June 27 - GSD Opposition Member Ellul-Hammond’s Budget Speech - Full Text
Introduction
Mr Speaker, it gives me great pleasure to address Parliament as Opposition Spokesman for Health, Social Services and Civil Contingencies. It is both a duty and an honour for us on the Opposition benches to contribute to, and vote, on this vital discharge of the responsibility of Parliament.
And what a year this has been Mr Speaker, a year in which the GSD opposition has held the Government to account on behalf of the people of Gibraltar. A year where the GSD Opposition has questioned Government policy where appropriate, occasionally even getting an answer to those questions. A year of positive and effective Opposition.
Civil Contingencies and the City Fire Brigade
Mr Speaker, I begin my address with Civil Contingencies and the Fire Service:
I start by referring to the Honourable Minister’s Budget speech of last year where he said that:
“Professional development in the form of training was unfunded and it was only until last year that some extra funding was provided for this”.
‘Unfunded’ Mr Speaker, I would impress on the Honourable Minister to check the present and past Estimates of Revenue and Expenditure Books to see that under the Head of ‘Operational Expenses for the City Fire Brigade’ & ‘Training Courses’, he will note that this has been funded to the tune of £90,000 for the last three years. He further stated that:
“We have increased it even further only months after coming into office”, as if only his Government could possibly understand the value of training and Continuous Professional Development. But wait for it, the increase was of £10,000 Mr Speaker for the 2012/2013 financial year, and not so important it seems this financial year, as the figure remains exactly the same, at £100,000 for training; not even an increase to account for inflation.
With much fanfare and many photo opportunities, the Minister said how he visited each watch of the City Fire Brigade to observe them performing different exercises in order to address the so-called ‘de-motivation’ that the fire service had endured for many years. How many more motivational visits has the Minister made to the three watches of the City Fire Brigade Mr Speaker? Perhaps he could have been a bit more honest by stating it was a familiarisation visit, as would be the norm, and not spin it to sound as though, if he hadn’t visited them, the fire service would have collapsed in a morass of demoralisation!
The Government commissioned Sir Kenneth Knight, the UK Government’s Chief Fire and Rescue adviser, to conduct a SCOPE Study of our local Fire & Rescue Service, which was completed last November. Seven months later, we are still waiting for the contents of the report, in full, to be made public. Not of course the first Government report that has been delayed; perhaps it has not yet been formatted. But we look forward to hearing of the findings of the report regarding the re-organisation and transformation of the Gibraltar Fire Service and Defence Fire Service. What the recommended modern working and shift patterns are; what the terms and conditions of service for the fire-fighters are.
There is also still no word on the relocation of the fire station, on which Sir Ken Knight would have had a view, and no commitment for it, again, in this year’s Budget. Such a delay in informing the public makes one think that Sir Ken Knight’s recommendations may not be what the Government was expecting. Will the Minister now be cherry-picking recommendations from the report so as not to upset the apple cart or are issues being moved in private by Government activists, as has become the practised norm of the GSLP?
The Honourable Minister was also critical in his last Budget that C3
“Table top exercises had not been carried out as should have been the norm” and that:
“C3 meetings would be convened regularly in order to evaluate current procedures”.
Well Mr Speaker, this is another budget commitment that has not yet been fulfilled, the full C3 has met three times in the last year and a half, hardly regular or evaluative. I wonder whether in one of those three meetings the civil contingency was discussed for when Gibraltar’s only two brand new emergency ambulances broke down, in the same area of flooding, along Queensway. Both of Gibraltar’s emergency ambulances, using the same route and out for the count at a time when they were potentially most needed. And the City Fire Brigade tied up rescuing them, when they too were on alert and most needed during a power cut on a day of pouring rain and floods. That procedure needs evaluating by C3.
We also hope Mr Speaker that the new Medical Priority Dispatch System goes live very soon. We have had several concerns raised where members of the public have called the ambulance in an emergency, only to be told that they are both busy and they either have to wait or get a taxi! The City Fire Brigade operates a third ambulance, which is also deployed in these circumstances, however they are neither paramedics nor trained health professionals. A pre ‘scoop of the patient’ triage system is absolutely essential to ensure that emergency ambulances are not called to incidents that are not emergencies, thus depriving those who REALLY need them.
