Deputy queries Health minister over the 'badly managed' PEH

THE hospital is badly managed and Health and Social Services needs to address the situation, Deputy Mike Hadley has said.

Deputy Mike Hadley

THE hospital is badly managed and Health and Social Services needs to address the situation, Deputy Mike Hadley has said.

Deputy Hadley, pictured, described the department’s recruitment efforts as ‘sheer madness’ and was surprised the wards had not reopened.

He has sent a list of questions to minister Mark Dorey to find out exactly what efforts have been made to employ nurses.

HSSD announced this week that De Saumarez and Divette wards would remain closed because it was unable to attract enough qualified nurses.

Comments for: "Deputy queries Health minister over the 'badly managed' PEH"

Backchat

Wouldn't surprise me at all, the Hospital and quite a few other States managed things, maybe the managers have just crept their way into position, not really knowing anything about management at all, the blind leading the blind, which is why we find lots of departments not being capable of controlling their budget!

GM

And of course the over-promoted managers won't ever leave of their own accord. They wouldn't survive in the private sector as they would be accountable, and that blasted pension scheme is too attractive to walk away from, so we end up being stuck with them even when they've proved not to be up to the role.

kevin

GM,

You are very quick to rubbish the public sector and States in general - why don't you stand for deputy and impart your words of wisdom to the Assembly?

Judging by the amount of time you spend on this forum it wouldn't be a problem to run your business at the same time, plus you could benefit from the gold plated pension scheme as well!

markB

Kevin.... I think GM is a states Deputy........seems to have all the time in the world to post on this site, plus has lots of insider knowledge.

Spartacus

markB

I think GM might sit on one of the committees.

GM

Kevin

Absolutely not! I'm an owner of my own company, I work 80 hours a week and so I a, able to spend whatever time I like doing what I want (within reason). I couldn't afford to waste 4 years or more of my peak earning years on politics, having invested 30 years of my life to get where I am now. In 10 years time my circumstances might be right, but I've got zero interest in being part of a body of which I cannot directly exert control or make change, and I just know that I'd never last 6 months at it.

Spartacus

I have never sat on any States Committee of any sort. The closest I have got to that was sitting on a couple of informal working groups about 10 years ago.

GM

Mark B

I don't have any "inside knowledge" at all. All the information I glean is from talking to people and, re the pension scheme, from studying the scheme info which is all online and from my 30 years of running financial services businesses. There are lots of subjects that I know zilch about and so you won't see me commenting on those, unlike Spartacus who willingly exposes her ignorance, but on issues like management, tax and pensions I will put myself up alongside anybody locally (with one or two exceptions).

TED

Like most of the States departments Managers get promoted because its their turn and not because they are the best candidate. I pesonally would like to know what the percentage is between the clerical and medical staff at the Hospital. Too many Chiefs and not enough Indians I bet.

Rachel

So who are saying are the chiefs and who are the indians? The clerical staff or the medical?

Dave Jones

Rachel

One of the biggest issues was the “Agenda for Change” that was visited upon our local health service and staff. It changed at a stroke the pay scales of our nurses and auxiliaries many of the auxiliaries received a reduction in their pay and a change to bog standard NHS working conditions. This was a prime example of a piece of NHS practice cut a pasted into our Health service with little or no consultation with local staff and which led to lots of local people who had worked for the Board of Health, leaving after many years service.

One of the arguments used was that it was needed so there would be a smoother transition from staff recruited in the UK into our health system. The Banding system of nurses was well understood. It was complete and utter rot in my view, as many of our nurses were recruited from Scandinavia, The Philippines, Portugal, India and other places completely outside the NHS. It was just that the mangers who wanted it came from the NHS by and large.

We also have lots of posts now that we happily lived without for decades, from infection control specialist nurses to pain control nurses. We have them because we are told it is NHS best practice.

When l when I was in our Hospital back in the 90’s and before, infection control was monitored by Matrons and Ward sisters who patrolled the wards looking for potential sauces of infection and eradicating them as soon as the showed up.

Well trained nurses looked after individual patient infection by regular changing of dressings and again close monitoring of wounds. Now of course I am not saying that does not happen today but we didn’t need a dedicated person dealing with it.

