IOM DHSC & MANX CARE

[Roger Mexico]

55 minutes ago, Two-lane said:

The inspection was carried out after Manx Care had been on the payroll for 18 months. Maybe Moulton should interview the directors to ask them how long they think it will take to solve these problems.

The inspection was 13-16 June, so more like 14 months, though there was such a vacuum at DHSC that the Manx Care people effectively started earlier.  But you would have hoped to see more of a difference, especially as the main area of disaster is under the heading of leadership.

There was a particular problem in A&E: "In the department there was a nurse manager (band 8a) post for the MIU and one for the main ED. The ED post had been held by an interim for approximately three years".  Clearly lack of a lead nurse caused extra problems, but support from above was lacking:

We spoke with a senior nurse who told us they were the nurse consultant for urgent and emergency care and the ambulance service. They explained that their role was an associate director of nursing type of role. They were also the lead for non-medical prescribing and for patient group directives. They said that their role was multi-faceted but they usually spent 50% of their time working clinically in the department and had line management responsibilities for all staff in the ED and MIU.

Some staff referred to ‘the matron’ and said they were not usually visible in the department. The nursing leadership was therefore unclear

[...] The chief nurse told us they worked shifts on the department. Another senior nurse told us they spent 50% of their time working on the department. However, more junior staff consistently told us they did not see senior leaders in the department.

And the CQC state:

Our visit corroborated all the concerns highlighted by the hospital and that urgent action was required my Manx Care at pace, to address these significant concerns. It was unclear if the current nursing and medical leadership team had the skills, attitudes and behaviours to manage this.

It's not clear if they are referring to the ED here or more widely, but this clearly isn't a problem restricted to there.  

Edited to add:  All quotes on p20-21 of report

Edited September 7, 2022 by Roger Mexico

[Two-lane]

5 minutes ago, Roger Mexico said:

The inspection was 13-16 June, so more like 14 months,

You are counting from their take-over date, but I am counting from the date they started receiving payment for their services. The shadowing period was to permit them to get an understanding of what problems existed.

They were being paid in that time - I expect something in return for the money I (and you) paid them. They have had 18 months...

 

[Two-lane]

20 minutes ago, Gladys said:

Yes, I was trying to remember the order of things, but Magson only finished this January, is that right?

Perhaps you are implying that Magson was a problem, and that it was only after her departure that things had a chance to improve. But who was responsible for monitoring Magson's performance? (I have no idea - don't tell me it was David Ashford).

[Gladys]

15 minutes ago, Two-lane said:

Perhaps you are implying that Magson was a problem, and that it was only after her departure that things had a chance to improve. But who was responsible for monitoring Magson's performance? (I have no idea - don't tell me it was David Ashford).

The board of Manx Care, surely? 

I may be wrong, so I am going to remind myself if the role of the various players in this whole melodrama. 

Edited September 7, 2022 by Gladys

[cissolt]

11 minutes ago, Two-lane said:

Perhaps you are implying that Magson was a problem, and that it was only after her departure that things had a chance to improve. But who was responsible for monitoring Magson's performance? (I have no idea - don't tell me it was David Ashford).

Wasn't it will greenhow?

Something about this whole thing stinks.  The bullying and blame culture are government wide issues, every employment tribunal or whistleblower incident reveals the same old story.  Adding manxcare to the mix has solved nothing, and costs tens of millions.

[NoTailT]

4 minutes ago, cissolt said:

Wasn't it will greenhow?

Something about this whole thing stinks.  The bullying and blame culture are government wide issues, every employment tribunal or whistleblower incident reveals the same old story.  Adding manxcare to the mix has solved nothing, and costs tens of millions.

Will Greenhow sits at the very top of historical problems in Government, it's departments and agencies. But there's no sign of the culture changing - yet - it's become very much instilled in the culture of how Government operates.

It appoints people that fits the culture. The board of Manx Care is no different in the most part.

But we've heard very little from Alf, very much taking the recess in his stride. He needs to be firm and take action and tell Hooper to buck his fucking ideas up or piss off.

Edited September 7, 2022 by NoTailT

[Roger Mexico]

8 minutes ago, Two-lane said:

You are counting from their take-over date, but I am counting from the date they started receiving payment for their services. The shadowing period was to permit them to get an understanding of what problems existed.

