Manx Care

[Andy Onchan]

15 hours ago, finlo said:

They are!

Quite so.

The non-professional medics that applied to join the Board presumably went through a selection process and so therefore do not represent the patients. They will follow the flow.

Perhaps it's about time a Patients Forum was created to hold Manx Care to account for delivering the services. It's clear that IOMG isn't going to do that, they set policy only (or so we're told). 

[code99]

On 5/13/2021 at 8:18 AM, 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.

What an awful experience that must have been for you and your whole family. 

I am aware of a not dissimilar story where a patient at the hospital was poorly treated by a specialist, and this patient is totally convinced that the inability of the specialist to communicate adequately in English was half of the problem. The other half of the problem was that the specialist did not seem to have an appropriate level of professional skills. The patient raised a complaint about their poor treatment but ultimately the complaint was whitewashed.

I agree with you that some problems at Nobles seem to be entrenched. The Complaints Department should be there to shine a light on these types of problems so that they can be fixed. Unfortunately, that process is also failing. 

We should not be in this situation, but we are. I beleive that for there to be any progress, patients must become more assertive and more vocal. Having patient representatives on the Manx Care Board would be a positive start. I think what also would be beneficial is if these types of problems were given coverage by the local mainstream media. Also, when the MHK candidates start 'curb-crawling' * for votes, we all need to make it very clear to them that the residents of this Island expect better, want improvements and will hold them to account. 

* metaphorically speaking

Edited May 15, 2021 by code99

[Apple]

The Manx Care Board, not any volunteer groups or front line staff, need to get out and talk to the public about their experiences. They should publish what they are told. That is the starting point. They will not like what they hear I suspect in all cases, but I think now people may be more astute about health care after Covid and DAs performances. 

Most of the money spent on the Sir Johnny's report was wasted in my view. It did not deal with many of the real issues and has left now a legacy of more spending that clearly does not always make the differences we need. 

I see from the organisational charts of the DHSC's new Governance Structure that we have even more wasteful oversight than before. Some of these are relevant, some definitely are not. Still, it's kudos to have a seat at the top table and some people live for that. 

How to avoid the really important issues - form a committee, don't publish minutes and quietly push out an annual report that is purely for political smooching. Thats how I would do it as well.

 

[Apple]

On 5/14/2021 at 9:39 AM, Andy Onchan said:

Perhaps it's about time a Patients Forum was created to hold Manx Care to account for delivering the services. It's clear that IOMG isn't going to do that, they set policy only (or so we're told). 

The nearest thing to it is supposed to be the lay people ( whatever they are) on the health and care consultation committee. The are supposed to be independent but from what I have been told they dare not raise the issues we see on here in terms of organisation failures. The DHSC can ignore their advice anyway and apparently often does I hear.

What is needed is and Patient and Family Support and Advocacy Service, funded by the CoMIN and not the DHSC, and there to help people to navigate the unnecessary complexities of complaints handling and to support those who, often in grief, struggle to be heard , understood (that is the big problem) and as advocates against the potential arrogance, dismissive attitudes and indifference to situations that need far more than hat they seem to receive. 

Why we don't have one yet beggars belief. Who will argue for that in their manifesto ?

[Roger Mexico]

1 hour ago, Apple said:

The nearest thing to it is supposed to be the lay people ( whatever they are) on the health and care consultation committee. The are supposed to be independent but from what I have been told they dare not raise the issues we see on here in terms of organisation failures. The DHSC can ignore their advice anyway and apparently often does I hear.

The Health Services Consultative Committee does seem to produce an annual report and (within the terms of the bureaucrat-speak these things seem to have to be written in) it seems to raise quite a lot of the issues:

Sadly, the HSCC is disappointed to be reporting limited progress in the majority of its members’ areas of health scrutiny. There are strong common themes in members’ annual reports and key recommendations: slow progress in clearly identified actions [...], insufficient strategic and admin support [...], and single point of failure staffing.

[...] A lack of timely Treasury decision-making in business cases in general and asset replacement in particular leads to unnecessary duplication of effort, additional expense and intense frustration amongst many frontline staff who already have a difficult time juggling patient care and organisational functions.

[...] a clear DHSC Communications plan which remains unachieved. Political Members are less visible, with largely unachieved specific P4G Actions. The DHSC management structure seems even less discernible to the public in general, and hospital staff in particular.

[...] Clear definition of essential health services and understanding of on/off Island clinical activity, are long overdue P4G actions. These have now been transferred to Transformation which has resulted in further delays on tough decisions and a lack of clear communication; both with the public and internally with staff

Good transparent governance is still lacking across the estate despite the welcome return of the Care Quality and Nursing Committees and some consistency in the Informatics and Nobles Patient Safety Quality Committees. The Executive Leadership Team (ELT) mechanism has not resulted in robust debate nor ensures essential governance issues are regularly reviewed through standing agenda items. Years of firefighting and management churn have resulted in a lack of calm consistent reflection, analysis and actions. The absence of core data sets contributes to a lack of timely and sound decisionmaking. Overworked senior leads manually analysing data whilst already having management and frontline facing roles, is an unproductive distraction for hard-working employees. Morale has not been observed as improving during our scrutiny interactions over the past year.

