Manx Care - Sir Jonathan Michaels Report

[craggy_steve]

22 hours ago, The Duck of Atholl said:

and the problem is finding the right people to run it. I doubt that they are already on the Island and unless you pay mega bucks you will only get UK cast off managers and administrators. 

 

There are many talented people on the island, including some quite capable of being a "Manx Care" board and running the proposed "Transformation Programme". Few if any in the Civil Service for pretty obvious reasons, the Civil Service is inherently about bureaucracy and administration not leadership or change so it neither wants nor attracts many of those people. As to who the heck would want to do the job, that's another matter - it's going to be a pretty thankless task. Most of the suitable talent pool on the island doesn't need the hassle, doesn't need the money - similar problems to the inhibitors the island has in trying to get good quality politicians. 

Key thing is to start with people who are firmly from outside of Gov't. One of the things that worries me most about the Michaels report is the theme that the transformation team should report to the Chief Secretary. I think it should be arms length and reporting to CoMin or Tynwald, not a civil servant and not any specific minister, because otherwise innovation will be stifled.

 

[woolley]

22 hours ago, Derek Flint said:

Yep,  

business and personal. Not huge increases, but enough to start to make things more realistic. The big bridge of benefit has long gone, unless you are a VHNWI.

And yes, big staff cuts. When faced with similar issues, Northumbria Council shed six hundred posts. We are a village in the middle of the sea, run as if it it is a provincial city, with the additional burden of 22 intrinsic fiefdoms. 

There is no sense of reality. And you are absolutely right, turkeys don’t vote for Christmas, so they ain’t going to vote in someone with that sort of Bernard Matthews approach. 

The only way it would ever happen is for the Island to be run from Whitehall. 

 

20 hours ago, Derek Flint said:

I’m not standing, so can’t be bothered doing detail!

Just as well. With your idea of the Island being (openly) run from Whitehall you'd be losing your deposit. That never goes down well with the natives. As for the local authorities, the smaller ones are in general better run and more responsive than central government and they give better value.

[Andy Onchan]

1 hour ago, craggy_steve said:

 

There are many talented people on the island, including some quite capable of being a "Manx Care" board and running the proposed "Transformation Programme". Few if any in the Civil Service for pretty obvious reasons, the Civil Service is inherently about bureaucracy and administration not leadership or change so it neither wants nor attracts many of those people. As to who the heck would want to do the job, that's another matter - it's going to be a pretty thankless task. Most of the suitable talent pool on the island doesn't need the hassle, doesn't need the money - similar problems to the inhibitors the island has in trying to get good quality politicians. 

Key thing is to start with people who are firmly from outside of Gov't. One of the things that worries me most about the Michaels report is the theme that the transformation team should report to the Chief Secretary. I think it should be arms length and reporting to CoMin or Tynwald, not a civil servant and not any specific minister, because otherwise innovation will be stifled.

 

Absolutely right Steve. Reporting to the Chief Secretary (whoever that may be) will be a pointless exercise, transformation will never happen as it will be just be one round of meeting after another. An endless cycle of blah blah blah.

It would be better if the Board reported to a specially set up Tynwald Committee that kicks ass to make sure it all gets done and on time. Assuming the timetable for transformation set by Michael is correct then someone/body should ensure that the milestones are met and kept on track. That won't happen if reporting done via the CS. 

[Non-Believer]

Just now, Andy Onchan said:

It would be better if the Board reported to a specially set up Tynwald Committee that kicks ass to make sure it all gets done and on time.

A contradiction in terms if ever there was one.

By the time it had set itself up with a cabal of CS and 40+ In, Out, Pending and Too Hard trays we'd be as you were.

[Manximus Aururaneus]

To be honest, they'd be better off putting together a team from across with a previous track record of producing change of this scale in a health setting - I'm sure that Sir Jonathan could make enquiries.

The sheer volume and scope of policies and procedures, protocols, not to mention actual Acts of Parliament is daunting to adopt on a week by week update basis - the idea of starting where Nobles currently is, and achieving all that in the given timescale is something that I cannot even imagine being achieved - and I've overseen it for my own healthcare businesses for the last 15 years. 

Pure 'business' businessmen may well be what is required in many financial respects - but unless they are already in healthcare then the terminology alone can take years to master, the NHS really is a one-off institution and as for CQC!!!