Mr Speaker, still on the topic of ambulances, the new ambulances and Patient Transfer Vehicles are very welcome: £1m well spent. Or is it? The Honourable Minister Costa, who was shadowing Health in Opposition, went to great lengths to highlight the inadequacy of the then fleet of ambulances and how they kept breaking down, some did not even start, and that they were not fit for purpose. Let me put things into perspective Mr Speaker, of how the situation is today.
In answer to a written question by me in February to the Minister for Health, I learnt that in just 14 months, the new ambulances and Patient Transfer Vehicles had broken down no less than 52 times and been off the road for a total of 565 days for repairs, which cost the taxpayer £59,000. Also, the cover for these broken down vehicles cost around £73,000; that is a total of £132,000 in 14 months for ambulances that had broken down. I assume that when Minister Costa stated in one of his seven ambulance-related press releases in just two months, as Opposition Spokesman for Health, that:
“The voters can at least dispense with Mrs del Agua’s services as an ineffectual minister at the next election”, he did not intend this to apply to his now Minister for Health, Dr Cortes?
Health
With regard to Health Services in Gibraltar Mr Speaker:
The Honourable Minister opposite presides over the largest community budget, which reflects the importance we give to the free provision of health care. The Estimated Budget for this financial year of 2013/2014 now stands at £94,506,000, including a contribution for capital expenditure. The GSD Government estimated a Health Budget of £78,880,000 for the financial year 2011/2012, which it saw half way through, until the GSLP/Liberals took office after the General Elections. In just two years, the Health Budget has gone up by £15,626,000, an increase of around 20%. While I welcome increases in the health budget Mr Speaker, it is imperative that those with the political responsibility ensure we receive a value-for-money health service that adequately foresees and pre-empts the problems ahead through careful planning rather than throwing money at it. Our health service therefore really needs to show some results and improvements in order to justify this increase.
Given this huge increase and the millions we spend on health care every year, it is my duty to raise the question as to why some serious issues have not been tackled: such as acute bed shortages and cancelled operations; long operations waiting lists; months to get an appointment with a Consultant; a CT scan that keeps on breaking down; locum cover that is still at a high of £2m, estimated for this financial year; and a GHA Board which remains ineffective with no accountability for how the GHA organisation works and to ensure that it offers ‘value for money’. These fundamental necessities and issues are not achieved simply because the GHA Board is meeting in public under a veneer of openness, as the GHA Board process remains exactly the same as it has been for the last 20 years, with little empowerment of its members. Perhaps Mr Speaker, we can put it all down to ‘rookie error’?
Mr Speaker, my Budget address has to respond to that of the Honourable Minister of last year; to assess whether his pledges have been fulfilled or whether his allegations made of the previous administration had any foundation.
Dr Cortes stated last year that the Executive Structure of the GHA, of which he and his party have been so critical, was created by the old regime in No 6 Convent Place; that doctors were banished from the Management Board and Directors were personally appointed. Well Mr Speaker, this is the very same Executive Management Structure that was advised and created in 2004 by the then temporary Joint Chief Executive, Mr John Langan. The very same Mr John Langan commissioned by Dr Cortes, who has been paid exactly the same as the former CEO, Dr David McCutcheon, to review his own GHA Executive Management Structure, with little change so far and still no Medical Advisory Council.
The same Mr Langan who withdrew the so-called ‘flawed’ Consultant Contract in December 2004 and was until recently, paid to find a solution to the ongoing Consultant Contract problem, which has still not been resolved as per his brief, despite last year’s Budget commitment to:
“Negotiate a fair reasonable agreement that places reasonable expectations on the consultants" and about which Dr Cortes stated:
"I expect agreement this year”.
Dr Cortes criticised a GHA that he inherited and then employed the SAME man, crucial to the 2004 implementation of the new GHA, in order to re-fix it.
The GHA now has a new Chief Executive Officer, or rather, should we refer to him as the Head of the Health Department with his ‘permanent & pensionable’ terms and conditions. This diminishes the accountability of a Chief Executive of an Authority who should be on contract, with specific targets, answerable to the GHA Board and therefore subject to removal from the position if not met, as per the constant concerns raised by the then GSLP Opposition that the then CEO of the GHA should not have his contract renewed. I am hopeful this CEO/Head of Department will succeed; however, I will be very interested to see what will happen should the Chief Executive not achieve the targets he has been set.