The same with pain control. My pain control regime was dictated to the senior ward sister by my surgeon, who in turn made sure her nurses followed the regime to manage any pain I might experience but again we didn’t need a dedicated specialist to this task.

All these dedicated positions are all very and they are great people of that I have no doubt, but they do cost a lot of money and it may be that is what happens in the NHS but it doesn’t mean with a much smaller health budget, that we have to mirror these practices here.

I don’t recall not having them in the past, resulting in huge problems in the hospital and I have spoken to several nurses who worked there in those days and they agree.

There are others but I will leave it there, if you want to know more talk to staff they will tell you of the dedicated NHS doctrine they are forced to follow on a daily basis.

Local Parent

Our experience seems to back that up Dave. When we had our baby a few years back some of the experienced midwives told us off the record they were annoyed by all the new fangled stuff imposed on them. When it comes to so called best practice I'd rather listen to a midwife with years of coal-face experience delivering babies.

Ted

I sometimes suspect that the trouble with several States departments is not too many managers but no proper managers at all. Time and again we see situations that could not be tolerated in a commercial organisation which imply the complete lack of organisation by civil servant "managers".

Jon

I think you'll find a lot of managers in the civil service are brought in on licenses, rather than promoted from within.

Interested

Why is this bad, I thought they were meant to train locals to replace them when their licences end

Dave Jones

Our Health Service has been hijacked over several years by NHS practices imported into Guernsey, which is why it doesn’t work like it once did.

Whoever takes charge must rid this island of this NHS doctrine and bring our Health service back to a Guernsey model, dumping all the same practices that have brought the NHS to its knees.

That is the solution, we have imported all the wretched bureaucracy that goes with it and all the costs that go hand in hand with this bureaucratic minefield which prevents common sense and workable solutions.

It will need investment but in the right areas and I know it will take a huge amount of political courage to wrestle this bear to the ground but it must be done and it must be done ruthlessly.

russm

Does the new minister for HSSD share your views or will he be another who is happy to cut front-line services rather than deal with the ridiculous bureaucracy that has been created?

Great shame you didn't win the vote for this position.

GM

Dave Jones

Absolutely spot on. The same could be said for several other departments who blindly import standard UK public sector practices without realising that we don't have the same bottomless pit of money to fund it. Education springs to mind straight away.

Having said that, those imported practices were adopted locally at a time when money seemed to be no object.

Spartacus

GM

Re education, the Mulkerrin recommendations are based on UK practices. That's what I was saying last year. No one else seemed bothered. Everyone, including Deputy Jones was lauding these expensive UK ideas.

Here’s a reminder of Mulkerrin's main recommendations

1. That the Education Department institutes an “Excellent Teacher” scheme with a view to retaining the best teachers on a licence.

2. The 1970 Education Law should be urgently reviewed and updated.

3. The remedial action undertaken by the Education Department has been comprehensive and should be continued.

4. GCSE and A-Level results for schools to be published in a format similar to England.

The full Validation Reports (VSSE) to be published and sent to parents of the school.

That the Education Department should have “Ofsted Style” inspections, in line with the schools, every four years.

5. Teacher appointments should be made by Headteachers, as part of Local Management of Schools, on the same lines as in England.

6. Guernsey moves to a Governing Body system, initially for the Grammar School and the three High Schools, and then followed by the primary schools. (As in England)

7. Guernsey should develop a system of Local Management of Schools (LMS) for the Grammar School and the three High Schools. (As in England) To be followed by LMS being developed in the primary schools (perhaps via a “cluster” approach whereby groups of schools would share a finance manager / bursar).

GM

Spartacus

It may therefore be more appropriate for Guernsey to give serious consideration to systems which may be working well in the UK on a case by case basis, rather than blindly adopting UK systems and practices which I fear has been the case in the past, without administrators fully understanding the "why" or "how" when it comes to implementation.

In other words, look to the UK for proven successful ideas and, if appropriate and able to be implemented in Guernsey, consider whether we should follow suit. That's very different to automatically following every change in the UK before we know whether it works or not.