It needs a team that could hit the ground running - a 'learning as you go along' approach would quickly get bogged down in detail (usually detail produced by those with an agenda against change in the first place) - it can be draining taking those sort of people on (not to mention the unions) - and they seem to have an inbuilt miraculous ability to produce a rule or regulation from some dark corner to say "you can't do that - it says so here".

You need people who cannot be waffled because they have already been there and done it in terms of large-scale change in a health setting. It's tough.

[Donald Trumps]

13 hours ago, Kitten Mittens said:

CoMin haven't decided to adopt all 26 recommendations; they've decided to support it when it goes to Tynwald. Thus hopefully meaning the other Tynwald Members also support it when it hits Tynwald, and collectively they can together decide on implementing it. 

Media suggested CoMin accepted all the recommendations

[thesultanofsheight]

1 hour ago, Non-Believer said:

A contradiction in terms if ever there was one.

By the time it had set itself up with a cabal of CS and 40+ In, Out, Pending and Too Hard trays we'd be as you were.

Sadly that will be the end result. The CS is almost the entire problem we have with the IOM. Everything would function perfectly well, and be perfectly more effective without most of the fuckers. This will be just another CS non-job creation scheme by the time they’re done. 

[Andy Onchan]

3 hours ago, Non-Believer said:

A contradiction in terms if ever there was one.

By the time it had set itself up with a cabal of CS and 40+ In, Out, Pending and Too Hard trays we'd be as you were.

No it's not a contradiction. If the process and reporting is kept entirely within the Civil Service then it will never see the light of day.

With a Tynwald Committee it will have to be held in public and records with contemporaneous minutes available for scrutiny. They can call the Board and Cyril's to account who are supposed to make it happen. Michael says this in his report: 

Quote

There are insufficient processes or levers to hold to account the people with decision-making powers (whether clinical or non-clinical). 

So if there is a contradiction then it started with Michael himself. 

[craggy_steve]

4 hours ago, Manximus Aururaneus said:

To be honest, they'd be better off putting together a team from across with a previous track record of producing change of this scale in a health setting - I'm sure that Sir Jonathan could make enquiries.

The sheer volume and scope of policies and procedures, protocols, not to mention actual Acts of Parliament is daunting to adopt on a week by week update basis - the idea of starting where Nobles currently is, and achieving all that in the given timescale is something that I cannot even imagine being achieved - and I've overseen it for my own healthcare businesses for the last 15 years. 

Pure 'business' businessmen may well be what is required in many financial respects - but unless they are already in healthcare then the terminology alone can take years to master, the NHS really is a one-off institution and as for CQC!!!

It needs a team that could hit the ground running - a 'learning as you go along' approach would quickly get bogged down in detail (usually detail produced by those with an agenda against change in the first place) - it can be draining taking those sort of people on (not to mention the unions) - and they seem to have an inbuilt miraculous ability to produce a rule or regulation from some dark corner to say "you can't do that - it says so here".

You need people who cannot be waffled because they have already been there and done it in terms of large-scale change in a health setting. It's tough.

Team from across: UK NHS does not have a good record. They may be such folks but the majority of UK NHS folk would be unsuitable for the transformation bit.

UK Health Regulation / Bureaucracy: One of the greatest inhibitors to progress in the UK NHS because it is so complex that nobody wants to risk trying to invent a better wheel, the regulatory environment stifles change  - but it can be done. I was part of an external organisation that forced the NHS (kicking and screaming) to adopt changes to a particular part of NHS "Guidelines", and by 'eck they fought back. (And no, I'm not putting myself up for any part of this).

Change / transformation is about communication, motivation, will, coordination and enablement. Let the health professionals worry about how to change operating methods whilst remaining compliant, the job of the change leadership is to make those professionals want the change, see that it is possible, and support them in achieving it. 

Not going to be easy, but it is do-able.

[Donald Trumps]

Have you looked at Scottish NHS at all Craggy? They (Scotland) seem to do a lot of things better

[craggy_steve]

15 minutes ago, Donald Trumps said:

Have you looked at Scottish NHS at all Craggy? They (Scotland) seem to do a lot of things better

Nope. Had peripheral involvement in Scottish care, but not NHS. No idea how their practices or performance might differ. If this article is true then it may be that NHS Scotland is well worth a look https://www.thenational.scot/news/16326265.can-you-compare-the-nhs-in-scotland-to-the-rest-of-the-uk/

[Uhtred]

8 hours ago, craggy_steve said:

Key thing is to start with people who are firmly from outside of Gov't. One of the things that worries me most about the Michaels report is the theme that the transformation team should report to the Chief Secretary. I think it should be arms length and reporting to CoMin or Tynwald, not a civil servant and not any specific minister, because otherwise innovation will be stifled.

