Jul 07 - Budget Speech By Isobel Ellul-Hammond
Introduction
Mr Speaker, it gives me great pleasure to address Parliament on the Budget for the third time as Opposition Spokesman for Health, Social Services and Civil Contingencies. It is 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.
Civil Contingencies and the City Fire Brigade
Firstly, it is with an air of sadness that I shall broach the subject of the City Fire Brigade and I find that I have to very precisely repeat my budget message of last year on the non-delivery of three key manifesto commitments:
1) A new, much needed, relocated Fire Station, where again there is no budgetary provision for it in this financial year’s estimates book. But at least Mr Speaker, we have a new park!
2) The implementation of the review by Sir Ken Knight, the UK Government’s Chief Fire and Rescue advisor, of a new vision for the holistic operation and management of Gibraltar’s Fire Service. Let us not forget that despite all the Government’s proclamations on publishing reports and transparency, we are still waiting, 19 months later, to see this Audit Review report of the City Fire Brigade which Sir Ken Knight conducted. And it ill behoves the Chief Minister to have chastised us at the last budget about raising concerns for their non-publication of this report, and five others, which they have still kept secret. The members of the Government benches used to make sustained political play of the GSD Government’s omission to publish the whole of the King Report. However Mr Speaker, it appears once more that this is a case of ‘do as I say and not as I do’. This Government continues to refuse to publish reports commissioned by them and paid for by the taxpayer; so much for the New Dawn Mr Speaker!
3) And what about the delay in going live with a Medical Priority Dispatch System, an essential pre ‘scoop of the patient’ triage system which will ensure that emergency ambulances are not called to incidents that are not emergencies, thus depriving those who REALLY need them. This has lately become an all too regular occurrence; we have many reports of incidents where ambulances are called out to non-emergencies in order for patients to get seen quickly at A&E, avoiding the unfortunately extremely long waiting times which might otherwise be encountered. We also have reports Mr Speaker of genuine emergency patients having spent up to half an hour calling for an ambulance because all three are unavailable, attending to other patients.
All these crucial commitments are still pending and still wanting and I say sadly, because every fire officer and employee from the Department I have spoken to is deeply disappointed and disillusioned by the empty promises of this Government. Our City Fire Service is a vital service, it is an Essential Service in our community and they deserve better but are ultimately being failed by the Government that, let’s not forget, offered all things to all men. No surprises there then because alas Mr Speaker, it could well be that the GSLP/Liberal Alliance considers that window-dressing our city and spending money on vanity projects such as the £4m on refurbishing No. 6 Convent Place are more important priorities in the grand scheme of the Government’s limited vision; but at least Mr Speaker, as you may have already heard, we have a new park?
Health
With regard to Health Services in Gibraltar Mr Speaker:
I must firstly commend the clinical team who have so successfully expanded and improved upon the Day Surgery Unit at St Bernard’s Hospital. More resources and a new enhanced care system have resulted in an efficient and problem-free experience for patients, well done GHA.
The Estimated Budget of the GHA for this financial year now stands at £101.6m. In just three years, the Health Budget has increased by £12.4m, an increase of around 14%. One might argue that in itself this is not unreasonable, that it shows investment in our community’s health services. This would be fine had it been planned, but the reality is that the increase was neither planned, nor controlled. Spending for this past financial year 2013/2014 has gone over-budget by £5m Mr Speaker, one of the 24 Government Heads which have gone over their budgeted estimates and suffered from the poor financial oversight by their relevant Ministers because, Mr Speaker, throwing money at problems without thinking the consequences through, is how this Government is managing our public finances.
£5m over budget Mr Speaker, no mean sum, especially when I quote the Honourable Minister for Health, from his budget speech last year, who said: “…For many years…there has been a managerial failure to control spending leading to constant overspend of millions. This Government expects expenditure to be controlled and I have taken steps to ensure that this is the case.”
So what happened Mr Speaker? £5m overspend, which contributes to the £50m over estimate spend this last year by all Government Departments, Agencies and Authorities together. And as the Leader of the Opposition pointed out, in order to keep these expensive Departments running with nearly 600 extra public servants employed these last two and a half years, Recurrent Expenditure now stands at £95.6m more than in the 2011/2012 financial year, when this Government came into power.