Dr Cortes mentioned at last year’s budget how he:
“Was briefed on the severe waiting list of over 200 patients in General Surgery and the increasing waiting lists in the other services.”
Well Mr Speaker, the last time I looked, there were 309 patients waiting for General Surgery and the waiting lists for all surgeries now stand at 1,081, from an all time high of 1,118 in April, an increase of around 15% these last 18 months.
Dr Cortes was also concerned then that the bed access problem was limited due to a total of 65 acute beds taken up by patients waiting for a Care Agency bed. Well again, in answer to a written question from me last month, there are now 80 acute beds taken up by long-stay elderly patients awaiting a place at the Elderly Care Agency, 15 more than last year, an increase of 23%.
And despite my ‘questionable use of statistics’ and my ‘not understanding how waiting lists work’, the fact remains that 65 operations were cancelled, due to lack of acute beds, in the first five months of 2013, compared to only 48 for the whole of 2012. It is obvious that the measures taken in 2012 had only proven to be a temporary patch to the problem.
However, we do welcome the positive initiatives announced by the Honourable Minister yesterday regarding the operating theatres , together with an increase in Care Agency and Mental Health beds to be rolled out by the end of the year, and look forward to seeing if the results they yield are lasting.
The issue of cancelled surgeries and bed availability which I have highlighted these last few months, demonstrates how effective Opposition questions can be at galvanising the government into action, into finding solutions which benefit the people of our community. That is the role of the Opposition and we will continue to monitor their delivery, praise positive results, but will continue to subject the Government to the checks and balances in order to ensure further positive action.
And yes there are some further positive stories coming out of the GHA: Minister Cortes will be happy to hear that no concerns have been raised with us about the control of the Norovirus at St Bernard’s Hospital this year; the employment of more nurses has been extremely welcome; the plans for solar heating, LED lighting and environmental measures generally are commendable; and so far, apart from a few hiccups reported to us, the new Primary Care Centre appointments system seems to be running smoothly, although some improvements could still be made to ensure consistency in the process. Patients now look forward to a new system for repeat prescriptions, without the need to see their GP. Credit must also be given to the health team in their quick response to the cases of TB and their measures to mitigate any spread of the infection.
Certain commitments for this year were made at last year’s Budget, but not all have been implemented Mr Speaker: such as the tabling of changes to the mental health legislation, which was due this year; and an agreement over the Consultants Contract, also expected this year. I understand that both these are still ongoing and will be tackled this year, as per the Minister’s announcement yesterday; however I hope not to be raising this issue again at next year’s budget. And despite the repeated answers in Parliament of, ‘it is being reviewed’ or ‘will be ready within a few weeks’, the public is still waiting for the publication of the £130,000 GHA Review Report which was completed in November of last year; but perhaps it too is being formatted.
As also stated yesterday, somewhere in the pipeline we still await the implementation of the new kitchen and food system; wait for the new permanent facility for Ambulance staff; wait for the colon cancer screening programme to actually start; for the new GHA website; the new Ombudsman GHA Complaints process; the completion of the Diabetes Strategy; the review of the Sponsored Patients Programme; the health promotion initiative to develop a co-ordinated programme in lifestyle change, where only the smoke free legislation and related awareness has been launched to this end, over and above the continued previous practice; and changes to the children’s health services, which members of the public have always been happy with anyway.
With regard to health promotion, much stock has been made of the Lifestyle Survey, conducted by the GHA in 2008, where the results will be used to raise awareness on changing lifestyles in order to improve health. A note of caution Mr Speaker, these results are now five to six years old, that makes the data unreliable and less relevant to the Gibraltar population of today. This needs to be highlighted by the public health team when promoting the booklet among the public and should not solely form the basis of advice to the general public on preventative lifestyle changes.
One area of policy-making, which has been lacking in Gibraltar, is that of sexual health advice and support. The Government’s manifesto commitment to offer IVF treatment through the GHA is welcome, and the happy news is that now contraception is available under the GPMS. But we believe that jumping from no official GHA sexual health service, apart from an ad hoc one offered by some GPs, straight to fertility treatment, without the proper sexual health advice services in place, is premature.
