Manx Care

[Apple]

4 hours ago, asitis said:

"Health Minister David Ashford says work is underway to improve this but that short-term fixes aren't the answer:"

I may get accused of having an axe too grind (again) but surely DA's resignation for the strategic and systemic failures has to be the first action. 

Many staff in the DHSC I speak to saw this coming given the way things have been allowed to deteriorate with Managers and Clinicians supposedly with 'expertise' come and go during his watch.

Maybe he should be 'escorted' out of the building as I was told happened to someone recently.

Where have all the clinicians been hiding whilst this has been going on. Strangely quiet. 

Significant breaches of waiting times for cancer referrals - just imagine the impact on women and families waiting for outcomes and results that have to put their lives on hold - Sorry David but he has to take accountability. He is the DHSC, as he often reminds us.

Edited May 13, 2021 by Apple
typo

[wrighty]

3 hours ago, Apple said:

I may get accused of having an axe too grind (again) but surely DA's resignation for the strategic and systemic failures has to be the first action. 

Many staff in the DHSC I speak to saw this coming given the way things have been allowed to deteriorate with Managers and Clinicians supposedly with 'expertise' come and go during his watch.

Maybe he should be 'escorted' out of the building as I was told happened to someone recently.

Where have all the clinicians been hiding whilst this has been going on. Strangely quiet. 

Significant breaches of waiting times for cancer referrals - just imagine the impact on women and families waiting for outcomes and results that have to put their lives on hold - Sorry David but he has to take accountability. He is the DHSC, as he often reminds us.

Should Matt Hancock also resign, and most likely too the health ministers in every single country in Western Europe?  Increased waiting times and reduced access for cancer services are an indirect result of the pandemic.  What would Minister Apple have done differently? And saying 'more staff, more clinics' etc won't cut it I'm afraid - where are the staff going to come from?

https://www.bbc.co.uk/news/health-57092797

 

[AlanShimmin]

7 minutes ago, wrighty said:

Should Matt Hancock also resign, and most likely too the health ministers in every single country in Western Europe?  Increased waiting times and reduced access for cancer services are an indirect result of the pandemic.  What would Minister Apple have done differently? And saying 'more staff, more clinics' etc won't cut it I'm afraid - where are the staff going to come from?

https://www.bbc.co.uk/news/health-57092797

 

Apparently David tried to resign but someone shredded his resignation letter before it got to HQ. 

[the stinking enigma]

Sack minister apple minister banana would do a better job end of.

[Andy Onchan]

7 hours ago, asitis said:

"Health Minister David Ashford says work is underway to improve this but that short-term fixes aren't the answer:"

I strongly suspect that a short term fix would be a great relief for women living under a cloud waiting to be seen !! 

If Ashford gets in next time then I think he should be handed responsibility for the DOI. Lots of things need fixing there as well.

I'm afraid I'm finding that The MBE has lost all sense of reality with decision making in DHSC. He's forgetting who put him in HOKs.

He should probably roll out the Manx Care CEO and get her to start nailing flags to masts so that we can see timelines and start monitoring the progress (or otherwise). They need to start delivering.

[Apple]

1 hour ago, wrighty said:

Increased waiting times and reduced access for cancer services are an indirect result of the pandemic. 

Another "indirect" cause was the state of health and social care services being run by austerity measures before Covid, both here and in the UK.

I see the operating theatre is undergoing (further) assessment not. With the KMT report a couple of years ago, Crouch and Quinn all raised serious concerns regarding theatre use (and the possibility of saving nearly £3 million pounds) if people worked more efficiently and effectively. That might help if they could.

The first thing I would do (as I am asked despite the insult) would be bring in KPIs for all clinical staff based on their outcomes and results and pay them accordingly. That is data the clinical teams and the hospital should be providing already. 

I know some clinical staff would rather see more waiting lists initiatives at £500 + a session for the Consultant (but nowhere near that for necessary support staff).

I would have stopped Manx Care from being introduced, not that it has any impact on the Consultants.

Another thing I would do is immediately stop all leaving payments and gagging clauses to any and all staff instead of going to an Employment Tribunal.

Thats just for starters. 

What would the medical society recommend - leave it all as it is? 

Edited May 13, 2021 by Apple

[wrighty]

1 hour ago, Apple said:

The first thing I would do (as I am asked despite the insult) would be bring in KPIs for all clinical staff based on their outcomes and results and pay them accordingly. That is data the clinical teams and the hospital should be providing already. 

I know some clinical staff would rather see more waiting lists initiatives at £500 + a session for the Consultant (but nowhere near that for necessary support staff).

I would have stopped Manx Care from being introduced, not that it has any impact on the Consultants.

Another thing I would do is immediately stop all leaving payments and gagging clauses to any and all staff instead of going to an Employment Tribunal.

Thats just for starters. 

What would the medical society recommend - leave it all as it is? 

Your first suggestion is almost certainly unworkable on an individual basis.  There has been some success with it at the hospital level in the UK - I'm thinking national tariff for hip fracture care - but for individual clinical staff, I really can't see it.  And if it were to be introduced would it perhaps lead to gaming the system, avoiding difficult cases and treating those that don't really need it.  See Harley Street for an example.

The solution to waiting lists is a full demand/capacity review.  Sort the staffing levels to meet the demand, or set referral criteria such that the demand doesn't exceed the existing capacity.  Or some combination of the two.  When it comes to the backlog then a short term solution such as waiting list initiatives either here or across might be considered, but there's not much appetite for them, and my colleagues and I certainly don't want to start doing evening lists and clinics, and the support staff certainly don't.

