Bringing in UK managers may make matters worse handle change

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WE now know that there is a crisis in the Health and Community Services Department that is so acute that it needs to be dealt with urgently. Why else would you parachute a team of five UK experts into the Island despite local prejudice against UK consultants telling us how to run things?

The prejudice might even have the ring of truth about it as far as health services are concerned, as we are urgently calling on the expertise found in the NHS, which is in a deep crisis itself.

Jersey will give these imported consultants a warm welcome, of course, but they will have to tread carefully while they spend months getting used to the Island and finding out how things are done here, let alone recommend any improvements.

Still, more brains focused on our apparent deficiencies in this area should help us towards a solution, even though it will be at a considerable cost.

Some cynics might say the money would have been better spent on improving services currently suffering from a lack of funds. The time now taken to even see a consultant or undergo specialist tests is an obvious cause of recent discontent with the health services, and that is mainly due to shortages of staff and equipment.

But there have also been several other moans recently, although few of them have been unique to Jersey. One of the most important problems is bed blocking in hospitals caused by the government’s neglect in the past by failing to expand social care, residential homes and domiciliary care.

Apart from those major issues, the general public does not appear particularly critical of the Island’s health services. We need more of them, particularly GPs, but then many jurisdictions have similar problems.

However, the public’s view of the treatment they get is very good when they get it. For example, last year’s Picker survey of hospital patients found there was much to celebrate in the care they received, and that’s according to the Health Minister. The survey found that a total of 85% of people who used urgent and emergency care services reported a positive experience, and the worst response was in community mental-health services, where 66% of people reported a positive experience.

Of course, that means there were a lot of people not satisfied, but who can be positive about being in hospital? There are also instances where people have been seriously let down by Jersey’s health services but, unfortunately, there will probably always be a few rare cases. After all, nurses, doctors and other health professionals are only human.

But there is no substantial evidence that Jersey is failing to meet acceptable standards, even compared to the struggling NHS or the higher standards found in parts of Europe.

So where did things go so wrong that caused so much fuss and forced emergency measures?

Well, it appears to be because we haven’t got any firm evidence to say that our health services are not failing.

For example, the first outside help sought by the Health Minister was from a learned professor and leading authority on health services, who concluded that there might be problems after he had conversations with a small percentage of HCS staff.

His report made clear that despite the hard work of staff, HCS’s clinical governance is poor and therefore Jersey does not know it receives the standards of healthcare it deserves. This was followed by a more recent report from the Comptroller and Auditor General, who spelt out the problem with bed blocking and the ‘unprecedented demand pressure’ on HCS due to factors such as an ageing population. The latter, incidentally, has been on the government’s radar for many years, so it should not have come as much of a surprise to the health planners.

However, the CAG, who is the ultimate bean counter, went on to criticise strategic workforce planning at HCS and the worsening of ‘effective working relationships’ between consultants and staff in senior management positions, in several key areas, and spelt out other governance issues.

Therefore, it appears that the key to HCS’s problems is a lack of governance, that catch-all, over-used phrase that many people find difficult to define.

The Oxford English Dictionary, however, defines governance as ‘the way in which a country is governed, or a company or institution is controlled’.

Therefore, governance is something that everyone in that country or company is responsible for, but the driving force has to come from the leadership or the management. Therefore, the Health Minister’s measures may not have actually spelt it out in embarrassing detail, but her actions indicate that she is accusing HCS of poor management.

This will not be a surprise to many Islanders, who may have noticed that the modern way of running health services appears to be to keep senior management away from the wards and the shop floor. Apparently, you won’t now see many senior managers managing by strolling around the Hospital poking their noses into what’s going on. That used to be the way of managers in the Hospital, and it appeared to work. But now, of course, there is such a complicated management structure necessary as services have grown and people’s expectations have changed that all the managers are too busy in meetings, strategic planning and answering to ministers to have contact with many staff.

That, of course, is a pity and may be unavoidable. Still, if it is the problem, then surely the current management should be allowed to make its own changes first without bringing in more temporary managers from outside the Island. If, of course, this has been tried and hasn’t worked, then other more drastic measures might need to be taken. But the Health Minister could have made matters worse by bringing in yet more managers from outside to prove that we can’t handle change ourselves.

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