And Mr Speaker, ‘no habia dinero’! This is the Government that said there was no money, that Gibraltar’s public finances were in a ruinous state; does the Government think the electorate is stupid? Is it the miraculous hand of God which has provided so bountifully since this Government came into power or are they pursuing a relentless and populist stratagem which will mortgage the next few generations of Gibraltarians?
And on the subject of financial management, for a Minister who claims he is listening to his staff, he is obviously not listening well enough to his Finance Director. On several occasions and at several GHA Board meetings, the GHA finance chief has raised concerns that the senior structure at his directorate “lacks the necessary robustness” to guarantee the proper accountability of a budget that now runs at over £100m. A lot of GHA management re-structuring to get rid of the non-locals or GSD supporters, but little focus on succession planning for the crucial department, necessary to ensure budgetary control in order to avoid an overspend of £5m!
Mr Speaker, I must emphasise that the Health budget represents about 20% of this community’s annual recurrent expenditure, one fifth of everything this Government spends, lack of budgetary control has a very significant impact on overall Government expenditure.
Let us examine in closer detail where this over-expenditure is occurring: Sponsored patients saw a £1.9m overspend this year and spending is up 30% since the Honourable Minister took over the running of the GHA. But of course, they have a manifesto commitment to implement which includes:
“We will completely review the sponsored patients’ mechanism” and the solution to this is, that now you can go for treatment to any hospital you wish outside of Gibraltar.
In two years the GHA has sent sponsored patients to 89 different hospitals outside of Gibraltar Mr Speaker, 79 of which the GHA has no Service Level Agreement with. This means it is very difficult to keep track on patients or vouch for appropriate standards, apart from anecdotal evidence of course. And of those 79 hospitals the GHA has no service level agreements with, 21 are private hospitals. Private hospitals Mr Speaker, GHA clinicians are baffled that we are paying over the standard National Health rates to send 114 patients, or patient episodes, to these private hospitals, for little clinical reason at all. These private hospitals offer care that could be offered here or in one of our tried and tested 16 hospitals the GHA has Service Level Agreements with. Why would the Minister allow this new approach in the management of sponsored patients to develop Mr Speaker?
We are also paying Xanit private hospital in Benalmadena over a quarter of a million pounds a month for a service which St Bernard’s Hospital could offer, by bringing in, as Xanit does, the clinical specialists from the Campo de Gibraltar and Costa area needed to treat the patients on the day. It is ludicrous that we should be paying such private healthcare rates, when we could be keeping our patients in Gibraltar and bringing the specialists to them at St Bernard’s Hospital, rather than continuing to send critical patients to Xanit.
What could the GHA do to buy in clinical services for over a quarter of a million pounds a month? Economies of scale are not a forte of this Government Mr Speaker, spending money indiscriminately, whether it is sustainable or not, is more their style, a style lacking in courage and unnecessarily costly to our community. But at least Mr Speaker, we have new park and we will get a small boats marina for the bargain price of £24m. ‘Y no habia dinero’ Mr Speaker!
The GHA spends around £30,000 per month outside of Gibraltar for specialist imaging, such as MRIs, PET, bone-density and ante-natal scans. Could it not be better used in training a few of our youngsters in these radiography fields, to purchase the necessary equipment ourselves and employ another Radiologist for our own in-house imaging services? We presently have to subject our citizens to tiresome trips to Spain for regular scanning and MRIs because of the lack of vision to provide such essential services here. Financial planning and foresight is necessary Mr Speaker, those economies of scale again.
The Health Minister last year in his Budget speech said that the GHA staff was ‘healing’ from low morale from a lack of past GSD leadership. It would seem Mr Speaker that this healing is happening at an almost imperceptible rate. The Minister will be dismayed to learn that, despite his efforts, including a couple of, shall we call them, entertaining appearances on the steps of St Bernard’s Hospital for the GBC Open Day, staff morale is reported to us as being lower than ever, and a general malaise stemming from the realisation that ‘nothing much is changing’ is setting in.
You see Mr Speaker, there are several indicators of an unhappy staff; a staff which is unable to shake of deep-seated discontent, they are:
rates of sickness and absence;
the number of complaints made by the public;
whether staff are consulted in shaping their management and how top-heavy it is;
and the ability to recruit & retain specialist clinical staff.
