By John Henwood
IF transparency and accountability are to be the watchwords of our government – and every utterance of the Chief Minister suggests that to be the case – then it is facing its first really big challenge in the shape of the Hugo Mascie-Taylor Report on the Health & Community Services Department (HCS).
Published at the end of August, it led to headlines on alleged bullying and questions over patient safety and quality of care. Serious stuff and one expected the story would run and run, but subsequent events drove it and everything else off the front page.
Time then to reflect and digest the report. In his opening paragraphs Professor Mascie-Taylor states: ‘It is an affluent island and all the people and patients of Jersey, irrespective of their individual financial circumstances, need and deserve high quality, safe healthcare… Sadly, it is not possible to conclude that this is the current situation, and the Government of Jersey, on behalf of the people of Jersey, must demand this service.’ The report goes on to describe just how bad things are.
On reading it, the phrase ‘lions led by donkeys’ came to mind. The lions were the ordinary soldiers fighting in terrible conditions during the First World War and the generals, sitting comfortably behind the lines directing events, were the donkeys. It is easy to perceive the front-line staff in our health service dealing with the medical equivalent of muck and bullets, as the lions, and their senior managers, sitting in their plush office chairs remote from the problems, as the donkeys. An unfair comparison? I think not and I defy anyone, having read the report in full, to think otherwise.
Major change is demanded, but here we run into the first buffer: ‘There is not a culture of transparency and indeed, resistance to it from some who view any form of governance with suspicion and any move towards assuring quality and safety with transparent accountability as unnecessary’. Considering that we are dealing with the difference between life and death for some, this is really shocking.
So, no transparency. What about that other watchword? ‘The lack of robust governance at the highest-level, driven by government not having the capability to hold HCS to account, inevitably results in the most used phrase by interviewees during interviews being “there are no consequences”.’
And evidently no accountability.
Anyone who has been in very senior roles in private enterprise or indeed government-owned businesses will know that deep-seated cultural and governance problems rarely, if ever, grow up from the shop, or hospital, floor, they trickle down from the top. What we have at HCS is a leadership issue. And I’m not talking about the Health Minister; she has barely had time to absorb the enormity of the task, although it is not encouraging that in her first considered response to the report she announced yet another appointment, a Freedom To Speak Up Guardian. Fifteen months ago, Dr Nigel Minihane spoke of the number of new administrative appointments made under the director general of HCS: ‘There is consistently more money for the recruitment of managers and to spend on IT systems… but investment in primary care is not evident.’ The list of Professor Mascie-Taylor’s interviewees (there were 77 of them) includes, to identify just a few from a long list of senior staff, the director of improvement and innovation, also an associate director of improvement and innovation, an associate director of people, a head of culture, wellbeing and engagement and a head of quality improvement. Where is the improvement, where’s the cultural change, the wellbeing and the engagement? Are all these senior managers failing or are there so many of them that they are falling over each other?
It seems every time a new problem is exposed the response is to appoint another manager. The previous minister seemed to accept without question everything his senior officers told him, but sooner or later Deputy Karen Wilson must ask her director-general why all these appointments have not led to the required improvements. The DG has been in post for four years, time enough, one would have thought, to sort out the mess. The recently announced extra £20 million to pay for a ‘turnaround’ programme looks like an expensive sticking plaster on a broken body.
As Professor Mascie-Taylor says: ‘It is safe to assume that driving change in HCS will encounter opposition, some of it substantial and noisy. The scale of ambition for change and coping with any fierce abreaction to it will necessarily and rightly ultimately be a matter for the Government of Jersey to both determine and assertively lead.’
Well, Chief Minister, is your government committed to transparency and accountability or not? Actions speak louder than words.
With this urgent issue just one of multiple problems facing the Council of Ministers, we don’t need the distraction of yet another electoral change. Deputy Ian Gorst, Treasury Minister, is proposing the re-introduction of the role of Senator and, not surprisingly, he has the support of other former Senators. They are trading on the post-election call in some quarters for the return of the Island-wide mandate. With the Commonwealth Parliamentary Association having described our electoral system as ‘complicated’ after it has just been simplified, we don’t need to take the backward step of re-complicating it.
The ultimate objective must be an Assembly of equals. Twenty years ago, when the Clothier Report was published, technology was not sufficiently advanced to contemplate all States Members being elected by the whole Island. But this is gigabit Jersey, the digital Island, and it must be possible to create a way in which everyone can cast their votes for any candidates. Rather than wasting valuable States time on another reform debate the Privileges & Procedures Committee should invite Digital Jersey to devise a suitable system.
