Damning report into Isle of Man’s health services

Noble's Hospital

Noble's Hospital

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A damning report into patient care at Noble’s Hospital has highlighted staff shortages, weak management and a culture of blame.

It calls for clinical staff to be given a proper channel for raising concerns – but suggests whistleblowers who contact the media in the first instance should be disciplined.

Concerns about patient safety at Noble’s were first raised in 2012 by 10 hospital consultants in a letter leaked to Isle of Man Newspapers.

This led to a backbenchers’ call for the resignation of the then Health Minister David Anderson.

New Health and Social Care Minister Howard Quayle – who was one those backbenchers – promised an action plan. He pledged: ‘I want a health service we can be proud of. No stone will be left unturned and nothing will be swept under the carpet.’

He added: ‘The vast majority of people who come into contact with the hospital are happy with the service they get. But there is always room for improvement. We’ve not been shut down, we’ve been criticised. Give us a year and you should see significant improvements.’

The West Midlands Quality Review Service (WMQRS) was commissioned to carry out a three-year programme of review of the Manx health service. Its first report follows an inspection of the emergency department, theatres and anaesthetics and critical care services at Noble’s Hospital in November last year. Staff in each of these areas were praised for their commitment to good patient care.

But reviewers highlighted immediate risks with lack of staffing for round-the-clock emergency theatre and critical care. And they said they had significant concerns both about the quality and safety of services resulting from systemic issues which may have ‘compromised the ability of politicians, managers, clinical staff and the public to work together to improve the quality of care for patients’.

They encountered a culture of blame with managers, politicians and clinical staff blaming each other and clinical staff blaming other clinical staff.

‘The prevalence of blame was undermining morale of staff and confidence of patients,’ the report found.

There was also lack of trust, a perceived lack of openness and staff frustration, while a culture and governance of the services had ‘drifted away from what is considered good practice in England, including a loss of insight into what constitutes a good healthcare system and good clinical practice’.

Reviewers saw many examples of ‘due process’ not being followed.

They found that with no mechanism for clinical staff to raise concerns about patient safety. It had become the accepted norm rather than the exception for whistleblowers to contact politicians or the press – leading to a demoralising effect on staff and anxiety for patients.

Clinical staff had tried going through appropriate routes but their concerns and suggestions were ignored. Management’s influence over medical staff appeared limited, concluded the report.

‘There was an apparent acceptance within the hospital that collaborative working between operational management and clinical staff had been lost, partly due a lack of management influence on the behaviour, conduct and clinical practice of some medical staff,’ the reviewers concluded.

The report notes it will not be easy for the hospital management team to address the issues identified.

It calls for urgent action to provide clinical staff with a mechanism to raise concerns about patient safety.

The report suggests all staff should be reminded of their responsibilities to follow procedures for raising such issues. Those who contact the press instead should be disciplined.

Mr Quayle said two areas of immediate risk had been dealt with straight away. A new anaesthetist had been appointed with two more to be recruited and there was now a documented emergency plan. He said work had begun on a ‘robust and comprehensive’ action plan to address outstanding issues.

He said he believed the intervention of backbenchers and the press had sped up the process of bringing in the external inspectors. He pointed out the review team had been asked to come in to look at where improvements could be made – they were not brought in following some ‘terrible catalogue of events’.

A second review by WMQRS was held on March 12 this year which examined acute medical admissions and the care of adults with long term conditions. A third review will take place on July 4.

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