A review of information provided by and described by the Minister as “of little benefit” and “for no apparent effect” in response to questions I asked at the last session of Parliament in May, has revealed that sickness rates for ALL employees of the GHA is up from 2012 to 2013. In order to provide some context and better enable the electorate to assess the extent of the malaise at the GHA, according to local leading Human Resources specialists, the average acceptable number of days’ sick-leave in a year for a private sector employee is 4.4; this is set as a golden standard to benchmark against.
Mr Speaker, to highlight the point, in 2013, the GHA administration and support staff each suffered on average of 11.4 days sick-leave a year; Medical and Allied Health Professionals suffered 12.4 days off sick; and Nurses, 15.5 days off each, on average for the year. The total number of days lost to sick-leave during 2013 was 14,825. 14,825 days of paying for cover or where the public missed out on a service. Including the whole of the GHA staff, that makes an average of 16 days a year missed by every GHA employee, compared to a golden standard of 4.4, and these figures take into account uncertified sick leave, short-term and long-term sick leave. The picture is indeed grim.
Another indicator to show whether our health service is ‘healing’ are complaints from the public: the number of formal and informal complaints is indicative of public satisfaction with the GHA and if you look at the statistics, there are no vast improvements or a reduction in complaints these last two years. In fact, 2014 has got off to a shaky start for the first five months, with the number of formal complaints already reaching nearly half the number that were recorded for the whole of 2013; and the number of informal complaints the first five months of 2014 are at 68, 76% of the number of recorded informal complaints for the whole of 2013.
Despite sickness rates and complaints, the GSLP’s manifesto commitment for a new GHA management structure has been implemented; this was to be the answer to all of the GHA’s problems. The Honourable members opposite finally got their way; they got a new GHA management which conveniently removed the three non-Gibraltarian and one local Executive members, who they had pinpointed, when in Opposition, as wanting out of the GHA management team, irrespective of whether they were doing a good job or not.
So we now have an even more top-heavy management Mr Speaker, with a CEO who is not contracted to deliver on specific targets within a timeframe; and this is not about the individual chosen, it is about holding the Chief Executive of the largest community budget to account, answerable to the GHA Board. An extra Operational layer of three Unit General Managers have been added to the GHA’s management structure, plus an extra group of managers for Clinical & Corporate Governance, all added to the existing GHA Senior Management Team. And let’s not mention the new GHA Strategy Development Group.
A new management structure Mr Speaker, which came from a £130K review, the report of which is still pending for publication and public scrutiny 19 months later, another report held in secret Mr Speaker. A review of the GHA and a new management which was set up in secret, with little or no consultation with clinical staff, only with a select few, and imposed on GHA staff despite their having no sight of the review report themselves, without the possibility to contribute.
Another indicator of a ‘sick’ GHA which is not healing is how well it can recruit and retain clinical staff. When the GSLP/Liberals were in Opposition they made much stock of the fact that the GHA, under the management of the GSD, was spending large amounts on locum or relief cover. Mr Speaker may find it interesting that the estimate for spending on relief cover this year is £2m, the same as the amount actually spent in 2011/12. The Honourable the Chief Minister in his Budget response accused my analysis of being incorrect with regard to locum cover, while defending his Government’s spend of £1.5m that year; but it is creeping up again Mr Speaker. Is this an indication that the Government’s alleged success in turning the GHA around is attracting clinical specialists to work in Gibraltar and retaining them, or is the reality that they continue to face difficulties attracting doctors and nurses to work in Gibraltar?
One thing is for sure Mr Speaker, if this Government wants its people in key positions, or has to honour promised promotions or positions for services rendered or because of family connections, they will do so. Having moved the goalposts for promotion, after the vacancy notice for one District Charge Nurse, the Minister, or another Minister, ensured that all three applicants were given the promotion, even though it was not clinically indicated, making the service top-heavy with 30% of the district nursing staff as managers. And why Mr Speaker? Cronyism Mr Speaker, the GSLP logo, a pattern we see repeated on the GHA complaints review panel and in every Government Department, Agency and Authority. By denying other GHA staff the right to apply for what turned out to be three jobs in community nursing, the GSLP/Liberals Government ensured that one of their supporters would get the job, of course at the expense of the taxpayer.
