Christian Jones sits down with Dr Prakash Thiagarajan from the British Medical Association to analyse the results of a survey of Manx Care doctors, which reveals a lack of confidence in management, low morale and a poor culture.
Manx Newscast
Manx Newscast: British Medical Association discusses 'sobering' doctors survey results
Hello and welcome along to another episode of Manx Radio's newscast, an opportunity to hear the topics we cover in a bit more depth than what you'll typically hear on the breakfast show, man in line, update or the hourly bulletins. Now the British Medical Association has released what it describes as sobering results from a survey of doctors, revealing a lack of confidence in management, low morale and a poor culture. This is the third year the BMA has run its culture of care barometer survey and consistent with previous years it's highlighting some fairly bleak findings. So I sat down with the BMA to analyze them in a bit more detail. I'm Prakash Thiagarajan. I'm a consultant pediatrician and neonatologist but I'm here in my capacity as chair of the local negotiating committee of the British Medical Association. First of all we'll just start with reflections on the survey. What's your take on the survey results? The survey results are deeply concerning. They indicate the organization's culture which is not healthy and therefore it is rather worrying. Doctors on the whole appear to feel unhappy, disenfranchised, not being listened to and there is good evidence that the worst the prevailing culture is the more it can have an adverse effect on patient care and therefore it is deeply concerning. The BMA has described the results of the surveys as sobering and has been aware of these issues for years. So what has the BMA done in that time to address the culture of what it is described as poor leadership and a lack of resources and banks care? Yes you are right. The previous year's surveys weren't much better either and we have tried our best to engage with senior management and we've come up with many constructive ideas on how to improve the culture and unfortunately not much as materialized for people to actually see and experience and obviously we've got much work to do. So why hasn't the situation improved? Is it because of a lack of listening from the senior leadership you said that you've presented ideas? Are they not being listened to? Are they not being actioned quick enough? What's the situation like? Senior management appeared to listen however the not sufficient actions that follow and from the board there is a perception that there is a disconnect between mankscare board and not just mankscare doctors but the manks people. I don't know how justified that perception is but it's there. Repeated surveys show the ongoing dissatisfaction among doctors with little progress year on year like you said. Do you think that the BMA's advocacy on the Isle of Mine is effective enough? I think it's actually making people sit up and take notice and I would hope that action will follow this time but then I'm an eternal optimist the time will tell. Could it be said that the BMA is failing doctors by not achieving meaningful change? It's, BMA on its own can't really achieve any change. It's like clapping you need both hands and one hand can't clap therefore we need full engagement from the mankscare board and the government because I mean at the end of the day we are here to provide the best possible service to the people of the Isle of Mine and we have to work together. So yeah we can only do this with full cooperation of the mankscare board and management. Survey's highlights a persistent culture of poor senior leadership and respect within mankscare so what power does the BMA have to enforce changes if leadership is failing to act? Obviously constant advocacy, empowering membership to speak up. There is always in the background sort of almost like nuclear options of industrial action, votes of confidence etc but those options invariably lead to a soaring of relationships for years and years to come and won't be undertaken lightly. A vote of no confidence would be symbolic though wouldn't it? It wouldn't actually have any bearing on the board. Correct yeah. Only 17% of doctors are proud to work for mankscare and fewer than 10% feel listened to by the board and that suggests a serious disconnect. Does the BMA believe that incremental changes are enough or is it more radical restructuring of mankscare's leadership needed? We believe that there has to be a radical restructure of leadership and it has to be genuinely professional led or medical led. We're not just saying that because BMA is an association of doctors. There is very good worldwide published evidence that health care systems led by actually led by doctors and physicians have much better patient outcomes, patient safety and are significantly more cost effective than organizations led by care organizations led by non doctors. Doctors have expressed concerns about their line managers behaviour with over a third saying that they're not treated with respect. Has the BMA considered recommending legal action or even like you said the nuclear option of industrial action as a means to challenge that ongoing culture of disrespect? No we haven't thought of sort of actions like that as far as possible we like to resolve because we want to focus on caring for our patients. We don't want to be in constant situation of conflict and we're as far as possible try and avoid that but clearly our strategy of constant engagement in negotiation is probably not bearing fruit like it should. So would does that mean that a more tough start should be taken because obviously this is the third year that this survey's been done and it's been fairly consistent results across the board. So at what point will the BMA say actually what we're doing is clearly not good enough. We need to do something else. It's well obviously we need to talk to our membership and decide whether we sit quietly and accept the current state of affairs which is not healthy for staff nor patients or are we going to take it up a notch but again that direction has to come from the membership. We'll move on to resources and workload 67% of doctors say they lack the resources to do a good job at 80% say they don't have enough time to do their work well. How does the BMA plan to ensure that Manc's care addresses these issues especially in light of the ongoing financial pressures which I'm sure you must be aware of? It may sound like an initial expenditure appointing appropriate number of staff members but in the long run that actually saves much much money. Say if we had the same number of staff as per the Royal College's in England guidelines our waiting lists probably would have never got to the stage that they did last year where we had to spend something like 28 million to bring in an external company to clear and with an initial investment of a few hundred thousands we potentially could have avoided that. So it may seem like an initial increased expense getting the right number of staff but in the long run and as you know safer health care is cheaper health care in the long run. Let's just go back to the right number of staff you said