And that's just from the first page of the Preface.  The Second page is even more damning but I don't want to upset John Wright with something too long.

It's a public document, but the media don't seem to pick up on such things unless they are handed to them in a press release from their chums in the Cabinet Office.  Which this wasn't strangely enough.

[Boo Gay'n]

44 minutes ago, Roger Mexico said:

The Health Services Consultative Committee does seem to produce an annual report and (within the terms of the bureaucrat-speak these things seem to have to be written in) it seems to raise quite a lot of the issues:

 

I just read through the document, which is a bit sad for a Sunday evening, but there we are.  Is the HSCC the only organisation on the island that takes the Programme for Government seriously?  The government certainly doesn't.

[Roger Mexico]

13 minutes ago, Boo Gay'n said:

I just read through the document, which is a bit sad for a Sunday evening, but there we are.  Is the HSCC the only organisation on the island that takes the Programme for Government seriously?  The government certainly doesn't.

I suppose the idea is that it's their job description to do so and point out where the promises haven't been kept.  They probably realise that the PfG under Quayle has basically been "Sit on your arse for 5 years and hope the money keeps rolling in", but they have to go through motions to make it clear just how much he and his cronies have failed to do anything else.  You'd have thought such a detailed analysis would attract more attention, but then the media don't really do analysis or detail or annoying the wrong people.

The HSCC seems mainly to be a governance monitor - checking how things work rather than outcomes - they actually seem unable to examine individual cases like the sort of body Apple suggests.  Their analysis does give 'official' confirmation on the sort of faults that many on here have diagnosed over the years however.  Which doesn't mean they will get fixed, but it does mean that Manx Care can't say it didn't know about them.

[Apple]

That  is a politely damning report but I can find no reference to it on Hansard or Govt website so presumably Tynwald have not commented or responded. So no-one has been held accountable, again ! Roll up that carpet again.

Quote :- "The allegation of poor performance of DHSC governance structures was refuted by the CEO during his appearance at the PAC in February 2019 prior to his departure." 

The rest of the document - mostly in Red and Amber refers to things PRE - Covid that shows that projects were not completed. As for the West Midlands Review - some of the recommendations still to be implemented. Patient engagement 'dropped".

What are we paying these people for. 

[Boo Gay'n]

1 hour ago, Apple said:

That  is a politely damning report but I can find no reference to it on Hansard or Govt website so presumably Tynwald have not commented or responded. So no-one has been held accountable, again ! Roll up that carpet again.

Quote :- "The allegation of poor performance of DHSC governance structures was refuted by the CEO during his appearance at the PAC in February 2019 prior to his departure." 

The rest of the document - mostly in Red and Amber refers to things PRE - Covid that shows that projects were not completed. As for the West Midlands Review - some of the recommendations still to be implemented. Patient engagement 'dropped".

What are we paying these people for. 

I have to confess that I have had a really sad Sunday evening and actually went back to have a look at PAC records that are mentioned in your quote (they are here).  To be honest, the executives being grilled seemed honest about the many problems that they were facing.  For example, think about what this means:
 

Dr Couch: I think we have to be honest with the Committee and say that there are still aspects of culture that can confound governance. I think again it is alluded to in Sir Jonathan’s Progress Report and certainly he has mentioned to me in meetings I have had with him that some of the challenges we have may need to be addressed actually through legislation. And this comes again – I mentioned earlier the duties of the Secretary of State in the UK through changes in UK law, the Secretary of State has duties which are then passed on almost directly to Trust chief executives and chairs and then are almost passed on directly to clinicians. They must adhere to them. Because we have an old-fashioned legal system, often people will cite ‘professional autonomy’ as a reason for not following a policy that has been mandated by the Department. So that is the ‘confounding’ point I think that is referred to in that response.

 

Mrs Poole-Wilson: So are you saying that we have staff in the DHSC who will refuse to follow – if we have all of these implementation plans and so on – to deliver real change?

 

Dr Couch: Yes, of course.

 

Mrs Poole-Wilson: That, as things stand, we will have people blocking them?

 

Dr Couch: Yes, of course.

 

Mrs Morris: Yes, most definitely.

 

The Chairman: I do not suppose you think that naming them here would help, do you? You are resisting the temptation – okay, you had your chance!

[Andy Onchan]

21 hours ago, Apple said:

The nearest thing to it is supposed to be the lay people ( whatever they are) on the health and care consultation committee. The are supposed to be independent but from what I have been told they dare not raise the issues we see on here in terms of organisation failures. The DHSC can ignore their advice anyway and apparently often does I hear.