So one must ask how the GHA is building a reputation for itself so it can attract new clinical staff? Well unfortunately, we do not have enough Gibraltarians to fill the entire specialist clinical roles of the GHA, so advertising for these positions continue to be carried out outside of Gibraltar; for example, we have 16 specialist nursing positions presently vacant, where advertising for them will have to go outside of Gibraltar, as we do for doctors. Yet nursing and other GHA contracts of non-locals are being terminated after four years of work, disregarding any verbal or written contract entered into with them under a GSD Government.
We are extremely concerned by the GHA’s stance and pernicious policy, and equally that of the Care Agency, towards contract and supply workers with reference to variation, termination of contracts, length of short-term contracts, permanent and pensionable status and gratuities. Employment rights are changing; employees are being targeted and discriminated against as the ‘9th of December’ has become the new ‘1st of July’ law! The way staff, especially experienced and well qualified specialist nurses on contracts, are being treated is causing stress and anxiety among their work colleagues and morale is at an all time low; that ‘unhealed’ malaise I mentioned earlier Mr Speaker. New working arrangements are being imposed without consultation or taking into consideration the interest of the patients who use the service.
Most of the employees affected by the policy of this parochial and short-sighted Government are nurses in Theatre, ICU, Mental Health and Paediatrics. A continued exodus or cull of these specialists, fed up with this overly-nationalistic and xenophobic policy, will have serious and detrimental consequences on the delivery of the high standards of care to our most vulnerable patients, potentially putting them at risk. By replacing them with inexperienced staff, this undermines the available skill mix and will have serious consequences on the way we care for our patients and on manning levels, this is where we can foresee problems in retaining staff or recruiting new ones into these short, insecure contracts; something which has already been happening in the Care Agency with care workers.
The behaviour of this so-called ‘socialist’ Government towards non-local EU contract workers, who have demonstrated a high level of professionalism, expertise and commitment to our health service and Care Agency, is disgraceful and shows little regard for the welfare of workers Mr Speaker. If Gibraltarians working in any EU nation, in which they planned to make their home, were treated in this way, we would be protesting en masse outside of Parliament in Brussels Mr Speaker.
Mr Speaker, the Budget session is the opportunity for Ministers to laud what has been achieved in their Ministry the previous financial year, and to promote their next lot of policies or initiatives for the financial year to come, supported by an estimated budget, which is then approved by Parliament. So let’s go back to last year’s Budget to see if Dr Cortes managed to deliver on all he promised, or were they just empty words?
Well for the last two Budgets, 2012/13 and 2013/14, the Minister for Health announced the following would be delivered within the year, but we are still waiting:
a conclusion to the negotiation of the Consultants’ contract with a new contract drawn up and signed, despite the Minister’s announcement yesterday that it was ready, we wait with bated breath;
the opening of a Children’s primary care clinic at St Bernard’s Hospital, or did I hear the Minister say yesterday that extra children’s clinics would now open at the Primary Care Centre?;
We still await a new Mental Health Act brought to Parliament;
and most importantly, remember that noises about this have been made for the last five years, the medical complaints process was to be taken over by the Ombudsman’s Office. We still await the necessary amendments to the Public Services Ombudsman Act, completed nearly a year ago, to come through Parliament; hopefully, this will be presented at the end of this year, as the Ombudsman highlighted in a media interview a few days ago. But of course I mustn’t forget, an improvement in the Minister’s eyes no doubt, that the paid GHA Complaints Review Panel was re-populated by the Minister’s friends, many of whom are happy to publicly spout aggressive, vitriolic anti-GSD rhetoric on Gibraltar’s social media.
The Minister last year also promised that the new Mental Health facility would open last October, seven months ago, and then in December he said it would open this spring, last month. Perhaps they are reviewing the size of the rooms after many concerns were raised that they are smaller than prison cells. Or perhaps, we hope Mr Speaker, that their manifesto commitment for providing on site sheltered accommodation for those patients who can be cared for in the community, but need home supervision and support, is being explored?
A Stroke care protocol, a Neurology service review and a management strategy for children with autism were also meant to have happened this last financial year 2013/14. The stroke care protocol is still being developed, a Neurology service is still being reviewed and certainly not enough for children with autism has been done, for parents to be satisfied that their children are being offered all the support and therapies they deserve Mr Speaker.
