IOM DHSC & MANX CARE

[mad_manx]

1 hour ago, wrighty said:

I’m going to hold my hands up and admit I’ve got the spelling wrong 🙁

It is Synaptik with a ‘k’, so I apologise for that. In my defence, many of the emails and messages I’ve had over the past few months have had it with a ‘c’, which looks more right to me which is why I used it. I did check before I posted earlier, but unfortunately I checked the equivalent news item reporting their previous assignment on Shetland, where it’s also a ‘c’. Their website is synaptik.co.uk - should have checked that instead.

 

Are the nurses/ anaesthetist  etc actually staff from the UK or local staff who are working  for the private  company? 

 

Edited May 7, 2022 by mad_manx

[wrighty]

5 hours ago, mad_manx said:

Are the nurses/ anaesthetist  etc actually staff from the UK or local staff who are working  for the private  company? 

 

From the UK, specifically Scotland. Synaptik stated that they would not poach/gazump local staff. Which again, is a good thing. 

[0bserver]

This kind of private set up will become increasingly common. I predict the NHS-style care provision will only handle emergencies and basic stuff. We'll shift more towards an American-style user pays system. 

[John Wright]

1 hour ago, 0bserver said:

This kind of private set up will become increasingly common. I predict the NHS-style care provision will only handle emergencies and basic stuff. We'll shift more towards an American-style user pays system. 

But that description is exactly what it isn’t. In fact what is happening is the very opposite.

Its bringing in specialist staff resources to allow the NHS to play catch up, reduce waiting lists, utilise operating theatres and allow surgeons/specialists to do their jobs.

Perhaps that’s firefighting, and we shouldn’t need to firefight. But we’ve had two extraordinary years, and things weren’t the best before that.

What is essential, when we’ve caught up, is to ensure we have the resources, staff, equipments, theatres, beds, so we don’t fall behind again. We need a degree of built in resilience.

Manx Care is only 13 months old. I’m quietly impressed with the initiatives.

They, and DHSC, do need to resolve the management issues, perceived or actual, and put patients and front line staff first.

[Boris Johnson]

17 hours ago, wrighty said:

In a way, yes, but from a contractual/legal/tax perspective it’s more complex than that. Synaptik are not an agency - their nurses can’t be pulled from their area and put on another ward for example. If they were simply agency staff the night manager, say, could move them to wherever they were needed in the hospital. They’re providing a specific service that is well defined and necessarily limited in scope. And it’s working brilliantly well in allowing us to do our joint replacements. Because of their specific role we’ve had no cancellations because outlying medical patients have been put on the ward, no cancellations because the theatre staff have been working on call the previous night, no delayed discharges because the therapist has had to go and help on ITU etc. 

Sounds good but expensive maybe?

In a way its similar to what I have thought Nobles should be doing, shipping people off island for specialist treatment and stop trying to be a Jack of all trades.

This brings the specialist teams here, same outcome, would be interesting which is more cost effective and which the patients prefer.

[Ghost Ship]

As a former NHS manager I can't see anything wrong with any of this - apart from the misleading newspaper heading.

So long as the service provided remains free to the patient at point of delivery it doesn't really matter how or by whom the work is done, and whether they are Manx Care employees or not.  It's irrelevant.

And the fact that a private health provider is acting as a "partner" doesn't necessarily mean that it's costing the Manx taxpayer any more.  If the health service has the funding available to provide a service but simply doesn't have the capacity to provide it (eg not enough staff) then it shouldn't really have any additional cost.

But even if there is additional cost involved, it can still make sense to incurr it if you are clearing up a backlog of waiting lists that have built up partly due to Covid and which are nobody's fault.  eg It might just be better to do 100 operations per week at a weekly cost of £180,000 than 50 per week at £100,000.  Money is a consideration but it shouldn't be the only one - particularly not post-Covid.

Lots of things are being done differently.  I had to have a hernia repair done ten days ago but I couldn't get it done on the NHS at my local (ten minutes walk away) all-singing all-dancing fairly new PPI hospital.  I had to get it done at a relatively run down hospital over an hours drive away because my local NHS commissioners have redesigned provision of the service to make best use of available resources to clear the backlog.  Fair enough.

I've also had scans done by private providers on behalf of the NHS because the NHS didn't have the capacity to do them - unless patients were happy to wait an inordianately long time.  Nothing wrong with that.

I was critical in an earlier post of a purchaser/provider split on the IoM because I thought the IoM health economy was too small to justify it.  But if it encourages different ways of looking at problems it might be a better idea...

[Ghost Ship]

24 minutes ago, Boris Johnson said:

Sounds good but expensive maybe?

In a way its similar to what I have thought Nobles should be doing, shipping people off island for specialist treatment and stop trying to be a Jack of all trades.

This brings the specialist teams here, same outcome, would be interesting which is more cost effective and which the patients prefer.

It doesn't have to be more expensive, but even if it is, it might still be the right decision to make.

Increased specialisation - at least in the short term - is how my hernia has been treated in the UK.  Rather than trying to provide hernia repairs across three different NHS providing hospitals, local health commissioners have decided that referrals (as far as possible) go to a particular hospital - not necessarily your closest one.  From talking to staff at the hospital where my hernia was repaired, they've become a production line for hernia repair.  (Or reduction line in the case of hernias... )

Certainly makes sense in order to clear Covid back-logs.

I suspect that in the case of the Isle of Man, any decision as to what health services should be provided locally and which should be done in the UK is a political hot potato.  If politicians can't grapple with relatively simple questions like who should be sacked over the prom* debacle, I can't see them sorting out the question of health provision.

* Or substitute any other debacle you like - eg airport parking barriers...