Given the introduction of Manx Care was unanimously agreed by Tynwald, was it even in the minister's gift to stop it?

Can't disagree with your comments on payouts and gagging.  

As for your final comment, there is certainly an element of 'change fatigue' amongst medical (and other) staff.  I've been doing much the same thing here for 15+ years - seeing patients with broken bones and worn out joints and fixing/replacing where required.  In this time there have been I don't know how many changes of management/organisational structure.  But it still remains difficult to institute any real change.  I'm no longer in a leadership role, I'm happy to say, but if, for example, I'd suggested that we needed to build a new clinic space and recruit more staff to deal with the increased demand, the likelihood is that general inertia means that nothing happens.  What the medical staff would like is to be facilitated in getting on with their job.

[Apple]

22 minutes ago, wrighty said:

There has been some success with it at the hospital level in the UK - I'm thinking national tariff for hip fracture care - but for individual clinical staff, I really can't see it.  And if it were to be introduced would it perhaps lead to gaming the system, avoiding difficult cases and treating those that don't really need it.

For what it is worth these are my views and opinions:

I am not convinced that 'gaming' does not happen here. The number of theatre cases done in any one session has been problematic, especially in one particular speciality I believe. Maybe the ideas that KMT thought about improvements and savings be revisited. Why has no-one taken responsibility for the Crouch and Quinn comments about the CQC shutting theatres down beggars belief.

We have a poor record on recruitment and retention strategy and procedures in some areas. Partly geographical I would suggest, but also in response to the reputation that has been created by the regular poor selection of some managers and some clinicians. Frequency of arrivals and departures is laughable.

As regards to off island CEO's, how ridiculous has that been. The message that gives out to staff and the public is that we are just not worth it. DA was wrong to appoint anyone on that basis, and still is. 

Re waiting lists initiatives - there are still some that will do them for only the right money I will wager, but support staff will not be part of them for what they receive. Pay them properly and they would do it I suggest. (actually had that very conversation today).

If I was the Minister I would have delayed Manx Care. The "unanimous" vote included a whole package of things in the mandate which have to my knowledge yet to be introduced, such as enhanced scrutiny by CQC. Tynwald needs to ask itself whether the DHSC and Nobles in particular were actually ready for such massive organisational change, especially with Covid on our doorstep. 

The next episode from Manx Care will be even more eradication of fairness in terms and conditions (and Pay) for 'their' staff as I think we all should be prepared for. 

I agree totally about 'change fatigue', and amongst more than just the medical staff. Alongside that some staff I speak with feel the 'soul' has gone from Nobles, that morale has suffered, that (some) staff have been treated unfairly and in some cases the stories I have been told about about bullying have been horrendous, and that has been wider than the hospital.

Not once have I heard about say Marks and Spencers managers and / or senior sales staff being frog marched or escorted out of the business entrance, some in front of members of the public, by security staff. What organisation does that ? I would venture to suggest one that has become too arrogant, too self important and one that needs to realign itself with todays prevailing public moods and best practices. 

I have worked with and alongside some very good clinical teams, who would fight tooth and nail for improving their patients lot. We hear nothing about what the current medical fraternity think of things. Maybe it is time we did.

 

 

[Andy Onchan]

Where's the patient voice in the new Manx Care?? Why oh why is there no patient representative on any Board??? It's quite astounding really. It's almost as if the patient is irrelevant in all of this.

[finlo]

Just now, Andy Onchan said:

Where's the patient voice in the new Manx Care?? Why oh why is there no patient representative on any Board??? It's quite astounding really. It's almost as if the patient is irrelevant in all of this.

They are!

[the stinking enigma]

1 minute ago, Andy Onchan said:

Where's the patient voice in the new Manx Care?? Why oh why is there no patient representative on any Board??? It's quite astounding really. It's almost as if the patient is irrelevant in all of this.

You mean service users?

[Apple]

39 minutes ago, the stinking enigma said:

You mean service users?

That terminology represents everything that is now wrong with our health and social care approach. 

[Uhtred]

9 hours ago, Apple said:

I may get accused of having an axe too grind (again) but surely DA's resignation for the strategic and systemic failures has to be the first action. 

Many staff in the DHSC I speak to saw this coming given the way things have been allowed to deteriorate with Managers and Clinicians supposedly with 'expertise' come and go during his watch.

Maybe he should be 'escorted' out of the building as I was told happened to someone recently.

Where have all the clinicians been hiding whilst this has been going on. Strangely quiet. 

Significant breaches of waiting times for cancer referrals - just imagine the impact on women and families waiting for outcomes and results that have to put their lives on hold - Sorry David but he has to take accountability. He is the DHSC, as he often reminds us.

Very interesting; very well put.

[Uhtred]

2 hours ago, Apple said:

We hear nothing about what the current medical fraternity think of things. Maybe it is time we did.

 

 

A good point that highlights a marked change from once upon a time. Not all that long ago the hospital medical staff weren’t backward in coming forward if the Minister wore the wrong tie. Today…Trappist silence.

[Apple]

12 hours ago, Boris Johnson said:

I think Nobles went into failure a long time ago. When you have witnessed your young son being transferred from a ward to intensive care and the ward nurses have to shout at, scream at and then finally take the crash bag off the crash nurse who was to accompany us on the short journey because he could not understand simple English requests, you would understand my feelings.

That must have been very distressing to have to witness and yes it is very understandable. I only wish events like this are one offs. Sadly from complaints I have seen, they are not. I hope he has recovered.