And where is the final realisation that the present GHA Board set-up, exactly the same as it was since 1987, but with even less candour from Board members as they sit in public, needs a new governance system? The Honourable the Chief Minister at the last Budget said proudly how people can now turn up and listen to what is going on at the GHA Board meetings; he means listen to ‘the silence’ Mr Speaker? The Chief Minister was right in implying that as an ex-Board member I should have admitted its governance needed changing, and if I may quote from my 2012 Budget speech, to refresh the Honourable members’ memories:
“As an ex-GHA Board member…I note that the GHA Board process remains exactly the same. A process I disagreed with then and one which I was hoping to change, had I been given the opportunity. If there was one lesson that came out of the 2008 global recession…it was that board governance…was unsuccessful in setting targets and holding Chief Executives to account. It was found that many Boards tended to be incompetent groups of competent individuals. Their expectations, if stated at all, tended to be unclear and incomplete, and the Executive reports reported against few or no criteria. This was something I felt the GHA Board was also guilty of. In the absence of clear instructions or clear assignment of the Chief Executive, we found evaluating performance was an exercise in futility".
The emphasis should not be on meetings in public, it should be on empowerment of the Board. Transparency is understanding how and why spending decisions are made. It is not just the production of data, presentations for the public which will ‘be considered’ and the issuing of a multitude of press releases.”
Mr Speaker, this is why a GSD Government would have further empowered the GHA Board, financial managers, Consultants and doctors. To exercise greater control over spending choices, budgets and service prioritisation to ensure the proper balance between medical services, value for money and budgetary discipline.
With regard to the GSLP/Liberals Ministers’ way of leading through micro-management and political interference, this has not allowed for our Minister for Health to cater for a clear separation of GHA activity from Ministry activity. Not a day goes by when we don’t hear of the Minister’s ‘open door’ policy to all, which ends in the interference of clinical decisions, helping individuals on a personal level, even though it means getting their preferred private hospital of choice. And this concern is not only levelled at the Minister for Health, we receive even more concerns in this regard of political interference and micro-management about the Ministry for Equality, Social Services and the Elderly where every action at every level of the Ministry is paralysed until a final decision is taken by the Minister. And the members opposite thought Sir Peter Caruana was bad…
But back to Health, an example of this political interference in clinical decisions is how for a brief while, over a year ago, Natural Procreative Technology was suddenly advocated as an alternative to IVF and on offer privately via the GHA. The Minister hailed this in a press release as:
“Government’s commitment to healthcare goes beyond the NHS”, where he showed surprise that I had questioned the validity of the GHA to pay for and offer such non-evidence based, non-approved by NICE or indeed a treatment available on the NHS; he even called me ‘unreasoned’ and ‘lacking consideration and sensitivity’. Well thank goodness I raised the issue, and I know that clinical opinion and lobbying from within the GHA soon followed, because in answers to questions last month, it seems that the Minister for Health has finally admitted the error of this political decision and NaPro technology is not on offer via the GHA as:
“Access to this technology is currently under discussion.”
The benefit of listening to your clinicians who know Mr Speaker, before political interference or allowing third non-clinical parties to interfere, in order to make the best clinical decisions for the patients.
Now Dr Cortes did listen to clinicians with regard to changing the Primary Care Centre appointment system to a one month advance system, however, as the Minister agreed yesterday, it does not seem to be working satisfactorily because very little else has occurred to run alongside this new policy to support it. Everyday Mr Speaker, I have concerns raised to me about it:
elderly citizens queuing outside the Primary Care Centre from 5am on the first day of the month in order to guarantee that they can get an appointment with their doctor;
no more appointments available after 10 or 11am on the first day of the month, leaving patients who genuinely need to review medication and control chronic conditions becoming lax about their own health care and not bothering for another whole month;
the non-answering of phones to make an appointment on the first day of the month; patients spend up to three hours ringing the Primary Care Centre, with no one answering the phone;
the multiple booking of appointments with their doctor in the month, by a now increasing amount of people, just in case they need them as they know the available appointments will run out within hours: this leads to an increase of DNAs (did not attend)/wasted appointments, as by the time the booked appointment comes around, the patient concerned is not ill;
and of course, there is no cancellation list from which patients can feed into when DNAs or cancellations occur.
Why a patient cannot simply call at any time of the month to see their doctor, with a commitment to provide some form of a single medical appointment within say 72 hours, as in the UK, is unbelievable? Is this not the definition of a medical appointment, to see a sick person when they are in need?