[wrighty]

21 minutes ago, Ghost Ship said:

 

I suspect that in the case of the Isle of Man, any decision as to what health services should be provided locally and which should be done in the UK is a political hot potato.  

This is one of the aims of the transformation project. Responsible clinicians have been doing it for years. It’s relatively simple to make the decisions, but there can be resistance from many directions (patients, politicians, management, clinicians) whenever any change is to be implemented. 

[Ghost Ship]

But clinicians in a provider service shouldn't really have anything to do with making those decisions, should they?  (In my experience clinicians are not necessarily the people best positioned to make decisions about what services ought to be provided and how.)

Those decisions need to be made by the commissioners of the service based on what they can afford and what resources the provider can call upon.

Well that's how I would have thought it should work on the island.  I'll admit it depends* on the knowledge, expertise and experience of the commissioning body, and whether they've been given a clear mission from the govt as to what is required of them.  I accept that that might be wishful thinking in the case of the IoM and might not work as well as it might do elsewhere...

As I posted above, maybe a purchaser/provider split on the island makes more sense than I previously thought.

* Of course it also depends on short-term objectives (eg clearing covid backlog) and more long-term strategic objectives like how dependent the service should be on the UK and/or private providers.  (eg the German dependency on Russian gas and oil dilemma).  The latter are difficult issues to juggle with, and priorities will change over time.  I doubt Manx politicians have the ability or appetite to address them..

 

 

Edited May 8, 2022 by Ghost Ship

[wrighty]

8 minutes ago, Ghost Ship said:

But clinicians in a provider service shouldn't really have anything to do with making those decisions, should they?  (In my experience clinicians are not necessarily the people best positioned to make decisions about what services ought to be provided and how.)

Those decisions need to be made by the commissioners of the service based on what they can afford and what resources the provider can call upon.

I disagree entirely with that. Clinicians, far more than non-clinical administrators/managers, understand the evidence for what they do, are linked to professional organisations such as Royal Colleges, and take part in real-time audit of process and outcomes. We receive guidelines from colleges, and reports from national audits. 
 

Take joint replacements, as I know a bit about them. We absolutely should be doing hip and knee replacements here as we do enough (evidence from the National Joint Registry and GIRFT reports) with outcomes well within, probably better than, national benchmarks. We absolutely shouldn’t be doing ankle replacements (we don’t) because numbers would not be enough to maintain expertise. If, for some reason, these facts change then our practice could change - I stopped doing spinal surgery as numbers fell when indications for surgery changed (with national guidelines from NICE) and it became non-viable for me to maintain my skills. My colleagues stopped doing partial knee replacements. 
 

Decisions over service provision should absolutely be clinically led. In my opinion. 

[cissolt]

Did any of this require the creation of Manx care? It seems like someone in a leadership position is actually making decisions aimed at tackling waiting list issues.  

[Ghost Ship]

 

46 minutes ago, wrighty said:

I disagree entirely with that...

... Decisions over service provision should absolutely be clinically led. In my opinion. 

We'll have to differ then.

I don't think that the people involved in providing a service are necessarily the people who should be deciding how much resource should be allocated to it, or whether it should be provided at all.

I'm sure you can give an expert informed view as to the pros and cons of providing hip and knee replacement as opposed to ankle replacement - and I'm sure any commissioning body would be better informed with your input.  But are you equally qualified to decide on the allocation of resources between "competing" specialties?  Should you be deciding whether orthopaedics should have funding priority over cardiology, or oncology or child and adolescent mental health?

Sorry - you might very well be the best orthopaedic surgeon in the British Isles, but I'm not sure that makes you (or any other clinical specialist) an appropriate person to shape the overall provision of healthcare on the Isle of Man.

Yes - whatever or whoever the commissioning body is should be tapping in to your clinical knowledge and expertise and asking you what the pros and cons are of different elements of orthopaedic surgery.  You and your fellow clinicians would be like expert witnesses in a court case - you'd be providing expert opinion based on research and experience, but you wouldn't be deciding what the right answer is.  You're an expert in a limited clinical area.  You are not necessarily an expert in other areas that may have to be taken into account when deciding on health priorities.

FWIW I live in an area of the country where the standard of provision and coverage of mental health care is appalling.  Apart from the fact that provision of the service has been managed unbelievably badly over the last ten years, the other reason is because of chronic under-funding of the service over many years before that.  And that underfunding of the service was brought about by decisions made by clinician led primary care trusts who had way too narrow and unbalanced a view of what their healthcare priorities should be.

Edited May 8, 2022 by Ghost Ship

[wrighty]

1 hour ago, Ghost Ship said:

 

We'll have to differ then.

I don't think that the people involved in providing a service are necessarily the people who should be deciding how much resource should be allocated to it, or whether it should be provided at all.

I think we're talking about slightly different things. I agree that I shouldn't be deciding how much funding orthopaedics gets, or which operations are commissioned.  But assuming our DHSC decides to commission joint replacement services, I certainly should be involved in deciding whether they're done on island in Noble's or across in the UK, and in fact me and my colleagues should be leading on that aspect, facilitated by our management colleagues.

[momo65]

1 hour ago, wrighty said:

I think we're talking about slightly different things. I agree that I shouldn't be deciding how much funding orthopaedics gets, or which operations are commissioned.  But assuming our DHSC decides to commission joint replacement services, I certainly should be involved in deciding whether they're done on island in Noble's or across in the UK, and in fact me and my colleagues should be leading on that aspect, facilitated by our management colleagues.

Commissioning at service level ie service specifications, should be done with clinicians, not to them. Commissioning in the wider sense needs clinical input but also needs other inputs, including the public. In theory public health too, but they've rarely actually been of actual use.

[Dr. Grumpy]

On 4/7/2022 at 11:08 AM, Dr. Grumpy said:

Is the judgement out yet?

Still nothing?