What is needed is and Patient and Family Support and Advocacy Service, funded by the CoMIN and not the DHSC, and there to help people to navigate the unnecessary complexities of complaints handling and to support those who, often in grief, struggle to be heard , understood (that is the big problem) and as advocates against the potential arrogance, dismissive attitudes and indifference to situations that need far more than hat they seem to receive. 

Why we don't have one yet beggars belief. Who will argue for that in their manifesto ?

Actually I don't think any Forum  or Service should have anything to do with COMIN, certainly not funded in any way. The only way to influence both parties (IOMG & Manx Care) for the preferment of patients is to treat them with equal disdain, if that's what is required. Government will have their own aims. as will MC and getting them both to see the patient's view point or demands should be paramount. Divide and rule, if you like.

[Roger Mexico]

16 hours ago, Boo Gay'n said:

I have to confess that I have had a really sad Sunday evening and actually went back to have a look at PAC records that are mentioned in your quote (they are here).  To be honest, the executives being grilled seemed honest about the many problems that they were facing.  

Judging from that excerpt, Couch and Morris's responses were all a bit "Nothing to do with us Guv, we're only the people in charge".   If consultants were really citing 'professional autonomy' they should have been challenged, but that would require management who wanted to change things rather than just finding someone to blame.  To be fair the fault may not have been entirely with the DHSC, it sounds like the AG's Office and others may also have been looking for excuses for inaction.

[buncha wankas]

On 5/16/2021 at 10:15 PM, Boo Gay'n said:

I have to confess that I have had a really sad Sunday evening and actually went back to have a look at PAC records that are mentioned in your quote (they are here).  To be honest, the executives being grilled seemed honest about the many problems that they were facing.  For example, think about what this means:
 

Dr Couch: I think we have to be honest with the Committee and say that there are still aspects of culture that can confound governance. I think again it is alluded to in Sir Jonathan’s Progress Report and certainly he has mentioned to me in meetings I have had with him that some of the challenges we have may need to be addressed actually through legislation. And this comes again – I mentioned earlier the duties of the Secretary of State in the UK through changes in UK law, the Secretary of State has duties which are then passed on almost directly to Trust chief executives and chairs and then are almost passed on directly to clinicians. They must adhere to them. Because we have an old-fashioned legal system, often people will cite ‘professional autonomy’ as a reason for not following a policy that has been mandated by the Department. So that is the ‘confounding’ point I think that is referred to in that response.

 

 

 

Mrs Poole-Wilson: So are you saying that we have staff in the DHSC who will refuse to follow – if we have all of these implementation plans and so on – to deliver real change?

 

 

 

Dr Couch: Yes, of course.

 

 

 

Mrs Poole-Wilson: That, as things stand, we will have people blocking them?

 

 

 

Dr Couch: Yes, of course.

 

 

 

Mrs Morris: Yes, most definitely.

 

 

 

The Chairman: I do not suppose you think that naming them here would help, do you? You are resisting the temptation – okay, you had your chance!

 

Sounds like the CEO accepted he had senior managers who obstruct change, but then reason says that if the system became efficient and effective their overpaid roll would become redundant.  Refuse to improve, make it look difficult equals job for life. 

[Apple]

Today's Tynwald written answer:

There were 59 full-time consultants employed throughout the period 1 April 2020 to 31 March 2021. This figures excludes 14 doctors who commended or ceased employment during the year.

No. of Consultants by Pay Range:

£200k +...............................26
£150k - £199,999...............23

£100k - £149,999...............10

Under £100k........................0
 

[littlebushy]

6 hours ago, Apple said:

Today's Tynwald written answer:

There were 59 full-time consultants employed throughout the period 1 April 2020 to 31 March 2021. This figures excludes 14 doctors who commended or ceased employment during the year.

No. of Consultants by Pay Range:

£200k +...............................26
£150k - £199,999...............23

£100k - £149,999...............10

Under £100k........................0
 

Link to pay scales for consultants in England here

https://www.bma.org.uk/pay-and-contracts/pay/consultants-pay-scales/pay-scales-for-consultants-in-england

Top pay scale in England (after 19 years service) is £110 683. Even allowing for local enhancements, on call and additional duty allowances, almost half the workforce on in excess of £200k + seems excessive/taking the piss*

 

 

*Delete as appropriate

[Apple]

8 minutes ago, littlebushy said:

Top pay scale in England (after 19 years service) is £110 683.

Plus possibility for awards up to  £ 77,320 +2.5 % which could take a salary up to the £200,000 mark. This was upgraded despite the public sector pay freeze I think. Of course it would be useful to know how these extra awards are added and / or removed and under what circumstances.

I don't begrudge the high salaries but I do have a problem with the lack of transparency that undermines or supports  whether or not a particular individual actually deserves it. They do in the UK. It should be insisted on here.

The ICU nurse who was part of the team that treated Boris Johnson has left the UK NHS citing reasons including the poor respect for the profession shown by the Govt there by suggesting a 1 %  pay rise. 

I assume we can pay our staff what we like so that's all right then.