And patients who are unlucky in getting their prized appointment for the month, end up in Accident & Emergency, swamping an over-stretched service under enormous pressure, with only 7 doctors 24/7 and often only 3 to 5 nurses. Nearly 50% of patients attending A&E should be seen by a GP, of which there are 17 in the Primary Care Centre from 8am to 5pm. We understand that morale in A&E is very low, more of the GHA ‘sickness’ Mr Speaker. A&E has no management structure for the doctors or nurses, doctors and nurses routinely work 12 hour shifts with virtually no break and may see 30 to 40 patients on a night shift (more during the day), and when from 9pm, there is only one doctor and no back-up. The risk of mistakes is significant and I go back to one of the indicators, staff turnover and sickness rates are high in A&E. Patients naturally are becoming more upset and aggressive in A&E with complaints daily as to waiting times as it is almost routine for a 3 to 5 hour wait time in A&E daily.
The Primary Care Centre’s current system is failing this community and the hospital, especially A&E, is bearing the brunt. GPs are not given the space they need to focus on health promotion and education, which mitigates some attendance to GPs; the poor access to appointments; and an A&E where care could become compromised: ultimately it is the patients who lose out. Mr Speaker, the Government has had two years to audit and get the primary care appointment system and the A&E service right, vital first point of contact health services that reflect on the rest of the GHA. It is unacceptable that they have failed so dismally to deliver Mr Speaker; so let’s spend less money on sending patients to private hospitals and instead invest in these frontline services. But at least Mr Speaker, in case he had failed to notice and so he doesn’t forget, we will have a refurbished No. 6 and we have a lovely, new and green in places, £5m park. That’s what matters doesn’t it?
Gibraltar has about 5 and a half GPs per 10,000 of the population, this compares to about 7 and a half per 10,000 of the population in the UK. Mr Speaker, the solution may be that we need more GPs. Some food for thought: as the Leader of the Opposition already mentioned, for the amount of £920K, the amount overspent by the Chief Minister on ‘Travel and Entertainment’ this last year; we could have employed 10 more GPs for a year and the waiting list would have reduced by 33%.
Social Services
Mr Speaker, along with the Mental Health facility at the former Royal Naval Hospital site, we also await with bated breath for the opening of the Alzheimer and Dementia facility. A facility, which after £12.1m on converting the site, was nearly ready to open when this Government took the project over. For 16 months the site ceased any activity and now, after another £17.5m to convert the conversion, the two facilities are ready and we must be awaiting, till later this year perhaps, the completion of the Dementia Day Care Centre, which is not a new concept by the way, with more funding needed for that, before the site is opened. £30m and counting for whimsical changes and avoidable delays Mr Speaker, ‘y no habia dinero’.
Notwithstanding the reckless, ‘devil may care’ spending spree of this Government, there is still no provision in the Estimates for extra staffing to man the site, despite training. Dates for these new facilities, first 18 months ago, then a year ago, then six months ago, were all expected opening dates. When will these two facilities finally open Mr Speaker and at what final cost? The Estimates Book includes no funding for the running and manning of the new facilities, does this mean we may need to wait another year before the facilities fully open? Can the Government bear to add to the already extra almost 600 public sector workers who have been employed since they came in to power? Or does the Government need to rein in over-spending, as the Care Agency has also over-spent its budget this last financial year by £3.7m, by 17%?
Perhaps Mr Speaker, the knowledge that the moment these facilities are filled, one of the acute wards of St Bernard’s hospital will again fill with elderly long-stay patients awaiting a care bed, as Sir Peter Caruana predicted many a time when then Shadow Health Minister Neil Costa complained about the bed situation, is this what is stopping the Government from opening the facilities? Or maybe there is no more money to employ extra staff to run these facilities; we wait patiently. There certainly seems to be money to build a £24m small boats marina.
Another site that was ready for use when this Government came into power was the former John Mackintosh Wing home; it has taken two and a half years, another re-conversion and another £4m to finally release the property for social use. Mr Speaker, forward planning and vision are not strengths of this Government, more like ‘making it up as we go along’.
Well at the past Budget session Mr Speaker, the Minister for Social Services said that under her watch, through constant reviews and working closely with management, the Care Agency is much less of a ‘beast’ than when she inherited it. From where we are it seems that this ‘beast’ is still alive and kicking because as with the GHA, there are certain indicators which demonstrate the low morale and unhappiness within the Agency. Sickness rates, turnover of staff and recruitment and retention of staff all point to this.