and we know that recruitment is a big challenge even if they did have the budget to bring in more doctors and fulfill what you're saying is the right level of staff that won't be a quick fix though will it? It won't be a quick fix but it can be relatively medium term fix and would be a good investment what we like to say call spend to save and it'll be a good thing to do overall to be able to provide and you're likely to attract more people also. If you have a healthy culture that listens to its staff members listens to their patients and actually act on their feedback because it's no good just listening if you don't actually act on it and that would improve the culture and the reputation of the organization which will eventually make the recruitment better. Now we know that Manczka has cited financial challenges including a savings target of 20 million pounds this year how is the BMA engaging with both Manczka and the Isle of Manc government to make sure that doctors working conditions are not continually compromised by the budgetary constraints? We try to speak to the Manczka we regularly try and meet with members of the board chief executive in various different forums and at that time we get listened to but if you look at the actions that flow that's probably been lacking. The Isle of Manczka Medical Society which is the professional arm of the BMA has actually got together and put a whole set of recommendations of how we can make Manczka a highly functional cost effective organization. And what's the proposed cost to action all of those points? Initial cost maybe probably what the Manczka both cost per year which is over three million. Now given the ongoing disputes over pay and the offer of a 6% increase last year what does the BMA view as a fair settlement? We put in a claim of 12.6% for the we're still talking about 23-24 and we wanted an acknowledgement of commitment to pay restoration like in the UK and most of UK jurisdictions have settled their pay disputes and for that reason a junior doctor or a specialist doctor wanting to move to the Isle of Man will be significantly disadvantaged pay wise as things stand. But does the BMA understand that obviously the UK government has a treasury which has an expenditure of about a trillion a year we have 300 million a year on healthcare? Yes but per capita our spend on health and social care is one of the highest in the British Isles. Our concern is it's probably not being spent in the most appropriate areas. Manczka says it's made significant progress on reducing the amount of bank and agency stuff. Do you think that's the case? Yes I think at least agency staff they have made significant improvement and we have many less agency staff than we had say three years ago. Now after three years of surveying there seems to be little measurable progress so what are the specific measurable outcomes that the BMA is expecting from Manczka to address these issues and what deadlines have you actually set for them to actually see real change? We haven't set any deadlines. The power balance is such that we don't believe we are in a position to set deadlines. What we did after the last year's survey was to have detailed conversations with many many doctors and we produced a document called what do doctors want and it was quite detailed one and it was at that time received positively and we hoped would lead to some real action but unfortunately so far it hasn't. Again the main themes were being listened to, being included in the actual day-to-day decisions, obviously being paid better at least on par with adjacent jurisdictions. I can share that document with you later. I know that you just said that you're not or the BMA is not in a position to set deadlines. Does that mean that the BMA has a lack of confidence in its own abilities? That's a good question. Obviously I need to ask the BMA that, the BMA headquarters to answer that question but on the ground colleagues are getting what's expression looking for fed up, waiting for positive change to happen. Again we will be consulting with colleagues to say where should we take this and seeking guidance from BMA headquarters? If these issues persist over the next year, what actions will the BMA take to ensure that doctors' concerns are not continually ignored? What point is there a point of which the BMA would recommend doctors withdraw services or escalate matters further? I do hope we never reach that. It may happen. With Mank's care acknowledging unpalatable and difficult decisions, do you believe that austerity-driven policies within healthcare are undermining doctors' ability to provide quality care? Yes, particularly when austerity appears to be applied very selectively. In my view and view of many of my colleagues, austerity should not be applied to any measure that affects patient care. That's the fundamental reason we are here. But austerity everywhere, perhaps layers of management. Let's talk about that actually because doctors are well paid. It's widely recognised that they are well paid. Do they have support staff? Not as much as they used to be pre-Mank's care. But they're still support staff. If we are looking at reducing patient-facing austerity measures, would it be an idea to cut back on the number of support staff that doctors have? Not at the lower levels, but at the higher levels. What do you mean by the higher levels? Because it's already cut to the bone at the lower levels. When I first joined here in 2005, I had a named full-time secretary. Now between seven of us, we share two. There is no more meat to cut at that level, but at higher levels, if you look at the number of managers, team leaders, etc. It is our view that there are savings to be made there. Obviously, they may not agree, but we do believe that. Some doctors have raised concerns. The Mank's care system is structurally flawed and needs reform beyond the leadership level. Is the BMA willing to push for a systemic overhaul of Mank's care's organisational structure? Again, the doctors are coming to that stage, but we ought to convince the BMA to actually move that way. We have actually provided the government from the Alamo Medical Society with our roadmap, and we are very willing to work. Again, unlike previous reviews that cost over a million, I think. This was done entirely voluntarily in our spare time. We are willing to actually even operationalise those plans. They are very high-level plans. We are waiting with open arms. One last question. You said last year when the survey was released that you were quoted as saying that you would be having open and transparent discussions to deliver positive change. With the release of this survey, in some cases, it's got worse. It's not entirely on Mank's care, is it? Do you acknowledge that? Yes. When we say we have failed to deliver change, that's both sides of the table. Yes, you are correct. Thank you for making it to the end of the Mank's Radian Newscast. You are obviously someone with exquisite taste. May I politely suggest you might want to subscribe to this and a wide range of Mank's Radia podcasts at your favourite podcast provider, so our best bits will magically appear on your smartphone. Thank you. [Music] (upbeat music) [BLANK_AUDIO]