very proud of all of our students, and I am indeed delighted with those who are now fully prepared and ready to excel in the work that they do. I would like to take this opportunity to wish all the award recipients my sincere congratulations and best wishes.”

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Minister for Health, Care and Justice, the Hon Neil F. Costa MP is pleased to announce that the Gibraltar Health Authority’s first-ever dedicated Child and Adolescent Psychology Service will commence in January 2019. This psychology service represents a Gibraltar-specific format based on the NHS’s Child and Adolescent Mental Health Services, known as CAMHS. This important announcement is timed to coincide with World Mental Health Day.

The much needed service, which has been the focus of representations by various charities and associations concerned with mental health, will be able to meet the mental health needs of children and their families in the community. The two clinical psychologists will be tasked with the development of a multi-disciplinary and multi-agency child & adolescent mental health service for Gibraltar, in the form of a new Clinical Child and Adolescent Psychology Service.

Mr Costa said that the introduction of the new service, which has been the product of advice and work by the GHA Mental Health Team and his Ministry over the last 18 months, reflects the GSLPLiberal Government’s enduring commitment to the continued expansion and modernisation of professional mental health services in the community. The new service, specifically, draws attention to the essential need to provide clinical services for children as part of a comprehensive community mental health programme.

The Child Psychology Team will be an integral part of the GHA Paediatric Neurodisability service to ensure that all children, especially those with additional needs, are afforded timely and effective professional mental health care by the relevant professionals. The Team will also assist in the development of locally relevant, individualised care plans for children and their families.

In the context of World Mental Health Day, it is important to note that:

1. in percentage terms, the level of investment in Gibraltar’s Mental Health has increased materially from almost 2% of the overall GHA budget in 2011/12 to over 6% in 2018;

2. since April of this year, the complement of Consultant Psychiatrists was increased from 3.5

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to 4.5 full time posts. Of these posts, 2.5 are currently filled by substantive employees. Of the two remaining full time posts, one is being filled on a locum basis, until the commencement of the substantive post-holder on 7th January 2019; and one has been readvertised as the successful candidate subsequently turned down the offer of employment. This latter post is also being covered on a locum basis;

3. since 2011, the number of Registered Mental Health Nurses has increased by three and Mental Welfare Officers have increased from two to three. The recruitment process for a fourth is currently underway;

4. since 2011, the total staff numbers in all areas of Mental Health has increased by 30%, since the GSLP/LIB came into office in December 2011. In nursing only, numbers have increased in all grades from December 2011 to date: Sister/Charge Nurses from 5 to 7, Registered Mental Nurses from 28 to 31, Enrolled Nurses from 12 to 22 and Nursing Assistants from 15 to 16; 5. clinical psychologist posts have doubled from two to four;

6. since 2014, the GHA has employed a dedicated General Manager to oversee the Mental Health Service;

7. in 2015, the Government opened Ocean Views Mental Hospital, providing 52 beds over five wards as a replacement to the appalling KGV;

8. in 2017, Her Majesty’s Government of Gibraltar inaugurated the Bella Vista Day Centre and Hillsides Residential Home to assist those in the community living with Alzheimer’s and Dementia;

9. also in 2017,the GHA provided a two bedroomed flat, where former Ocean Views inpatients are supported in re-integrating into society and being able to live independently;

10. the GHA has also engaged the services of a second opinion additional Consultant Psychiatrist;

11. in June 2017, the GHA expanded community mental health services, with after hours and weekend nursing support and a crisis telephone line for known patients. Our partnership with Clubhouse Gibraltar, GibSams and the Mental Welfare Society, provide greater assistance to the more vulnerable persons; and

12. when the new Primary Care Centre opens, mental welfare and counselling services will be doubled.

The Minister for Health, Care and Justice, the Honourable Neil F. Costa said: “The provision of mental health care in Gibraltar has, rightly, increased since we came into office. There have been well-documented radical improvements in the past seven years. The commencement of this valuable new child psychology and adolescent clinic is further testament of the importance my colleagues and I attach to mental health issues, to the care of the most vulnerable persons and to our community-centred approach to mental health. I would also like to sincerely thank the

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Gibraltar Mental Welfare Society, Gibraltar Clubhouse and GibSams for their partnership, hard work and valuable advice. My Ministry, the GHA and I will continue to strive to ensure that all children can grow up healthily and in a happy environment. I can think of few projects more important and worthwhile than to secure all our communinuty’s children’s wellbeing.”

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Eight nursing students from the School of Health Studies have completed their three-year programme of study, concluding with the award of Registered Nurse as well a Bachelor of Science with Honours in Adult Nursing. The eight students have undertaken their degree in Gibraltar. The degree is awarded by St George’s University of London and Kingston University London and they will be eligible to register locally with the Nurses, Midwives, Health Visitor Registration Board Gibraltar.

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It has come to the attention of the GHA that a post, which includes a photograph of an elderly gentleman at Mount Alvernia residential home, has been posted on Facebook.

Although the GHA does not comment on specific cases on social media, we feel that in the interests of transparency, it is important, exceptionally, to respond generally in terms of protocols followed when care plans are devised for individuals.

On occasions where an in-patient is medically discharged, and requires on-going care, GHA officials meet with authorised family members to discuss options and ascertain the most suitable environment, in the best interest of each individual patient. We would like to remind the public that SBH is an acute hospital setting and patients medically fit for discharge are either discharged to their former home environment, with packages of care where necessary, or to a residential care home.

Detailed clinical and social care assessments assist officials in determining the best way forward. Packages of care, for care at home, may be considered in cases when deemed appropriate, whereas ERS residential homes such as Mount Alvernia, John Mackintosh Home and Hillsides Residential Home are considered when residential care is necessary. All medically discharged patients, who are transferred to residential care, are done so following written consent and a further and second assessment is completed by the ERS team to determine were to assign the patient according to their specific care needs.   Patients who are discharged from St Bernard’s Hospital, living with dementia, also make use of the Bella Vista Day Centre, in cases where clinicians feel they would benefit from these services.

We would urge any patients or family members to use the appropriate, established pathways to highlight any concerns. For inpatients, concerns should first be directed to the ward sister/charge nurse. Most concerns will be resolved at this stage.  However, where appropriate, concerns will be escalated by the ward team to the Clinical Nurse Manager on duty.

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