We should do what is right and appropriate for Guernsey. We can take ideas from anywhere. The real expertise will be in subjectively and critically analysing those ideas, deciding how they might work here in an integrated manner, so that our system doesn't become an unco-ordinated hotchpotch of ideas. Do we have that expertise available to us to enable to make those decisions? That must be questionable. Mulkerrin might be able, but who beyond him?

The default option always seem to be "what they do in the UK". Whilst that might be understandable, there are many elements of the UK system which are completely rotten (and I'm not lacking about comprehensive v selection).

Spartacus

GM

sorry but that was on of the two things Mulkerrin said Guernsey does right.

Section 8

Strengths identified of Education in Guernsey

The Director of Education and the Education Board have been astute in avoiding

many of the costly education mistakes made in England over the last decade such

as the tick-box national curriculum. Because of its unique status, Guernsey has had

the luxury over the years of being able to “watch and see” how new ideas in the UK

have developed. Over the years there has been a pattern in England of new

educational initiatives which have gone badly wrong. These were announced by

senior politicians with a great fanfare of trumpets, only to vanish with a whimper a

few years later, often at considerable expense to the tax payer.

GM

Spartacus

If that's the case then long may it continue. I have my doubts that the process of automatically importing "standard practice" from the UK is sufficiently ignored, so it may be that it needs to be an even more robust "challenge" of new UK procesures than it might be at present.

Rachel

Dave, can you please give a few examples of NHS practices which you think should be abolished?

jimbo

Get rid of so-called "managers" and bring back matrons and ward sisters.

Sarnia expat

There are still ward sisters! in fact one very good ward sister on a ward which is closed now finds herself with no ward to manage. What a disgrace and what a waste of such skills.

johno

Dave Jones & GM

Couldn't agree more.

Unfortunately the more people we bring in from the UK on licences, to take up highly paid civil service jobs, the more UK bureaucracy (and therefore cost)they bring with them.

You're right Dave I think the old Guernsey Model worked very well and gave us a Health Service to be proud of.

At the risk of being accused of being Xenophobic (again!) when top jobs in the Civil Service were taken by local people the island was far far more efficiently run.

Dave Jones

The problem is that those who have arrived to take up jobs cannot help but bring their UK ways of doing things with them. I have seen it in the Planning department and in other areas right across the States.

It is not their fault as all of us tend to revert to those things we know best.

In Housing when I meet a new member of staff who may have come from the UK, I make it very clear that they must leave their UK practices back in the UK as Guernsey has its own ways of doing things and that we are a small very close knit community that values our unique systems and there is very much a "Guernsey way". If they want to change it, then Guernsey is probably not the place for them.

I have banned the use of the word "acres" in our documents, as we have our own Guernsey land measurements which we should use.

The Guernsey heritage is hugely important to me and I will do everything I can to protect it, we don't need consultants or advice from the UK as we have always done things much better in my view. I am not anti English as I am from the UK myself so I have a right to support the island that has supported me and given me a way of life that is the envy of many.

Interested

Out of interest, does anyone know how many of our top civil servants are or we're on licences and when they finish?

Mo

I'm just going to throw this out there. Do you not think the management posts would be given to local people if the locals were qualified or experienced enough?

If I were ill in hospital, I'd want the most experienced and educated staff looking after me not the person who got the job because they're local.

GM

Dave Jones

Once again -spot on. Perhaps you need to spend a year running each of our main departments to get that message across.

Mo

Yes we should get the best person for the job, regardless of where they come from, but surely the objective must be to ensure that we educate locals and develop them so that they are at least equal to the non-local. If that means that the local needs to be seconded off-island to gain extra experience, then that's got to be part of the personal development strategy. Apart from the fact that gaining experience on-island might sometimes might be restricted, we should ever fall short on education. Good training programmes are vital though.

Spartacus

GM

I think some comments which have been made by people are very condescending to other deputies who have been voted to serve in high positions on their own merits.

I totally agree with your response to MO.

Dave Jones

I am not sure ,

I have spoken to Mark and he knows what needs to be done, it will be for him and his board to turn health around and I am happy to support him in his efforts.

He will need a strong will to bring our health service back to something Guernsey people recognise, in my view he needs to lay out to his senior staff what him and his board expect and then make sure those wishes are carried out, I am not saying it will be easy but it must be done and although Mark is softly spoken he does have an iron will when he sets his mind at something.

