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‘inappropriate’ to insist that the next chief executive of the DHSC live on the island.


Manx17
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22 hours ago, Galen said:

From medics I have spoken to over the years the problem stems from the fact that the IOM is not at the cutting edge (no pun intended) of the medical world.

It's routine work as the 'specialist stuff" gets sent off Island - mainly to the North West (Liverpool, Alder Hey, Clatterbridge etc) to medical centres where its their routine daily work. The result generally is any medic looking for career progression does not want to come to the Island. Those that do tend to already be at the level where they are unable to progress further e.g. a consultant. They usually have a youngish family, know the Island, want to settle down and want to 'soft peddle' for the next 20+ years doing the routine stuff.

In more recent times the lack of other professionals (Dentists, vets, pharmacists, teachers etc), expensive housing, higher costs of living, weather dependent travel on/off Island, and lack of decent shops, intrusion into health matters by politicians who know very little about health but think otherwise, any attraction of coming here is considerably diluted.

Yes, we have some good medics, but increasingly they are rare breed. One solution might be for the Island to be a formal offshoot of say the Royal Liverpool Trust, where medics can be formally rotated between working in a big acute hospital (Liverpool) and the provisional one (the IOM). This would get round some of problems of getting locums and mean the 'top notch ' medics would be here for say 4 weeks in every 3months. Perhaps not ideal, and would need some creative thinking given the tax position etc. but is an option. Increasing the use of telehealth with remote diagnostics such as the Island did with fetal medicine (I not sure if it is still being used but was a successful service for those who needed it) might be also worth doing but requires serious investment in IT, staff and training.

With the Island's population, being in health terms, 'small', we are always going to have to send patients to the UK for conditions that fall out of the 'routine medicine' or are specialised such as heart, neonate babies, certain types of cancer etc and that is yet another price we pay for living on an Island. 

This lack of top notch medics and a 'second class' health service  means that those that are attracted to the Island to run the service from a managerial point of view, tend to be those who are unhappy with the UK system, don't want to work abroad, are looking for more money, aren't good enough for the UK system, or are looking to use it to fill in until the next job elsewhere becomes available. Staying in the UK and not living here means they can move and go to job interviews more easily.

The medics you have spoken to will probably also tell you that the problem   isn’t entirely about difficulties in “recruitment” it is also about “retention ” - or rather “failing to retain “ staff.

Over the years there have been some excellent consultants  who have been  appointed, but then leave.

This  has nothing to do with the Island as a place to live.

Characteristically, initial  enthusiasm fades as they discover they work in a system that  appears to have a special ability to frustrate and discourage.

They leave.The  system continues as before.

The medical world is a small world, though.Word gets around.

 

Edited by hampsterkahn
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On 11/28/2021 at 9:15 AM, Galen said:

From medics I have spoken to over the years the problem stems from the fact that the IOM is not at the cutting edge (no pun intended) of the medical world.

It's routine work as the 'specialist stuff" gets sent off Island - mainly to the North West (Liverpool, Alder Hey, Clatterbridge etc) to medical centres where its their routine daily work. The result generally is any medic looking for career progression does not want to come to the Island. Those that do tend to already be at the level where they are unable to progress further e.g. a consultant. They usually have a youngish family, know the Island, want to settle down and want to 'soft peddle' for the next 20+ years doing the routine stuff.

In more recent times the lack of other professionals (Dentists, vets, pharmacists, teachers etc), expensive housing, higher costs of living, weather dependent travel on/off Island, and lack of decent shops, intrusion into health matters by politicians who know very little about health but think otherwise, any attraction of coming here is considerably diluted.

Yes, we have some good medics, but increasingly they are rare breed. One solution might be for the Island to be a formal offshoot of say the Royal Liverpool Trust, where medics can be formally rotated between working in a big acute hospital (Liverpool) and the provisional one (the IOM). This would get round some of problems of getting locums and mean the 'top notch ' medics would be here for say 4 weeks in every 3months. Perhaps not ideal, and would need some creative thinking given the tax position etc. but is an option. Increasing the use of telehealth with remote diagnostics such as the Island did with fetal medicine (I not sure if it is still being used but was a successful service for those who needed it) might be also worth doing but requires serious investment in IT, staff and training.

With the Island's population, being in health terms, 'small', we are always going to have to send patients to the UK for conditions that fall out of the 'routine medicine' or are specialised such as heart, neonate babies, certain types of cancer etc and that is yet another price we pay for living on an Island. 

This lack of top notch medics and a 'second class' health service  means that those that are attracted to the Island to run the service from a managerial point of view, tend to be those who are unhappy with the UK system, don't want to work abroad, are looking for more money, aren't good enough for the UK system, or are looking to use it to fill in until the next job elsewhere becomes available. Staying in the UK and not living here means they can move and go to job interviews more easily.

The gist of what you're saying is probably right, but you shouldn't draw the conclusion that we lack 'top notch medics' simply because we're not a university teaching hospital in a major city.  To carry out specialised, highly technical work, it's the infrastructure and multi-disciplinary teams we would need, not just 'top notch medics' - you could have the world's finest cardiologist working at Noble's, but without the back up of state-of-the-art catheter labs, physiologists, radiographers, perfusionists... he/she wouldn't be able to do much more than listen to chests and prescribe aspirin.

University teaching hospitals do attract a certain type of medic, but not necessarily the highest quality when it comes to clinical work.  One of the worst surgeons I've ever come across was one of the most highly published academic surgeons anywhere, but if possible you wouldn't let him butter toast.  One of the best surgeons I've come across was not a consultant, and was working in a DGH.  I'd have trusted him with my or my family's lives without question.

There's more to a medical career than ascending the ivory towers of academia.  I chose to come here, instead of a university teaching hospital, because I thought I'd have a better work-life balance, and also that I'd probably do more good for humanity as a whole by bringing some new skills to a smaller organisation, than I would by joining an already established team of specialists.  And I have no regrets in doing so.  Perhaps that's what you mean by a 'soft peddle (sic)'.

There's definitely something in the rotational working you mention, but in some respects it's the worst of both worlds rather than the best, certainly from the medic's perspective.  And right now for medical jobs it's largely a seller's market - doctors, certainly in some specialties, are in short supply and can pick and choose where they'd like to work.

Back to the OP - I don't think you can force a CEO to be resident here, it's not like us where we are contractually required to be within 30 minutes of the hospital (I think, it might be 20) when on call.  But I'd argue that the most effective CEOs would at least maintain a regular presence on the shop floor, particularly in such a small jurisdiction as this where the population can routinely bump into their health minister in the supermarket, and be accessible for a face-to-face at short notice should anything urgent crop up.  Like the Manx Care CEO who did move here properly.

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8 hours ago, Gladys said:

Is Dr Ewart here?  She invariably joins the press briefings by Zoom.

Dr Ewart lives on the island. She normally does do the briefings from Zoom.

As for Kathryn Magson, there are no flies on her and she doesn't have the wool pulled over her eyes. Long term I think the CEO does need to be here permanently, even if the DHSC role is now largely strategic, but Magson has done plenty of grafting.

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