Under the radar, over the top

Formed when it was realised that Guernsey GPs simply having a ‘special interest’ in areas of medicine, like surgery or anaesthesia, was no longer good enough, the MSG has been the prime provider of secondary medical care in the island for decades. Now that role has been assured for five years, thanks to a new contract with the States. So I suppose they have to accept that they are very newsworthy in the goldfish bowl which is Guernsey.

I want to focus on two news stories which relate to the MSG. In one I think their involvement has rather flown under the radar. In the other, criticism of this private medical business has, in my view, been way over the top.

I am going to start with the scandal of the care previously provided on Guernsey’s maternity ward. As Deputy Barry Brehaut and former deputy, and senior nurse Sandra James have pointed out, so far all the focus, blame, humiliation and responsibility has been laid at the door of the midwives and their immediate managers. But midwives don’t operate in isolation, so what about the obstetricians?

Of course, I have to tread very carefully here. Until all investigations – legal and otherwise – have been completed we mustn’t jump to any conclusions. However, it was very clear from the NMC hearings that one issue at the heart of the problem was telephone instructions to administer drugs which should only have been prescribed after a proper medical examination. How did that happen?

Obviously the midwives have to take their share of the blame. They should have refused to treat patients with any medicines that hadn’t been properly prescribed. But frankly, in their relationship with specialist doctors the power is definitely not on the midwives’ side. Despite all of the talk about midwifery being a profession in its own right, when it comes to interaction with obstetricians they are very much the junior partner.

So what responsibility should lie with the MSG? I don’t know until all of the facts emerge, but I do know they have to accept some. I also know from my time at Health that it was not meant to be this way.

Years ago, when consideration was given to a sleep-in obstetrician, the MSG argued, and HSSD accepted, that this would be an expensive and rarely used solution to the problem of overnight emergencies. Instead the specialists were supposed to be on call and able to get to the maternity ward within about 15 minutes. It was argued that this was just as quick as an on-site doctor could manage on a large hospital campus in the UK.

If being on call and ready to come to the ward immediately had somehow morphed into being on call and ready to issue instructions over the telephone, then something definitely went badly wrong. If it changed further to a policy of trying not to disturb the doctors at all during the night, that was even worse. If so, who was responsible for that ‘practice creep’?

At this stage I am not willing to condemn or exonerate anyone, but I do know the facts need to come out in order that the responsibility is allocated fairly.

Moving on. The story where I feel attacks on the MSG have been unwarranted, excessive and bordering on hysterical is in relation to its planned relocation in respect of outpatient appointments.

Let me say at once that I don’t know the building they are planning to make their new home and if there are any issues regarding either parking provision or disabled access, then those are legitimate concerns. That said, I imagine an organisation such as the MSG would have considered these issues fairly carefully themselves.

Beyond that, the idea that moving the site for their outpatient appointments by half a mile is somehow a doomsday scenario is hard to comprehend.

If Heath president Heidi Soulsby is right and there was room for their outpatient consulting suite to be accommodated on the PEH site, then I suppose that would have been ideal. It is hard to see where the clinic space, or the extra parking needed, would have been provided, but purely from the point of view of having specialists on campus in case of an emergency the benefits are obvious.

That being the case, it might have been an idea to mention the possibility during the recent contract negotiations. It’s a bit late once an agreement to purchase another building has apparently been signed, subject to planning consent.

In effect, the deal has been done, as it’s hard to conceive of a valid planning objection to such a change of use. So this belated raising of the PEH option seems rather like crying over spilt milk. After all, we can demand the MSG be many things, but it’s hardly fair to expect them to be clairvoyant.

In fact, the criticism of the move down the hill seems particularly unfair given that during the contract negotiations the States’ side apparently told the MSG to look to reduce overheads on things like accommodation costs. When it does so it gets blasted for it. If it was so important to the States negotiators, the issue of where the outpatient service was provided could have been part of the terms of the new contract.

For our top politician, P&R president Deputy Gavin St Pier, to wade in with his own criticism seems to me to take the issue to heights which it doesn’t deserve.

This is a private provider, albeit that the States contract represents the vast majority of its work. It has taken a decision to relocate its outpatient clinic to a new site, still very close to the PEH, and it’s very rare for that proximity to become a real issue. After all, the time when the PEH is most vulnerable because it has fewest doctors on site is at night, when the MSG outpatient clinic is closed anyway.

So my message is, criticise the MSG where it is warranted, but also cut it some slack. After all, if the States wanted 100% control over every aspect of secondary care in Guernsey it could have taken the opportunity of the old contract ending to employ its own consultants instead. It didn’t and, on balance, I think it was right not to do so.