I would start by making lots of visits to the coal face, just him and his deputy minister on their own, talk to the nurses and other medical staff about the problems away from line managers where they can speak freely. More importantly listen carefully to what they say. He will learn much more from the front line staff than he will ever learn around the board table and that is true in any organisation.

Once he has a general picture about what is happening on the ground then he will have a better idea about what needs to be done to address some of the problems.

Brian Shepherd

I have stated often and including here to Dave Jones a definite reason HSSD have problems recruiting and retaining staf are the housing licenses. I have myself moved with jobs throughout the UK and in lots of cases move to Nurses accomodation look at the local area find an area I like then look for property to buy or rent and moved from the accomadation into my chosen property. However in Guernsey there are several issues surrounding doing this,

1 License if we move from HSSD accomodation in general we then restrict our stay to five years max including period prior to moving into local market property.

2. Cost regardless of rent or buying is extremely prohibitive but also the TPR issued by housing limits us to what size property we can have.

I do know nurses who have decided to leave because of these factors, I`m extrremely lucky in that I can just about afford a local flat. I love Guernsey but will eventually have to return home because of the housing costs and licensing system. Mr Dorey will hear this in his visits no doubt,Would it not be more cost effective to allow nurse who wish to stay longer licenses rather than allow them to leave which involves their one month or two in some cases notice advertising posts in UK and abroad, bring interviewee`s for interviews, they then work their notice taking almost four months from initial notice of an individual leaving until their replacement arrives on island, plus the advertising costs travel relocation packages etc. And Jimbo we do have Matrons and we do have ward sisters,

Spartacus

Brian Shephard

You are exactly right, this is the major recruitment problem for Guernsey.

If we were not a tiny island there would be adequate jobs for all local people and newcomers to the island who respond to vacant positions. However if all incomers stayed here permanently, the job market would eventually be saturated. Due to their restricted experience local Guernsey people could not compete with non local job applicants who have more experience on their CVs due to working in a much wider field.

Te housing licence system therefore fulfills a purpose but presents a problem. My understanding of the current solution to the problem is to

a) Hire a non local for a limited timeframe and only do so when a local cannot be found to fill the position.

b) During that timeframe a local should be able to be found or trained to the desired skills.

c) The solution for when that doesn't happen is to prolong the timeframe by using temporary agency staff.

More initiatives are required in relation to part b) to avoid the exorbitant costs of c) however this doesn't help your situation. Your situation would only change if Guernsey changes its population strategy in order to solve the short term problems. It could happen, but they need to think it through.

Dave Jones

Brian

Firstly Guernsey is not the UK and we have our own rules which have served us well for many years. They do not always suit those who come to Guernsey but as I say they are our laws and we are likely to stick with them until the new permit system comes into force.

As you rightly say, those that live in HSSD accommodation don’t need licences and yet the turnover amongst nurses in this HSSD accommodation is just as high as it is amongst those that here on licence, so the evidence does not support the case you make and recruitment and retention clearly isn’t just a licence issue it is as much about remuneration. Also Housing has issued lots of 15 year licences to Health and Social services staff over the years, many of these licence holders have since left and moved away.

My last point on this issue is that our records show that HSSD have not been refused a single licence for specialist health employees they have asked for.

The cost of Housing is expensive for everybody on the island; the fact that HSSD have their own accommodation for their employees, actually makes it more affordable for those coming in, than it is for local people. We spent 8 million on a purpose built accomodation block for nurses and other health employees.

The TRP issue is to try and protect properties at the lower end of the property market for local people, as some Health workers Doctors and other highly paid professionals can afford to live in properties at the higher TRP rate.

The long term answer to this issue, is a massive training programme for local nurses and health workers, we have done it with teachers and it has worked particularly well in the primary school sector where by far the majority of teachers are now local people.

Deputy Sandra James a new board member and a 40 year veteran nurse is now on HSSD and has some new ideas on how training local nurses can be beefed up and in the end it will cost much less than expensive relocation packages and loyalty bonuses that are used at present to recruit and retain staff.

Finally Mark Dorey was a former Deputy Minister of Housing and is well versed in all the issues to do with Health workers and housing licences and I have already said to him that if he has any issues we can help with at Housing, he only has to pick up the phone.

