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This report; https://www.gov.im/media/1367006/final-full-report-september-2019-1.pdf illustrates perfectly the main problem with the psychiatric service on the Isle of Man. It is nurse led and pays no heed to, import or understanding of the role of senior doctors. This is at all levels from the department of health down and is sadly perpetuated by the quality of doctors in key positions within psychiatry at the moment who do not lead, innovate, educate, take responsibility, or work collaboratively across professional boundaries. The author, a nurse himself ( albeit with the title of doctor from a research project) has undertaken a piece of work investigating the practices of nursing staff on the acute psychiatry ward with a view to reducing risks and enhancing quality of care. This has been done without interviewing or seeking any input from the Consultant of the ward or Clinical Director. Perhaps the former was away in meetings or eating cake and the other was up in front of the GMC defending himself against gross patient boundary transgressions? Or perhaps they were not asked because the interviewer was a nurse and doesn’t understand that the doctor is a key professional on the ward? the Consultant being the one who takes the final decision and the final responsibility about all patients on the ward or certainly should do. The only doctor interviewed for this report is not on the GMC specialist register for psychiatry and has not even been through any formal psychiatry training scheme. All research shows that wards that do not have good medical leadership are poor. Nurses are not responsible for the overall management or risk assessment of a patient, the named Consultant is, as the head of a multi-disciplinary team. Nurses are not paid to be left wholly responsible for this risk. This is why doctors are paid the big bucks. The report misses any discussion of how the role of nursing staff interfaces with the medical role and instead focusses on multiple policies which I can tell you will not have been read by agency staff and probably live in a folder and never see the light of day. The flawed assumption is that If a policy has been written then it is obviously being followed. There is mention of a psychologist providing supervisors. And support as an add on rather than integrated into the multidisciplinary team decision making but no mention of the medical input on the ward at all. No wonder there are too many in-patients with no clear care plan and no positive risk taking. That’s what you get with a nurse led service as nursing is protocol driven and risk averse. I will also say that from the amazing ratios of patients to staff the unit should be running like clockwork. Much better than anywhere in the U.K. Overall, there is a recurrent problem with management not listening to, dismissing or even asking for senior ( trained Consultant) medical expertise across the hospital services. Similar is happening now with the air ambulance!! Yet another opportunity wasted. I would suggest a Royal College of Psychiatry visit against their audit tool for acute psychiatric wards would have been more rigorous.
Why is the clinical director of psychiatry allowed to continue as lead for the department of psychiatry whilst being investigated by the GMC for having a sexual relationship with a patient? https://www.dailymail.co.uk/news/article-7231657/Married-psychiatrist-58-two-year-romance-patient.html I hear that the person who he gave a job to and who he signed off to become a consultant via article 14 are acting as character witnesses. Conflict of interest?