The GSD’s policy to set up a sexual health advisory clinic to offer free, confidential advice and information on sexual health, sexually transmitted diseases and contraception, addresses this. Its objectives to enable people to make informed choices about sex and to enjoy sexual health safely, have the knock-on positive consequence of reducing the number of unwanted teenage births. And awareness and screening for certain sexually transmitted diseases will mitigate the end result of infertility, with couples having to resort less to IVF treatment at a later stage in their sexual life. I urge the Honourable Minister to look at this policy area seriously for consideration.
As I commented in last year’s Budget, no address on health by me would be complete without saying something on breast cancer care services in Gibraltar. Although an honourable but empty gesture for the GHA to raise awareness with ‘Breast Cancer Support Gibraltar’ about lymphoedema to the upper body of breast cancer sufferers and survivors, and to state in press release No 154 of 2013 that:
“It is important to highlight the vital need for lymphoedema to be detected and treated as early as possible, thus ensuring quality of life to those affected,” with which I concur, there are still too many women being failed in this regard.
Many women are struggling to receive the appropriate therapy; treatments are not regularly given, which need to be administered for the rest of their life, and many women are waiting far too long to be re-assessed, measured, and checked, feeling there is no individual care pathway for them in place. This potentially affects every breast cancer survivor who has had their lymph nodes sampled or removed, affecting a majority of 1 in 8 of us women. A walk-in lymphoedema clinic is urgently needed Mr Speaker, and I urge the Honourable Minister to listen to the concerns of Breast Cancer Support Gibraltar on this matter and to take heed, and not to take it as another photo opportunity.
The Breast Screening Programme has now been in place for two and a half years, a period during which all women eligible in Gibraltar have been invited for a mammogram for their first time. In 2012, only 58.2% of women invited took up the offer of a mammogram, this is a figure that falls well below the UK’s ideal uptake figure of 70% and below the lowest uptake figure of 59%, seen in some areas of the UK, and which has received concern from UK health professionals. This is a service that should be taken up by almost 100% of our women eligible Mr Speaker, due to the easy access to healthcare in our small community.
However, I am heartened to see that for the first five months of 2013, we see an uptake of 74.4% of women, which is much more acceptable and only hope will move in that direction. Yet I again repeat my pledge to the Honourable Minister and urge him, as part of the GHA’s public health policy, to conduct an awareness campaign on the benefits of the Breast Screening Programme and to encourage women to take up the offer of a mammogram. It may mean life or death for some.
On a point of principle Mr Speaker, since this Government has taken office, it has become common for the GHA to be used for issuing press releases, rather than the Government’s press office via the Ministry for Health & the Environment, the latest being press release number 370 of 2013 of 30 May. It is entirely inappropriate for the Health Authority to question and challenge the Opposition Spokesman for health on matters of party political policy, or respond with vitriol and spin.
The GHA can by all means issue press releases on data information, GHA initiatives, charity donations and so forth, which it does, but should remain removed from the political interchange. It is completely inappropriate that press releases should be issued in the name of the GHA, which are pointedly political and designed to attempt to damage the reputation of those serving on the Opposition benches. Has the GHA now become a political organ of the Government or does it remain a part of the public services, of the people of Gibraltar, which should remain apolitical?
Social Services
In February this year, after Danny Feetham became the Leader of the GSD, we saw a reshuffle of portfolios among the GSD MPs. After moving my Education portfolio to Edwin Reyes, I was then charged with shadowing Social Services. In order to get to grips with this new responsibility, I obviously reviewed all the press releases and announced policies by the Government to check what had been achieved so far in this Ministry. Well not much of substance yet Mr Speaker, a lot of photographs in the media for turning up to events and a few policies that are just the continued GSD practice in areas of training and domiciliary care.
In 18 months, the Calpe Ward has opened with 18 beds, which is welcome but had little impact on cancelled surgeries; more social workers have been employed, which is also welcome; the Clubhouse Project has been given temporary premises, we look forward to hearing of news for a permanent facility; Care Agency nurses have parity again with those of the GHA, which is welcome plus the payment of salaries electronically; and disability access to various sites around Gibraltar has increased, which is right and proper and to be applauded. However, the new access to Catalan Bay was not planned in consultation with the disabled users of the beach, nor sought guidance from the DPC. It has failed to provide proper access to the shoreline, unlike the facilities and services enjoyed by those at Eastern Beach. Yet another ill-conceived and poorly executed project announced with great fanfare but failing to deliver.