Johno

Dave Jones

How on earth do the other States Dept's go about changing the current approach, if they all had your attitude we would be in a far better place, in my opinion.

It is not just in the States but in other areas of life, that you come across people who have just taken jobs up locally having come over from the UK try to change OUR way of thinking, rather than adapting to our way of life.

This has always baffled me me, as this is why they came here in the first place!

You keep running your Dept with the good old fashioned "common sense" approach Dave and hope it rubs off on other Dept's..............I won't hold my breath!

Taz

I think we need a Mulkerin for HSSD! Lets face it, HSSD runs on a model probably thought up decades ago, is it really fit for 21 century?

There needs to be a shift in the thinking, start with what exactly do you want the service to do? Dave Jones is right in some ways its us, the public, who want a gold standard service but we dont want to pay for it.

On the flip side, I think wer are saying, we are giving you the money, you dont seem to be spending it where we want it to go, i.e. on front-line services.

If somewas was to go in and talk to the staff they would find lots of examples of where money could be saved. Some of it would be by reducing the top heavy management.

I personally think there should be proper audit of services and departments to see if they are fit for purpose now.

A.J.

Well said Dave Jones. We would also have less housing licence problems if we were to train locals to do the jobs in the first place.

Disgruntled

My daughter is local. She and her peers qualified in September, around 12 of them. Jobs were not guaranteed and indeed proved to be very scarce. She is surrounded by non local staff who get the plum jobs. You wonder why morale is low?

Whilst writing, can someone please explain to me why De Sausmarez is constantly being described as a ward which has been closed because of staffing issues? De Sausmarez had a full contingent of staff - it is the medical wards that have the issues.

West

I wish I could vote for Dave Jones

St Peter Port South

So do I. Not that I would, I'd just like to be able to.

Island Wide Voting

I can,but I won't be voting at all next time if island wide voting is stifled again

A.J.

(To Disgruntled). Try changing your surname to Smith, or Jones, that might work!allthough I doubt it.

Taff

My experience is that a well-run organisation decides how best to operate, defines the processes, and trains the staff as necessary. There should be no UK way, or Guernsey way, but the "best way" for that particular organisation. As defined by management.

Which reflects the job to be done and the skills of the staff available. It should be the basis of how that organisation is managed. Which appears noticeable by its absence in recent events. HSSD being a prime example.

I have worked professionally in the UK, Spain, France, Holland, Germany, and the USA, and was often recruited to define better working standards and practices and train staff to use them. And the only real problems I encountered were those of language.

My experience is that good staff react well to being taught to do things properly, and they often taught me things as well. The learning process is continuous.

Oilcan Annie

Whilst not exactly keeping to the main theme of this thread, can I reassure the people of Guernsey that there are nurses who are happy in their jobs! Admittedly I do not work for HSSD, left that sinking ship a long time ago, but still working at the coal face .

Nursing is still a great job and one I have no regrets doing for the last 30 years.

Today at work I chatted with,laughed with ,cried with, hugged and even gave one patient a kiss! Perhaps not very PC these days but a hug often goes a long way to make someone feel better.

The problems facing our Health Care are vast but the vast majority of patients are still happy and grateful for the care they receive from us worker ants on the shop floor!

sarnia expat

No one goes into nursing without a modicum of sympathy, empathy and a huge sense of humour - especially black humour. Nurses love humour..... which is why a hospice can be a really happy place to work, despite its grim overtones for example. Where I think the girls get unhappy has little to do with their patients, and more to do with the disorganised "Boards" who understand little on what it is like to work on the coal face, and who are constantly told one thing, only for the complete opposite to be piped through to the media. Honesty should be the watchword for HSSD 2013.

Interesting that you too left the "sinking ship". Wonder why that was and what made you come to that conclusion?

I know that when I trained as a nurse back in the 1980's, the PEH was THE place to be, but then we had good ward sisters, a good matron, good doctors and a good board of health to be proud of.

A.J.

(Sarnia expat) Let's hope that History can repeat itself.

Buttercup

At last! The truth is out. Front page - HSSD have lied to the public about the staffing problems at the PEH. This has been so badly managed......questions need to be asked about the management at the PEH.