LOW MORALE in the public health sector, says Llamas

This is an extract of the Budget speech by LAWRENCE LLAMAS of the GSD:

During the past year, I have tried to understand low morale and absenteeism in the Gibraltar Health Authority. 

Last year I carried out a survey on morale and the results coincide with everything that is being said by our Unions and workers, not just in our health sector but in our law enforcement agencies and civil service departments too.

Workers feel neglected and often not consulted. Workers claim to be undervalued and under resourced.

There are also allegations of bullying and intimidation which don’t often get reported, or if they do, not rigorously investigated.

Greater consultation and communication with employees in the sector is required. This must be conducted in a safe and secure manner that does not expose employees to their detriment.

At the same time, absenteeism is of huge concern. I have tried to understand through questions in this house the extent of absenteeism in our public health sector together with the reasons for absenteeism too.

Unfortunately, I have been unable to study any statistics in relation to this, because the Government don’t adequately harvest any data.

However, absenteeism is a costly affair with relief cover running into the millions of pounds and substitution allowances being paid left right and centre.

This is a serious issue which must be tackled.


The Government have not given this the priority it deserves.

In the Principal Auditors report from 15/16, the Principal Auditor highlights the mismanagement and lack of control in the GHA with regards sick and annual leave records.

This goes to the heart of why e-services is so important, not just for service users but for the Government as an employer too.

The Principal Auditor has given examples of leave records not being updated for over 7 months in some cases.

He has also highlighted approximately 24% of records examined as inaccurate. This is worth investing in and managing, we have technological advances at our finger tips to turn this round, but instead we do nothing.

I would like to take this opportunity to thank the Minister for Health, Care and Justice Mr Costa. He has opened the doors to his Ministry and made available senior officials to discuss particular cases or issues.

I applaud his non-partisan approach when dealing with matters brought to his attention.

With a proposed budget for this financial year of £128m, questions about the GHA’s efficiency and value for money need to be made.

It can certainly be said that our GHA is not limited when it comes to funding, and long may it continue, but there are systemic problems in our health service which means the investment does not trickle down to the relevant services.

The GHA is to be commended for the number of surgical and non-surgical procedures it undertakes, the Minister should be rightly proud of his legacy in this area which he has fought hard to achieve.


However, the breakdown in communication systems internally and with patients is a gap that needs to be addressed. The proper filing of records and the ability to locate files promptly are critical matters which must be addressed too.

Additionally, the need to repatriate services has never been more essential than it is now, with the backdrop of Brexit and the challenges this may bring.

Whilst I appreciate that the Government have been focused on this issue, evidenced by the record breaking £19.4m spent on sponsored patients in 16/17 to £11.4m spent in the past financial year.

The increase in this year's forecast to £14m sends mixed signals as to the intention of the Government moving forward.

I have publicly asked the Government to provide details in relation to contracts entered into with health providers.

It may be standard in commercial contracts that parts of it may be commercially sensitive such as itemised value of specific services, however, there should be certain information which could be made public.

I therefore repeat my plea to the government to respond on what I feel are reasonable and legitimate questions that is:

1) The overall value of the contract

2) Whether fees are payable per patient treated or a flat monthly fee; or a combination of both

3) The commencement and expected duration of the contracts

4) The number of patients currently receiving care at these tertiary centres and the expected number of patients expected in the future under these agreements

5) Aftercare patient support procedures

I would be grateful for clarification as to why the increase in the forecast for the current financial year to £14m in this area?

Despite the huge budget in our health system, we are still dependent on tertiary centres for standard cardiac and neurology care.

This surely must become a priority for our short term future.

I call on the minister to seriously consider employing full-time specialists in these areas locally.

We welcome the Minister’s achievement in securing access to pharmaceuticals at the best prices via the NHS drugs framework in two years time and the exceptional interim procurement of pharmaceuticals via NHS Trusts, this will no doubt reflect in a positive cost reduction for the taxpayer.


I would also like clarification regarding the rental contracts entered into for the new Primary Care Centre and the new paediatric centre.

We know the rental costs will exceed at least £1.3m per year, but how much has the actual extension buildings cost?

What has happened to the new building for the ambulance service and the new MRI supposedly catered for in last years estimates alongside the new PCC and paediatric centre?

Finally, what would happen if Government owned buildings better located become available and a future Government would wish to consider moving the facilities to a new facility, what are the arrangements with regards the buildings built on rented land paid by the taxpayer?