"Progress" in improving health – but overall change could take up to five years

Tuesday 11 July 2023

"Progress is being made" to implement 61 recommendations that will improve the governance and operations of the island's healthcare service, says the head of the health board.

In a scrutiny hearing yesterday, Professor Hugo Mascie-Taylor – who was recruited to lead the independent Health and Care Board on a 12-month contract last November – updated the Public Accounts Committee on the progress of 61 recommendations which he outlined as necessary to improve the island's health service in a damning report last year.

However, he said that the "cultural shift" that needs to happen at management levels within Health will be a "four-to-five year process".

Senior clinical lecturer Professor Mascie-Taylor was asked to undertake a review of “clinical governance” in the island’s health service by then-Director General Caroline Landon last year.

Published in August 2022 and based on interviews with more than 50 staff, Professor Mascie-Taylor's resulting report claimed that bullying, a "bias against standardisation" and "vested interests" are dominant in the island's health service and posed a threat to patient safety.

The Health Minister accepted all recommendations, and the Government CEO, Suzanne Wylie, set up a 'turn around' team to address them and improve the operations of the service.

One key action was to establish a board of governance which would oversee and lead the department, and Professor Mascie-Taylor was subsequently appointed as its interim chair.

The Health Department defended Professor Mascie Taylor's appointment, saying that it did "not perceive the appointment of Professor Mascie-Taylor for a period of 12 months as a conflict of interest as he now moves from author to implementor".

Pictured: Professor Mascie-Taylor's £85,000 report alleged that a 'Jersey Way', 'bullying' and a 'bias against standardisation' in Health were threatening patient safety and that an updated health board with new leadership was part of the solution.

Addressing scrutineers yesterday, Professor Mascie-Taylor said that of his 61 recommendations, some had been completed and he was working to assure compliance, and some were yet to be completed.

He said: "My role is to move from someone who wrote a report, to the role I'm in now where I assure myself those are being put into place.

"Progress is being made, but some of [the recommendations] are going to be very demanding, because they demand really a very substantial cultural change, and introducing to the organisation an understanding of the nature of accountability and the importance of measurement, of transparency, is a very major challenge.

"These are notions that were repeatedly rejected as I did my report."

He said there had been a "lack of enthusiasm for some of measures that you see across the world that drive quality and safety", such as the implementation of clinical guidelines, which are put together by experts to ensure best practice.

"If you follow the guidelines, then your practice improves," he said.

Professor Mascie-Taylor continued: "It was put to me that these were not required in Jersey. But the senior leadership team have now said the guidelines will be followed and that's coming this afternoon to the board for endorsement."

He said the challenge was "to assure compliance with those guidelines".

"I'm not convinced as yet that we've done sufficient work around compliance," Professor Mascie-Taylor added.

He explained: "We need a change of vocabulary here, where I'm not engaging with you and asking you to do it, but ultimately this is an organisation that works for the people of Jersey, we are a board, and this will have to happen. This is part of the cultural shift."

He said that there would need to be "tricky conversations" about the line of accountability.

Professor Mascie-Taylor added that there were not yet any key performance indicators for the new board, which was not yet formed, but said: "If the view is it's not value for money, then it should be closed down. To make the board work, there needs to be consistent and active support from Government."

At the scrutiny panel, Chris Bown – who was appointed as Interim Chief Officer of HCS in March following the shock departure of Caroline Landon – was also questioned on the New Healthcare Facilities Plan.

He said a "clinical strategy" was needed for the island which would then "define the workforce and digital strategy" for the new plan.

Pictured: Chris Bown officially became Chief Officer of Health and Community services on 1 April on a 12-month fixed-term contract.

He said: "We have buildings and we'll need to retrofit that strategy to the buildings that we are going to see developed. That's where we are, and there's a great deal of work for the board and for HCS to do to look at the services provided."

The "workforce plan", Mr Bown said, would be "critical".

He explained: "The big challenge for us is even if we had all the money in the world, you have issues with recruiting. We need radiographers to staff two sites, not one. It's not the money, it's finding the people.

"We want to avoid having buildings and equipment we can't use because we don't have enough staff."

Mr Bown added that the service was not currently "over-managed", and the 1.7% of staff is managers: "It's low, considering the agenda we have to give over the next five years."

Professor Mascie-Taylor, whose appointment ends in mid-November, said the "shadow board" has met once and was in the "run-up" to its first public meeting.