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IOM DHSC & MANX CARE


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1 hour ago, Dr. Grumpy said:

It's quite a damning read isn't it.  This paragraph struck me particularly (top of page 12):

All grades and disciplines of staff told us the incident reporting system was seen as a tool to apportion blame. The system was described as ‘weaponised’. We were also told that reporting was discouraged. Some staff said they could not access the system, they had to request that someone else input any incidents on their behalf but this was frequently denied.

Which if nothing else suggests that the 13 serious incidents they claim were a big understatement.

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https://www.gov.im/media/1377727/part-2-board-papers-1-september-2022.pdf

 

These are the published Board papers from the meeting earlier this week.

The problems are widely expected as many people who work /worked in DHSC are aware of. All they had to do was ask.

Past underfunding and misspending are also mentioned (politician make note - mandate requirements must be funded !)

The report mentions / highlights car parking charges at nobles and serious nursing staff shortages for the safe care delivery but apparently enough to use for Private care ward (unless the private company brings their own staff next year).

Anyway, they seem to asking for a £31 .7 million (Options paper for 23/24).

Still no discussions yet tough about how they intend to incorporate patients and client and public feedback into their "recommendations". 

Manx care now is the only way forward but their reports need to be less repetitive, more succinct and relevant to the public as well as to themselves.

Edited by Apple
typo
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1 hour ago, Dr. Grumpy said:

The whole report makes shocking reading. The following excerpt illustrates how bad things are. It is hard to comprehend how this department was allowed to get this unprofessional - who allowed this to happen? Given how bad this department has become, it seems highly unlikely that every other department is not in the same woeful condition.

1. We found areas where the service could make improvements. CQC told the service:

• Mandatory Training – Mandatory training levels were low, including life support training and there was an ineffective system to ensure oversight of all mandatory training requirements for all staff within the department.

• Safeguarding – No staff had undertaken safeguarding adults and children training to the appropriate level. There were inconsistent messages about the processes and staff did not always have the skills to identify or action a safeguarding concern.

• Environment and equipment – There were inconsistent processes to ensure cleaning, maintenance and calibration of equipment. There was no ligature free area to be used by patients at risk of self-harm. Substances which could cause harm to patients were not stored securely.

• Assessing and responding to patient risk - There was an inconsistent approach to assessing and responding to patient risk. Patient care records did not provide assurance that risk assessments were carried out.

• Medicines – There were ineffective systems to have oversight that medicines were managed safely and securely. This included controlled drugs.

• Staffing – there were insufficient numbers of staff to ensure safe care and effective management of patients.

• Patient care records - Staff did not complete patient care records in line with the standards required by their registering bodies, for example the Nursing and Midwifery Council and the General Medical Council. Records were not always stored securely.

• Incident reporting - Reporting was discouraged and there appeared to be a blame culture in the department. The reporting system was described as weaponised. We saw limited evidence of learning from incidents.

• Policies - We saw several policies that were out of date, had not been reviewed to ensure they reflected the most up to date guidance and there was no consistent oversight or ownership of this.

• Patient outcomes – There was no data displayed relating to patient outcomes in the department. In addition, there was limited local audit to provide evidence of safe, effective care.

• Consent – The policy was out of date and required review. Consent was not always recorded in patient care records and there were no audits to provide assurance that consent was obtained in line with guidance.

• Access and flow – The key performance indicators in place were not always met and showed a deteriorating picture in terms of access and flow. During our onsite visit, patients requiring admission were experiencing long waits for beds in the hospital. 20190416 900885 Post-inspection Evidence appendix template v4 Page 3

• Governance - The governance processes were not robust. This meant the department leaders had limited oversight and were unable to be assured they were providing safe care and treatment.

• Risk management – Risks remained on the risk register for many years, with no evidence of actions to reduce or mitigate the risks, some of which were graded as high and extreme.

• Managing information - The quality dashboard was not always effectively completed which meant leaders did not have oversight of the department’s performance to enable them to evidence safe care or to identify risks and where improvements were needed. Different systems for patient records meant staff had limited oversight of patients’ care records.

• Learning and continuous improvement - We saw limited examples of any quality improvement initiatives or continuous learning.

2. We have also identified areas of concern which we have escalated to the IOMDHSC:

• Culture – The culture within the department was of significant concern. We found lack of support for staff health and wellbeing, relationships were “toxic” and there was a bullying and blame culture.

• Leadership - At the time of our onsite visit we had concerns around skills, attitudes and behaviours of both medical and nursing leadership teams. There was a significant disconnect between the nursing and medical staffing in the department which could have the potential to cause or contribute to patient harm." 

Edited by code99
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18 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.

After this utter shocker of a report, I wonder if anyone still thinks that many of the senior management team can fulfil their roles effectively without ever even setting foot on Island?

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1 hour ago, Roger Mexico said:

It's quite a damning read isn't it.  This paragraph struck me particularly (top of page 12):

All grades and disciplines of staff told us the incident reporting system was seen as a tool to apportion blame. The system was described as ‘weaponised’. We were also told that reporting was discouraged. Some staff said they could not access the system, they had to request that someone else input any incidents on their behalf but this was frequently denied.

Which if nothing else suggests that the 13 serious incidents they claim were a big understatement.

The funniest thing today was after this was covered on Manx Radio the number of anonymous DHSC staff texting and emailing in to Beth Espey saying how shit they were to work for and that people we’re leaving in droves. 

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And while I am in a bad mood - note that the inspectors came up with that list in only 4 days of work. (I find that impressive).

Manx Care should have come up with that list in their first week's work. Maybe they did, but thought that finding work for a Deputy Chief Information Officer and other sub-deputy roles was more important than the healing the sick.

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13 minutes ago, Sheldon said:

After this utter shocker of a report, I wonder if anyone still thinks that many of the senior management team can fulfil their roles effectively without ever even setting foot on Island?

Get with times, senior management can be effective remotely as has been clearly demonstrated. // sarcasm mode off.

MC has only really had effective on-island management since Ms Cope's appointment, so the first year was essentially wasted or has my recollection of the order of things become blurred? 

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5 minutes ago, Two-lane said:

And while I am in a bad mood - note that the inspectors came up with that list in only 4 days of work. (I find that impressive).

Manx Care should have come up with that list in their first week's work. Maybe they did, but thought that finding work for a Deputy Chief Information Officer and other sub-deputy roles was more important than the healing the sick.

Sir Jonathan Michael spent over a year (and over a Million squid) and didn't find any of these frankly huge risks?

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4 minutes ago, Gladys said:

MC has only really had effective on-island management since Ms Cope's appointment, so the first year was essentially wasted or has my recollection of the order of things become blurred? 

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

 

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Just now, Two-lane said:

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

 

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

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I refer to my post many pages ago about how the board forced their main governance man to leave the Manx Care organisation because they didn't want to be accountable for good governance.

Manx Care is broken from the get-go.

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1 minute ago, Dr. Grumpy said:

Sir Jonathan Michael spent over a year (and over a Million squid) and didn't find any of these frankly huge risks?

You beat me to it. Astonishing. This alone is pretty damning. Will any MHKs step up to the mark and enquire into it? Moulton or Robertshaw should make a point of asking the question. 

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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 by Roger Mexico
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