The announcement by Minister Balban to review the eligibility criteria and rules for use of Blue Badges spaces and the increase in disability allowance are very welcome; however we are still waiting on the results of the Disability Services review, life planning for the disabled and new legislation on disability. Also on hold, and part of some ongoing process of the amalgamation of Social Services and Elderly Care, which the Minister claimed at her 2012 Budget had not yet occurred, is the filling of Mount Alvernia’s nursing co-ordinator post and that of Tangier View’s residential Home Manager. Considering the enormous overall increase in the number of civil service posts that has occurred since this Government came to office, I would have thought that these two key roles would have been quickly filled.
The secure unit for children with severe challenging behaviour, plus the full review of the Children Act, as pledged at the last Budget, still remain elusive. Other issues which appear to have failed to gain any traction are the Dementia Strategy, the refurbishment of the Jewish Home, promised at the last Budget, and the long delay in the opening of the Waterport Terraces Day Centre.
Mr Speaker, if every change of Government resulted in them behaving in the manner of the present one, social progress would grind to a halt. The Minister for Social Services, in pursuing the GSLP policy of rubbishing everything the GSD ever did, has set the cause of the elderly and vulnerable back by at least two years, and this in order to try and convince us that she is saving the day from disaster. To say that work finally started in April 2013, after 16 months of inaction, Minister Sacramento needs to explain why there have been no works at the former Royal Naval Hospital site previously and for so long. What have the construction workers been doing for 16 months and how much has it cost the taxpayer to keep them waiting to start work again on the project until April 2013, having to re-mobilise them?
The reality is that the GSD’s plans for the Alzheimer & Dementia facility were perfectly acceptable and well within the guidelines and recommendations for NHS Registered Elderly Homes. The specifications were provided by the Care Agency and GHA Deputy Chief Executive Officer, Mr Joe Catania, who were part of the design team all along, where their brief recommended rooms sized within the NHS minimum standards required.
The downstairs single rooms, which are the only ones highlighted, were the smaller ones at 9.6m squared. This is an accepted size for the restoration of an existing historical building, with the option to remove the dividing wall to convert it into a twin room at 19m squared, larger than the NHS minimum for a twin, set at 16m squared. Additionally, the ceilings in these smaller rooms were reinforced to take overhead hoists, so there was no need to bring a mobile hoist in, as demonstrated by the grimacing Minister for Social Services, to show how cramped they could make the room look for the media!
It is greatly disappointing that almost from the first day of entering office, the GSLP Government chose elderly care as a battleground for scoring political points against the former GSD Government, rather than embracing and building upon the ongoing projects in a timely manner. However, if this is the style of Minister Sacramento, the very least she should have done is look at the previous GSLP Government’s policies where funding barely existed for Social Services and the elderly. And judging from the interruptions of my Hon friend Mr Selwyn Figueras, if we had said, as the Hon Minister has to us, that they had put vulnerable adults at risk, there would have been an explosion in the benches opposite.
As for the ‘independent living complex’ planned by the GSD for the more mobile and independent elderly persons at the old John Mackintosh Wing of the former St Bernard’s Hospital, which had been completed and ready for people to move in; it has now been gutted, with brand new kitchens and bathrooms torn out, some recycled but most thrown away, at a cost of £1.43m to the taxpayer, according to the Estimates book subsequent ‘statement of reallocations’. More money thrown away to convert the facility into an Alzheimer & Dementia facility, this was not the original intention of the refurbishment. Had the Government opened the new facility on the 1st April 2012, as planned, a considerable number of elderly people would now have been enjoying the new facilities, thus alleviating pressure on the Housing Waiting List.
Mr Speaker, there is a case that would have had Minister Costa, who shadowed Social Services last term, still jumping up and down in his chair and stamping his feet, had it happened under the GSD’s watch. A Looked After Child was for 48 hours in Spain while in care. A case that made headlines in the Gibraltar and Spanish media, that had the Gibraltar and Spanish Police involved, that had members of the public from both sides of the border searching. So what happened? How did this child escape, was he a flight risk, were contingency measures in place, where was she found? Unlike the parties opposite, we are not concerned in making capital on an individual case; we are concerned that the right systems are in place to protect vulnerable children.
