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EXPRESS OPINION: Clinical safety vs political judgement

EXPRESS OPINION: Clinical safety vs political judgement

Wednesday 19 January 2022

EXPRESS OPINION: Clinical safety vs political judgement

Wednesday 19 January 2022

As U-turns go, this morning’s Ministerial manoeuvre over Samarès Ward is quite spectacular.

In a week of political chicanery, it was quite literally an 11th hour reprieve.

At 11:01 exactly last night, the island’s politicians were told via an email from the Health Minister, Richard Renouf, that Ministers would now be accepting a proposition “…to reinstate the full suite of stroke and injury rehabilitation services facilities and beds at the earliest opportunity, but no later than 1st March 2022, either at Samarès Ward at Overdale or at another suitable location.”

No doubt Ministers ‘sniffed the wind’ and realised that they were going to lose. That was combined with the decision of senior figures to break ranks, so as not to be on the losing side. 

Rather than suffer an ignominious defeat, a last-minute volte face was seen as politically preferable. Once the dam breaks, it does so quite spectacularly.

But no one is celebrating too much just yet, as the devil may well be in the detail.


Pictured: Senator Steve Pallett, who brought the Samarès proposition.

the proposition’s words - “or at another suitable location” - mean there is absolutely no guarantee Samarès itself will be reopened, not least since a demolition application will soon be heard for Overdale

It could simply mean that the current rehab services provided on Plémont Ward in the General Hospital will be improved so that it can be said to offer “the full suite…of services…and beds.” That doesn’t mean the care experience will be the same as it was on Samarès. 

Words matter, fundamentally, particularly in the phrasing of a States proposition. And Ministers’ acceptance of it specifically zoomed right in on that wording (our emphasis in bold):

After long discussion and having carefully considered again the wording of the main proposition, we now believe that we can accept the request as it is worded and work to achieve the outcomes we all wish.

We’ll see.

That is not to say that Senator Pallet, who brought the proposition, hasn’t won a very significant victory. Step back…and consider what has happened.  

It was only 48 hours earlier that some of the most senior clinicians in the island – no less that Patrick Armstrong MBE, Jersey’s Medical Director, and Rose Naylor, the Chief Nurse – were put in front of the media to argue that reopening Samarès would be a mistake

Their clear view was supported by a slick social media campaign including a video featuring rehab staff explaining why the care they could give on Plémont Ward was just as good – it’s apparently ‘patient-centred’ by the way, and I dread to think of any medical care which doesn’t meet that criteria. 

Video: The urgently filmed social media video about the services on Plémont Ward.

In an open letter to politicians, Mr Armstrong and Ms Naylor said that the decision must be made calmly by clinicians, and not based on the emotional stories of some patients and their families.

"This proposition, along with the threat of a further proposition to reverse our decision to restrict visiting in the hospital, causes us great concern that clinical voices may be ignored...We need to be wary of the danger of non-expert advice, no matter how well intentioned, driving decision making which in turn can lead to those decisions being clinically unsafe," they wrote.

So rejecting the Pallett proposition was actually a matter of "clinical safety." The temperature was increasing. 

Mr Armstrong and Ms Naylor, and various medical colleagues, were pushed forward to make Ministers’ case, as it was clear support for Samarès was building, and the vote would be exceptionally close. 

Last minute social media videos, political briefings and news media campaigns all tell a tale of a big problem on which Ministers feared they were going to lose. 

It was a key ministerial judgement call to go ‘all out’ in a last-ditch fight… only to then meekly surrender in a twist of 70 words on the eve of battle.

The problem for those very senior health professionals is that once thrust into the limelight, they will have nervously looked over their shoulders, expecting Ministers to be standing firmly behind them. They weren’t.  

Naylor Armstrong.jpg

Pictured: Rose Naylor and Patrick Armstrong who warned the Pallet proposition involved issues of clinical safety.

Having clearly stated their position that the rehab services provided on Plémont Ward were currently fit for purpose, they will now have to accept the improvements mandated by the Pallett proposition; or they can argue “the full suite…of services…and beds” is already available – in which case why the very public, and apparently resolute, opposition to it?

This matters. Obviously, patient care is at the heart of it, not least in the sense of implications for the Jersey Care Model

But more broadly than that, it speaks to judgement. It turns on trust. Fundamentally, no one wants the future of rehab services to be decided by a play on words. 


Ministers U-turn over Samarès Ward after late-night meeting

Senior medic speaks out over hospital staffing crisis

Gov makes last-ditch attempt to win rehabilitation vote

OPEN LETTER: "Moving rehab services back to Overdale would be a mistake"

Stroke survivors and families make plea for Samarès Ward reopening

READER LETTER: "The day I was transferred to Samares Ward was the day of my rebirth"

Government fights bid to reopen rehabilitation ward at Overdale

READER LETTER: Do not have a stroke in Jersey

Constable: Patients and hospital staff "let down" by leaders

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