An external review into the Manx health service has highlighted concerns about governance and a growing ’dislocation’ between management and medics.

The findings of the latest review - the seventh of eight - have just been published.

West Midlands Quality Review Service has been commissioned to carry out a rolling programme of independent inspections between 2013 and 2018.

Its latest report notes that care of patients is impressive, ’despite the systems and processes within which staff were working’.

But it says the common theme that emerged strongly during the inspection was a concern about governance and management structures and relationships.

It says: ’The barriers between different parts of the health and social care system appeared stronger than ever and the dislocation between management and clinical staff seemed to have grown since review six.

’Several staff in the services reviewed were disillusioned, defensive and felt unvalued. Staff were keen to improve services but were not empowered to make the necessary changes.

effective

’There did not appear to be effective multidisciplinary team (MDT) working in operation. We did not see effective co-ordination of care between teams.’

The areas inspected for the latest report were musculo-skeletal patient pathway, care of people with chronic pain, care of people with drug and alcohol problems and screening services.

A statement by the Department of Health and Social Care said the immediate risks highlighted in the report had all been addressed and the DHSC is committed to improving standards in patient care, staff development and effective leadership.

Inspections were carried out over three days in October last year.

All the areas, with the exception of drug and alcohol services, saw ’governance as a concern’ but the report says that arrangements for handling of complaints appeard to have improved.

The report says: ’There was a significant lack of information and monitoring to provide the Isle of Man health service assurance that care was provided in a timely and effective way. Data was not routinely collected, and where data was available there appeared to be little evidence of systematic review and assessment.’

Within the drug and alcohol team an immediate risk was raised.

It said: ’It was reported that dihydrocodeine was being prescribed to people in police custody without a drugs test being performed.’

toxicity

This is despite advice from a coroner’s report after the inquest of Michael Davidson, who died in 2012 from ’drug toxicity’.

It found he had been prescribed a large amount of medication in both police and prison custody after his arrest.

However, the report did praise the changes made to drug and alcohol services in recent years, including the holistic approach to support, improved links with child services and prevention schemes which have proved successful.

WMQRS also noted it had been unable to see mandatory training records for staff or occupational therapists so could not provide assurance of competency and that ’the very traditional management structure of the department appeared to be promoting the divisions between these services and acting as a barrier to integrated working’.

Further issues were found in bowel screening where Manx residents are at risk of having lower standards of care than UK counterparts.

But breast screening in the island is more frequent than the UK standard, says the report, with reviewers suggesting the potential benefits of ’increasing the screening interval’.

The report heaps praise on the island’s health care professionals. It states: ’Throughout the services reviewed, there was evidence of caring staff, lovely facilities and vibrant community engagement.’

WMQRS also commends the readily-available information for patients and their families, efforts to allow people to die in their own homes if they so wish and the improvement in links between wards 11 and 12, responsible for musculo-skeletal problems.

’The door between the two wards had been removed, and staff were working flexibly across the two wards.’

The framework for orthopaedic nurses, streamlining of occupational and physiotherapy services and the health care assistant development programme were also noted as successes.

Health and Social Care Minister David Ashford welcomed the report saying: ’It is very pleasing to see good practice highlighted in a number of areas, and our committed, caring and compassionate staff impressed reviewers once again.

’However, there are areas of concern too, and in that respect the report will be a catalyst for change.

’To ensure we have the health service our population demands and deserves, effort to improve standards will be required from staff throughout our complex system.’