Like other GHA staff, sickness rates among Elderly Care nurses this last year was higher than for 2012, they missed an average of 8 days each a year, and that is not taking into account short-term sick leave or uncertified leave. When compared to the HR golden standard of 4.4 days, twice as many elderly care nurses are off sick than really should be.
Another indicator is the high turnover of staff of the Care Agency and Social Services Department, which over two and a half years has seen 64 people resigning under this Government’s watch, in what is now the tamed ‘beast’. In comparison, 69 GHA staff resigned in that period, in an Authority with a third extra staff employed than in the Care Agency. In the Care Agency, the loss of on average, since this administration took office, a constant two members of staff a month. These include 44 Care Workers, 15 who worked with the Elderly and 29 within other areas of the Care Agency. 6 Social Workers have also resigned from their position. This demonstrates a high level of dissatisfaction and low morale at the Care Agency, especially when the Children and Families Team has been under immense pressure to cover caseloads and effectively undertake the full range of essential tasks necessary for the wellbeing of our most vulnerable.
The persistent loss of staff has also required a high number of supply Care Workers from private sector providers, filling in the gaps in order to provide cover and a service to our most vulnerable. Even these private carers are not lasting long in working for the Care Agency; difficulty in recruiting and retaining staff in the Care Agency also extends to private care providers. The result is that many vulnerable people have been deprived of the benefit of a close working relationship with the workers they relied and depended upon. Stability, continuity of care, familiarity and security with a regular group of carers is constantly under threat. For the Minister to have argued that staff turnover was as high during the GSD’s time in office is nonsensical, because nothing has changed and this flies in the face of the ‘taming of the beast’ that was the Care Agency.
Last Budget Mr Speaker, the Minister proclaimed that the Children and Families team was developing an adoption and fostering policy and that they were undertaking a review of the Adoption Act. Despite a commitment to such a review, in two and a half years there have only been 7 adoptions and 7 foster placements. Most worryingly, the 7 foster placements took place in the first six months of this Government’s term of office; there has not been even one in the last two years.
Worrying because there are many families in Gibraltar willing to provide a safe and stable environment for children and young people during a difficult time in their lives and who for, whatever reason, cannot be looked after in their own home. Such a vital service as this, which the Care Agency should be committed to in terms of training and supporting adults as potential foster carers, has not been happening and it means we are denying our most vulnerable children the breathing space to get away from a very difficult life. The Children and Families team has been so over-stretched and under pressure, they did not have the time or the will to offer this vital service. We hope that the extra Social Workers will now pick up the slack and we look forward to learn more of any new measures with regard to fostering.
Again, as announced at the last budget Mr Speaker, there is still no news on legislation to vet those who work with children in the voluntary sector; there is no news on the challenging behaviour unit, or funding provision for it in the Estimates Book. It is good that our elderly are being provided with new facilities and options for domiciliary care and residential services, but it should not be at the expense of those vulnerable children who cannot defend themselves and who must rely on the state to make the proper and full provisions at their disposal and on their behalf.
Another vulnerable sector of our community, the disabled, are still waiting for the Government to ‘urgently honour’, as their charity representatives described it, their manifesto commitment which said, that ‘in their first year they would legislate to further protect disabled people using the terms of the UN Convention as a model’. The Minister has re-committed to this today, let’s see how it is enacted later this year. Despite some physical improvements in Gibraltar for those with disabilities, there is still a long way to go. Representations to us from those with mobility issues claim they are unhappy with the:
access from ramps on the beach to the seashore;
unhappy that the disability stands at the Cavalcade & National Day do not cater for the families of those disabled to join them;
and that there still is no appropriate, audited supported employment which actively and appropriately transitions those with special needs from education to employment and adult life, such as ‘Project Search’, a pioneering model that the Disability Society advocates.
However, with this Government’s poor track record on focused and accredited training, audited apprenticeship schemes and the Future Job Strategy, which my Honourable friend Mr Bossino, will have some more to say on during his intervention Mr Speaker, I am not surprised that the sheltered employment scheme also leaves much to be desired.
One thing is throwing in the odd training day here, holding a conference day there, raising awareness by handing out leaflets Mr Speaker, the other is actively working together with the groups and people who know what the real issues are in order to design the services and provisions that really matter and that can make a difference in the lives of those with disabilities.