 

Totally agree - it's not reassuring to have the transition team reporting to the top bureaucrat. As to the (eventual) membership of Manx Care I fear that, as is so often the case, the quality people won't bother, for all the reasons you list in your post, and we'll end up with Tynwald appointing their mates (again) and hence very much eroding the principal of 'arms length'.

[Manximus Aururaneus]

5 hours ago, craggy_steve said:

Team from across: UK NHS does not have a good record. They may be such folks but the majority of UK NHS folk would be unsuitable for the transformation bit.

UK Health Regulation / Bureaucracy: One of the greatest inhibitors to progress in the UK NHS because it is so complex that nobody wants to risk trying to invent a better wheel, the regulatory environment stifles change  - but it can be done. I was part of an external organisation that forced the NHS (kicking and screaming) to adopt changes to a particular part of NHS "Guidelines", and by 'eck they fought back. (And no, I'm not putting myself up for any part of this).

Change / transformation is about communication, motivation, will, coordination and enablement. Let the health professionals worry about how to change operating methods whilst remaining compliant, the job of the change leadership is to make those professionals want the change, see that it is possible, and support them in achieving it. 

Not going to be easy, but it is do-able.

Absolutely agree with your statement, the majority of UK NHS folk would indeed not be suitable (which is exactly why they need turning around) but there are now some crack teams with a proven track record of NHS Trust turnarounds (as Sir Jonathan alludes to).

They often present themselves as a 'Pack of Three' - CEO, Medical Director & Finance Director / Company Secretary. Excuse the language but that do not Feck about! Their way or the highway etc.

Scotland (to answer DT) is a mess, a right mess, especially in terms of budget control, outcomes and (most of all) recruitment - Wales is if anything worse.

It would seem to me to be the height of planning folly to invite an English NHS turnaround specialist (Sir Jonathan), pay him for a year to compare the Island system with the English system,   produce a report to that effect, have it accepted in principle, and then to turn around and say that we are going Scottish not English??????? Bizarre.

[craggy_steve]

1 hour ago, Manximus Aururaneus said:

Absolutely agree with your statement, the majority of UK NHS folk would indeed not be suitable (which is exactly why they need turning around) but there are now some crack teams with a proven track record of NHS Trust turnarounds (as Sir Jonathan alludes to).

 They often present themselves as a 'Pack of Three' - CEO, Medical Director & Finance Director / Company Secretary. Excuse the language but that do not Feck about! Their way or the highway etc.

 Scotland (to answer DT) is a mess, a right mess, especially in terms of budget control, outcomes and (most of all) recruitment - Wales is if anything worse.

It would seem to me to be the height of planning folly to invite an English NHS turnaround specialist (Sir Jonathan), pay him for a year to compare the Island system with the English system,   produce a report to that effect, have it accepted in principle, and then to turn around and say that we are going Scottish not English??????? Bizarre.

Interesting perspective on the Scottish NHS - as I said I'm not close to it so I've no idea.  As for the UK NHS turnaround specialists, UK NHS trusts are structurally very different to the IoM NHS and I think we want a different outcome - a successful UK NHS trust model may not be the best fit for IoM, which is not to say that these people would be ineffective here but they might need a different game strategy for the IoM case. In any transformation there has to be a bit of "you're with us or you're against us" - transformation programmes cannot afford to tolerate guerrilla saboteurs so there are likely to be casualties.

[Kitten Mittens]

16 hours ago, Uhtred said:

Totally agree - it's not reassuring to have the transition team reporting to the top bureaucrat. As to the (eventual) membership of Manx Care I fear that, as is so often the case, the quality people won't bother, for all the reasons you list in your post, and we'll end up with Tynwald appointing their mates (again) and hence very much eroding the principal of 'arms length'.

I heard an interview that the Minister of Health had with MTV where he confirmed that all progress on implementing this would have to be reported to both CoMin and Tynwald on a 6 monthly basis. This also makes progress publicly visable!