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The Health Minister has said she is prepared to face hostility at the Hospital as she attempts to change what she described an “entrenched culture” there.
Deputy Karen Wilson has launched her plan to make changes in “clinical governance” in Health, which she says will be “wide-ranging and delivered at pace”.
Her plan follows a report from Professor Hugo Mascie-Taylor, who has reviewed health care systems around the world.
Based on interviews with more than 70 staff, the senior clinical lecturer’s report claimed that bullying, a “bias against standardisation” and “vested interests” were dominant in the health service.
However, he said that he said it was a “minority that are bad apples” and he did not single out any one department or individual in his report.
He called on the management at Health to be more assertive, something Deputy Wilson seems prepared to be.
Pictured: Health Minister Karen Wilson.
“What Prof Mascie-Taylor has done, very cleverly and astutely, is unpick some of the issues around that, and being objective in his assessment about that as to what some of the core issues are,” she said.
“That, I think, is not just a feature of history but of how people learn to operate and learn to survive in a system that has some very entrenched ways of working that have not been open to some of the scrutiny in which most modern health systems operate now.”
So, does the minister expect conflict, particularly with those who hold the “vested interests” that Prof Mascie-Taylor identified, including some clinicians who allegedly make sure their private patients rise to the top of waiting lists.
“There may well be conflict, and I think that’s the reality when you’re trying to bring in what I would call a patient-focused change programme,” said Deputy Wilson.
“My orientation around this is patients, and if that means that people have to change the way that they practise because the impact of the way that they currently practise is having an effect on patient safety and quality, then I will not be frightened to stand up and address that.
She added: “What I would hope is there is an appetite and that people see the opportunity to try and put this right in a way that actually allows some of the superb clinical practice we have already to be brought into an accountability framework.
“That framework should be is open and transparent, so people can see where the quality is, what affects safety, what makes work joyful, productive or meaningful, and delivers good clinical outcomes for the people.
“At the minute, we can't give any assurance any of those fronts because I think there are systems and arrangements in place that mitigate that.
“We have a high number of areas where we want to bring standardisation, so that there is an agreed set of standards to which people work to, and it’s not open to individual practice.
“We want to make sure that we’ve got the best clinicians doing the best work and that means putting data and systems around their work, so that they can account for it opening transparently.
“It also means that we need to make sure that staff are supported, so that they’ve got a good job plan, supervision in place, and that the workforce mix is right to help deliver the best outcome for patients.
“At the moment, we are fighting fires and the reason is because we are carrying on with the way in which things have been, and clearly this is now starting to reveal that we’ve got really serious problems about the way care is governed and we have to do something about it.”
Deputy Wilson said she did not believe her programme would prompt an exodus of staff from Health, and potentially make recruitment more challenging.
She said: “I am calling on the clinical experts that we have in the system to work with the Government to bring their quality and expertise to the fore, and it is not distracted by some of these issues which have been revealed in the report.
“I think this is something that people welcome and I have had a lot of positive response to this. [The report] is the experience of staff in their own words, and this is the view that patients have been expressing for so long."
Six weeks on from the publication of the Mascie-Taylor report, what has been the feedback?
Deputy Wilson replied: “To be honest, I have had really good feedback. I have had senior clinicians come and say ‘I want to help; I want to be part of this’.
“I’ve had some people who have remained silent on it but I have also had people who have been so pleased that this has been made public because they have been felt oppressed in a way and not able to express their views.
“People have nothing to fear from this report. My job is to put the right conditions in place for people to do their best work. The most important thing is, I want to retain the talent and skills that we have.
“But I have to be really clear: we cannot continue in a culture of bullying and harassment, poor job planning, lack of supervision, lack of evidence-based practice, and ineffective team-working because, ultimately, that affects the patient experience and it also impact patient outcomes, from a quality and safety perspective.
“That is a no-go area for me, I’m afraid.”
The Minister denied that her ‘transformation’ would lead to Jersey simply adopting UK NHS standards.
“This is not the NHS, this is Jersey, and we have our own way of doing things but what we are aligning with are the best practise standards that are available, not only in the NHS but also internationally.
“The reason I say that is these are evidence-based; they are not developed out of a unique view or opinion that somebody has. They are absolutely grounded in evidence.
“If you have a look at some of the American systems, for example, they have a very strong emphasis placed on the patient experience and how they measure it. I want to emulate that and be really customer-centric in that regard.
“The clinical standards are the clinical standards wherever you go, so if you go to France, Spain, Italy, Germany or the UK, treatment for cardiac conditions or asthma, there is an international evidence base that drives practise and that’s what I want Jersey to be in a position to utilise.”
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