Opinion: John Henwood
LAST month this newspaper devoted considerable space to issues of concern regarding the management of our health system.
For once it was not all about the proposed new hospital although the letters pages continue to be filled with negative views about that including the location, access and the cost.
This time the concern was for the wellbeing of frontline staff working within the health service amid allegations that there are too many chiefs – for which read administrative management – and not enough Indians – for which read doctors and nurses.
It’s a familiar picture. Margaret Thatcher’s 1980s solution for the NHS, which was ailing even then, was to introduce better management of the service, but this was soon interpreted as more management and the cost of all the additional bean counters was to the detriment of clinical staff and ultimately patient care.
A senior Jersey general practitioner, Dr Nigel Minihane, claimed the problem was not new, but had got much worse. He criticised the newly approved Jersey Care Model, saying measures were being pushed through without the support of GPs who would be required to bear the burden of the changes.
He said: ‘There is consistently more money for the recruitment of managers and to spend on IT systems…but investment in primary care is not evident.’
Responding to the criticism Health Minister Richard Renouf made this statement: ‘The morale of Health and Community Services colleagues is incredibly important to us and there are a number of programmes including a package of wellbeing support delivered by a multi-disciplined team, the appointment of two dedicated staff for counselling and therapy, a number of trained mental-health first-aiders, and a series of wellbeing activities.’
Deputy Renouf’s own words? I’m not sure. This is straight out of the NHS managers’ guide to argle-bargle in response to real concerns.
It is bunk and blather and serves to indicate how wrong the States was to nod through the Jersey Care Model, the route to a lookalike NHS which, as every thinking person knows, is an out of date, failing care system.
Why do we need all these counsellor/therapist jobsworths?
As anyone who has run a successful enterprise will tell you, leadership involves listening to those at the sharp end who almost certainly know more about it than you, and not forgetting to say ‘thank you’ and occasionally a deserved ‘well done’.
The problem seems to be that we employ lots of people with the word manager in their job title, but very few who know how to value colleagues and staff.
Dr Minihane’s views followed those of Ann Esterson, former chief officer of Social Security, who pointed out that the government contribution to doctors’ bills had not increased in a decade. This despite the cost of living increasing around 35 per cent during the same period.
I know what Dr Minihane meant when he said the problems were not new. For a year from March 2009, I tried to extract basic information from what was then called the Health & Social Services Department. All I wanted to know was how much of the annual budget (the largest in the public sector) was spent on administration and how much on clinical services.
During that period, I corresponded with or met two Health Ministers, an Assistant Minister, the chief executive of H&SS and sundry other officers and all I got was obfuscation. It was easy to surmise that the information was so damaging that they did not want it in the public domain.
We are seeing similar tactics today with the annual ‘warts and all’ departmental report initially withheld from the public because of fears about how its contents would be reported by the media. That immediately sends the message that it must contain some pretty damaging material they’d rather we didn’t know about.
Meanwhile, the proposed new Public Health Law is coming toward the end of a period of public consultation. Sometimes it feels like we are being consulted into submission with something new being thrust at us at every turn.
Whether it’s deliberate or not, I can’t help feeling that the level of reference back by government to the public is resulting in consultation fatigue and fewer responses.
I try to read every new proposition, to study each new report, but in a full life it’s almost impossible to keep up. I wonder whether all States Members, whose job it is, read everything.
For instance, have they all considered every line of the proposed Public Health Law?
Those who have will have noted that the post of medical officer of health, always filled by a qualified medical practitioner, will be done away with.
Instead, we’ll have a director of public health who does not need a medical qualification and, it would seem, does not come within the Heath Minister’s responsibilities. But hold on, hasn’t that particular gun been jumped?
Hasn’t someone been appointed to this newly created position before the States has debated the law? It looks increasingly like the Heath Minister is not setting the policy for his own department, which is apparently controlled by ex-NHS bureaucrats.
A couple of weeks ago I wrote about the lack of policy programmes being put forward by new political parties. Well, here’s a thought: there are votes waiting for the party which commits to throwing out the Jersey Care Model and, should the States approve it before the election, repealing the Public Health Law. I don’t suppose I’m the only person who does not want an NHS-type public health system thrust upon us.
Let’s make it a major election topic.