At least Mr Speaker, I was able to get these answers and reassurance through direct communication with the Minister for Social Services (thank you), something the party opposite was not willing to do when in Opposition; I also complied with all concerns raised by the Ministry and Parliament over this case. But the modus operandi of the party opposite, while in Opposition, was always to issue a press release first, ask the sensitive questions in Parliament, to try and score cheap points off the back of vulnerable individuals, point the finger of blame and never ever try to understand the realities and difficult decisions that Government Ministers face on a day-to-day basis, which I acknowledge today.
That is the difference between the party opposite and us, and what got us re-elected four times.
Equality Issues
Mr Speaker, in relation to equality for women, the same issues I raised at last year’s Budget still exist, nothing has changed; women still find themselves struggling as single parents with erring ex-spouses defaulting on maintenance payments. Trying to make ends meet or surviving on benefits, which has gladly risen in this budget, many single mothers are at the mercy of grey areas in law such as access to legal aid and the recognition of common law relationships. It is shocking that the Government has still only published new rules to expand Legal Aid that enable defendants, accused of complex fraud crimes, to hire expensive specialist lawyers at public expense. No thought has gone into, or takes into account, the plight of single parents, who are not entitled to legal aid if they earn above the qualifying threshold of £5,000 income per annum, which we would have increased to £12,000. Additionally, if these women own the family home or a car, they are still not entitled to legal aid, a blanket rule which penalises lone parents struggling with mortgage payments and paying legal fees in order to pursue erring partners in their duty of care as a parent. The measure announced yesterday to eliminate stamp duty on the transfer of deeds after a marital breakdown is however welcome news.
Equally, the introduction of parental leave, whereby either parent is able to take entitled leave after the birth of a child, is a policy that would be welcomed by many working parents across Gibraltar. Working parents would also look forward to changes in working hours that are more family friendly.
As was discussed in Parliament in relation to Parliamentary Reform; with regard to statutory bodies, it is imperative that where necessary, their composition should be changed to improve the constitutional checks and balances on governmental power, as recommended by the Commission on Electoral and Parliamentary Reform. I believe that this cannot happen without proper representation from members of our diverse community. This means reflecting the composition of Gibraltar society in these Statutory Bodies, which at present are comprised mostly of, and reflect the view of, white, middle-class males. The provision of meaningful checks and balances to Government, a role which these bodies should be providing, is hindered by this narrow view. This is one of the many reasons why I recommend Marlene Naon as our candidate for the upcoming By Election.
In order to address this balance, as I have stated publicly before, it means actively inviting more women and minority representatives to sit on these bodies. Out of the Statutory Bodies Gazetted so far, only 10% of their composition is women, some of whom are the secretaries of the Boards, and even fewer are from different ethnic backgrounds. This improvement to composition can be done quite simply, with a little more consideration and active positive discrimination when inviting individuals to sit on these Statutory Bodies. Membership of a Statutory Body is not through a process of applying for the role, the assessment of applicants and the recruitment of the ‘best person for the job’; it is simply through the invitation, via a letter from the Minister responsible, to join and form part of that Statutory Body.
As a former trustee of the Heritage Trust and former non-Executive member of the GHA Board, I am acutely aware of the continued practice of giving little thought to actively selecting individuals, who represent all sectors of Gibraltar society, when considering the composition of Statutory Bodies. I therefore ask for the serious consideration of the fulfilment of some kind of a prescribed quota when selecting people and inviting them to sit on a Statutory Body; that is positive equality in action.
Mr Speaker, we are yet to see some Equality policies regarding the Moroccan residents of Gibraltar.
Conclusion
Finally Mr Speaker, I have to end with an example of ‘playground politics’, which reflects everything that this Government’s parties are about and what they stand for.
It was very unfortunate that the Honourable the Chief Minister of Gibraltar, the highest office holder in our land, should have reduced himself to insult me personally by mocking my surname at the GSLP’s AGM this year. Such childish tactics, playing to the gallery of his most hysterical supporters, say so much more about him than about me. Thankfully, Mr Picardo’s speech is broadcast to all via the internet; let people hear for themselves how petty this Chief Minister can be.