Again Mr Speaker, the Minister for Equality announced the setting up of a Domestic Violence forum last year, which we learn today does not yet exist, despite the Minister stating it did in answers to Parliament questions this last year. This forum was to make recommendations and act on initiatives that would come from them in order to tackle this scourge. I now look forward to any initiatives coming from the Forum which will NOW be set up. Last year, 55 incidents of domestic violence were reported to the Police, and in the first five months of 2014 there were already 84 cases reported against persons ranging from the age of 13 up to 76. About half of the cases will be legally pursued Mr Speaker, ending up possibly in persons charged. But more frightening is that these are only the number of reported incidents; the ‘dark’ figure of unreported crime, can be anything from three to five times that figure, especially with Domestic Violence.
It is to all these voiceless and frightened victims that we have a responsibility to react and to make a difference, and as the Minister said in a press release last year:
“To ensure that such violence is entirely eliminated in Gibraltar,” and which is why I welcome the psychological support for victims and any preventative measures that are introduced.
In that same press release for the ‘International Day of Eliminating Violence Against Women’, the Minister for Equality also said that:
“This is not a partisan issue and I trust I will be able to count on the support of the Opposition for our work on this front.”
Well they do have our support Mr Speaker, but we would like to hear of the work that is being done in this area and to contribute where we can.
But not one policy in relation to women’s equality issues has come from the Ministry of Equality; the Equal Opportunities Commission is still three words on a manifesto page, despite a commitment today that it will be created this year. The ideas, pilot projects and reforms remain elusive, despite press releases of the Minister attending a women’s conference here, another somewhere else in the world, another one somewhere else; the ideas are not brought back to Gibraltar, they remain abroad in those elusive conferences and among those hallowed groups. Interestingly, while the Minister participated in the British Islands and Mediterranean Region, Commonwealth Women Parliamentarians’ Inaugural Conference, her contribution was linked to the participation by women in politics to push for increased representation. She highlighted the critical role that current women Parliamentarians can play in inspiring other women to enter politics. Let us hope that this is the case, if not the Minister’s words on ‘Women’s International Day’ of:
“My aim is to mobilise meaningful change where this is necessary in order to achieve gender equality,” are just empty words, so we look forward to the Conference early next year and to see what comes out of it.
Conclusion
Mr Speaker, on the 9th of December 2011, Gibraltar experienced a new dawn. Dawn gave way to a cloudy day and the sun has scarcely shone on this community since. Hanging above this community is a dark cloud of fear, control and secrecy which engulfs Gibraltar as the GSLP/Liberals way beds, once more, into our society. Their answer to everything, as they figure out what they are doing, is to spend, spend, spend and of course to blame the GSD. ‘The GSD could have done it in the last 16 years’ argument no longer washes with the electorate. So much had to be done, and was achieved, by the GSD to pull Gibraltar up after 1996, and of course more remains to be done.
But financial governance is now the responsibility of this Government. They are spending money with reckless abandon having inherited the GSD’s golden legacy Mr Speaker. What they don’t seem to realise, is that Gibraltar’s public finances are not a bottomless pit. What money we have, we have because we still, as a community, have the resources available for the Government to spend, but one thing is clear; out of control spending must not be allowed to continue unabated.
As my friend the Honourable Leader of the Opposition has stated time and again, including yesterday, the channelling of public money by Government through a private company which is free to invest in whatever ill advised project it decides, and then using its private commercial status to hide its activities from public scrutiny is scandalous and an aberration of the very concept of democracy and public transparency. This goes against all that European governments, in particular that of David Cameron, are successfully fighting to stop. This is a very worrying pillar-stone of the Government’s general modus operandi and more akin to the governance of so-called ‘banana republics’ than a community member of the European Union. Even more seriously, it is a contemptuous affront and disrespect to the people of Gibraltar.
However, thankfully for Gibraltar Mr Speaker, the sun has now begun to set on this Government’s term of office and as dusk approaches, the winds of opportunity are starting to blow. The winds of change, like a fresh westerly after a spell of muggy levanter on a sunny August morning, will soon rid Gibraltar of the transient, visionless and hopefully short-lived ‘leadership’, in inverted commas, of this community by the GSLP/Liberals, and usher in the dawn of a new GSD government when the Chief Minister calls the next election.
