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FOCUS: Another review identifying more failings in Health

FOCUS: Another review identifying more failings in Health

Friday 26 August 2022

FOCUS: Another review identifying more failings in Health

Friday 26 August 2022

The Mascie-Taylor report is another in a long line commissioned by senior leaders at Health and Community Services that identifies significant concerns.

The Government say that the report was commissioned by HCS Director General Caroline Landon at the request of the Medical Director Patrick Armstrong and Chief Nurse Rose Naylor.

It was therefore initiated by the senior doctor and nurse at the Hospital.

It adds that the report was commissioned because Executive Team, which is headed by Mrs Landon, “wanted to understand why it is challenging to get traction in the organisation at pace to improve governance.”

It added: “It was important post-covid to recognise long-standing issues which needed to be addressed comprehensively.”

This is one of a series of reviews established by senior management of HCS which identifies shortcomings in the organisation they lead.

A review of theatre services, published last June, had more than 100 recommendations, including “senior management should establish a robust monitoring process for compliance with the process” and “review individual performance at least once a year and identify any training or development needs to undertake role to improve performance”

Hospital Health Operating Theatre.jpg

Pictured: A review of hospital theatres last year had more than 100 recommendations.

That month, Quality and Performance Review, which was initially withheld from the public for fear it would be "sensationalised", highlighted nearly 20 areas in need of improvement, including waiting times and processes in A&E.

Just a month later, a review of maternity services had 29 recommendations for change. 

That review found, for example, that there was no agreed “single maternity strategy which describes agreed outcome and performance goals for maternity services”. 

It added: “Such a strategy is vital to establishing a modern maternity service that meets the need of our population.”

Thirdly, an independent review of Adult Mental Health Services in Jersey found that there was a lack of senior management leadership and direction, a lack of multi-disciplinary teamworking, silo-working and more supervision structures.

Recommendations included reviewing the senior management structure within Adult Mental Health Services and making sure the service had “clear objectives that are regularly reviewed”.

Health has also been reviewed by twice in the last five years by the Comptroller and Auditor General.

Last September, Lynn Pamment found that arrangements were failing to hold the Director General and senior managers properly to account.

While Mrs Pamment noted the governance of Jersey’s health service had “visibly moved forward” since a review by her predecessor in 2018, she found that just six recommendations had been acted on.

Positive steps, she said, included the external reviews, reviews of ‘care group performance’ and new systems for standards, regulation and risk management.


IN-DEPTH: "How much evidence does Jersey’s health service want?”

Q&A: How will the Government act on the Mascie-Taylor report?

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Posted by Aston Francis on
Another review... the director general, medical director and the chief nurse had a good sense of changes coming at the top post-election and decided for a smart preemptive move. The recipe is well known and has been previously used in Jersey too. You hand-select a free-lancer management consultant - (avoid well-known reputable organisations like CQC), you agree the terms of reference and methodology, you pay with taxpayer money and get the report you expect. Previously it was Kim Hodgson - our Health paid her over half a million for various reports and we all can judge how much the performance have improved since. The waiting list for July exceeded 12 thousand patients and are growing. It is regrettable that Professor Mascie-Taylor did not provide more details on the methodology. According to Appendix 3 he interviewed 29 managers, chiefs and directors of all sorts and attended some top management meetings. He spoke to 22 consultants - yet we don't know how they were selected. One may expect that they were recommended by the leaders who commissioned the report. It is not clear how many of the 22 were those who left Jersey Hospital recently. Not clear either how many exit interviews did the author study. Most likely none - as they are not being conducted. It is surprising that the report did not mention the results of the last 'Be Heard' survey where almost half of the Health staff participated and the results were very unfavourable to the leadership of Health, worst of all GoJ departments. None of the chiefs or consultants selected for interviews mentioned the highest ever number of sick-leaves due to stress including long-term leaves. After reading the report you can easily guess who sponsored it. It is like those drug reviews sponsored by their manufacturers. Don't get me wrong - the recommendations are all good, but they divert attention from the critical issue of incompetent leadership. We all read about the toxic culture at the Department, we have relatives and friends working at the hospital. That very leaders who commissioned the report are responsible for the culture, for the bullying ad heavy handed management styles of the people they selected to the chief roles. None of the actual recommendations addresses that. The director general, medical director and the chief nurse they had years to address the deficiencies in structure. They did like the structure and they kept adding layers and layers of managers and chiefs buying loyalty of people with titles, perks and money. The report did not go far enough to analyse competences or even the experience of people interviewed representing these numerous layers of managers and chiefs. I hope it was not the case for us, but in some of the recent reports concerning the scandals in the UK and elsewhere one of the main reasons for the toxic environment, blindness to patients' needs was a quality of upper and mid management, the kind of people promoted to these roles, mediocre, young individuals, some previously suspended by regulatory bodies, ones that could not earn the respect of their peers in other ways. Then they were for ever grateful to their top chiefs for being selected and became deaf and blind to the critical, sober voices of those at the front lines. Again - I a not saying this is the case for Jersey but I do not believe that the 60-plus recommendations can solve the problems we have. Last not least - most of the recommendations have been well known and universal for various health systems for years. I bet none of them were new for our director general or medical director. Most of them would not require so many leaders and chiefs being interviewed, so many visits to our lovely island. It would have been enough to call 3-5 people and to read the existing performance reports to know that we don't have proper performance indicators. The rest and more you could get from reading 'Be Heard' results and the newspapers for the last three years.
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