I was clarifying rather than contradicting, hence also pointing out that the takeover really started before April.  For example Cope seems to have sacked Angela Murray early in 2021 - from the Ranson tribunal:

Dr Ranson reminded Mrs Cope by email of a prior conversation early in 2021 and it made a number of pertinent points including this one regarding Ms Murray:

• “You told me that you had never encountered behaviour as you witnessed for yourself from Angela Murray and you told me that you had 11 members of staff come and tell you about their treatment at the hands of Angela Murray and that was why you summarily dismissed her. There is a culture at Noble’s – which Kathryn was fully aware of – of bullying and threatening.”

Magson seems to have acquiesced in the dismissal of her henchwoman.  So they were clearly in charge and aware of the problems.  They also were aware of the ED problems:

Manx Care were not positive in their self-assessment of leadership in the ED. This was stated as being due to serious RN staffing gaps, a reliance on temporary workforce for both nursing and medical staff, the adequacy of leadership, the culture, the breadth and depth of quality assurance being insufficient to evaluate quality. They also cited: unresolved RCEM issues, a lack of paediatric separation, the lack of provision of a dedicated mental health cubicle, poor mandatory training and safeguarding training compliance, concerns about the management of people detained under the mental health act, lack of compliance with care of people with sepsis, having an embryonic mortality review and the immaturity of policies and procedures.

But they seemed powerless to take action.  Or realise that leadership comes from the top.

[NoTailT]

No doubt @wrighty will be along to tell us it's all bullshit, it doesn't sit in-line with his experiences of Nobles or the health system and that he and his colleagues are the best of the best.

[Roger Mexico]

39 minutes ago, Lilly said:

Having unfortunately having to used Nobles recently it's not everywhere at the hospital,  Nobles are really providing a good service in other areas kind and compassionate nurses, l was fortunate enough to meet one such nurse on Monday, she went above and beyond to help me. 

Apologies if l have crossed over two subjects.

Well I've crossed you comment over to match, but it's worth saying that the one area that got some praise in the CQC report was caring:

We witnessed staff interacting with patients in a kind and caring manner. Some staff spoke passionately about wanting to make a difference for patients and their families. They explained that the wanted to care for people in the same way they would want their own families to be cared for.

[...] Staff provided emotional support to patient and when possible families and carers to minimise their distress. They understood patients' personal, cultural and religious needs.

[...]  We observed staff supporting and involving patients, families and carers to understand their condition and make decisions about their care and treatment, where possible.

Of course this puts all the comments about a failing 'culture' in context.  The basic culture of caring for patients seems to work just fine.  So the failings are clearly of management - acknowledging that might be a start.

[NoTailT]

10 minutes ago, Roxanne said:

That's extremely unfair. 

Dear, do tell me why its unfair?

That's the usual defence on here: 'Not in my experience.'

But in reality he's been an integral part of the culture, happily paraded out on live video conferences.

Although I have a lot of time for his colleague Mr Hutchinson.

[Dr. Grumpy]

1 hour ago, Two-lane said:

I recall Cope was on the payroll in December 2020 - one month before the "shadowing" exercise began.

 

Correct. But what's the bet that her "Voyage of Discovery" will last (at least) another 3 years?

[Dr. Grumpy]

42 minutes ago, Gladys said:

The board of Manx Care, surely? 

I may be wrong, so I am going to remind myself if the role of the various players in this whole melodrama. 

More tragicomedy

[manxlass]

I know someone who broke their arm early January, was plastered for 6 weeks. Cast was then removed late February and they were told your arm is still broken. Not going to put another cast on as you will lose too much mobility. Early April they were in Liverpool for a hospital appointment for something else, consultant noticed that they were holding arm. Asked what was up, they explained what had happened. They were sent straight away for a scan and orthopedic consultant summoned. The orthopedic consultant said this should have been operated on straight away. Where the break was it would never have healed. He also said whoever left your arm like this should be struck off. Early May the arm had major reconstruction in Liverpool.

[Manx Resident]

Manx Care are seeking £18m to reduce current waiting lists.

A friend has just been advised by their GP that tests have confirmed they need a significant operation and that they will be referred to the hospital as an urgent case. They were told it will probably be about two years before they are seen because of waiting lists (presumably the GP doesn’t think the £18m will expedite their case) and they will have to manage their pain.

The health system is completely broken …..

[Two-lane]

14 minutes ago, Dr. Grumpy said:

But what's the bet that her "Voyage of Discovery" will last (at least) another 3 years?

Where is this quote from?