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Minister David Estwick Declares War On Forces Undermining The Queen Elizabeth Hospital

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Minister Estwick
Winston collymore-CEO QEH
CEO Collymore

Minister David Estwick in his contribution to the 2008 budget debate cited several difficulties which he has encountered since assuming the post of Minister of Health in January 2008. Since the halcyon days when Senator Branford Taitt was Minister of Health, the QEH stock has been diminishing at a concerning rate for Barbadians. In 2008 the problems at the QEH appear to be complex and will take the cooperation of all the players to ensure that the healthcare dispensed from that institution is not compromised. Minister Estwick from the House of Assembly has sent a clear warning to the several factions at the QEH that enough is enough and he will be taking decisions in the interest of the PEOPLE of Barbados.

At the centre of his frustration appears to be two core issues:

  1. The Queen Elizabeth Hospital Board is being undermined
  2. Some Doctors at the QEH appear to be shortchanging the PEOPLE of Barbados by ‘moonlighting’ on the job. Consequently the core medical pool which is required to ensure an above adequate healthcare delivery is under threat. He cited the example of Consultant Brian Charles who appear to be a jack of all trades if we are to judge by the number of hats he is currently wearing. Then there is the matter of the Human Resource practitioner whose contract was terminated.

The Minister Estwick has sent a strong message in a way only he can, he will not be tolerating any behaviour which seeks to undermine the authority of the QEH Board – see media release below written by QEH Board Chairman

QEH 1

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113 responses to “Minister David Estwick Declares War On Forces Undermining The Queen Elizabeth Hospital”

  1. Body Slam Avatar
    Body Slam

    David Estwick ole stupid dog.

    Always barking like a idiot.

    He could shut e damn mout and keep quiet.

    http://www.nationnews.com/story/48836098120469.php

    QEH board ‘must clean up its act’
    Published on: 7/10/08.

    Minister of Health Dr David Estwick (right) with Senator Peter Gilkes at Parliament yesterday.

    ENOUGH is enough!

    General secretary of the National Union of Public Workers (NUPW), Dennis Clarke, is calling on the board of management at the Queen Elizabeth Hospital (QEH) to clean up its act if it wants to avoid a stand-off.

    This follows approximately 200 workers from various departments summoning Clarke to a meeting yesterday morning at the Martindale’s Road, St Michael heath facility.

    Clarke promised workers that if a resolution was not met by tomorrow, they would continue to meet every morning from 9 a.m. to review the situation.

    “You want someone to carry the hospital forward. It’s high time an investigation is carried out. I’m calling on that from today. If he is cautious this is the only acute hospital service we have, we want things to improve.

    He made it clear it was not a strike, but a gathering among workers “crying out for help to get this operation working”.

    “They had enough of the management of the hospital which is not in keeping with the smooth operation of the hospital.”

    Grievances include no structure in place on how the QEH is managed in the absence of chief executive officer Winston Collymore, overtime pay, only one X-ray machine in the Radiology Department and no proper office for the Ambulance Service.

    Clarke said while former director of human resources, Ann-Marie Lorde, was having a meeting to address the proper structure of overtime pay, a directive was given for her to stop the meeting.

    The DAILY NATION obtained a copy of that letter from Collymore addressed to all staff of the Human Resources Department and copied to QEH board, stating that Lorde was not authorised to enter the building, use the hospital’s equipment or have access to its systems or files.

    “Similarly, no one is authorised to share any hospital-related information with Mrs Lorde, as from 30th June 2008 . . . Any hospital information obtained by Mrs Lorde from 30th June 2008 will be assessed as to the legality of its acquisition,” the letter added.

    Meanwhile, a Press release issued by the QEH stated staffers who gathered under the trees yesterday were in breach of the collective agreement with the union. It added this was undesirable, given the impact on patient care. (KB)

  2. David Avatar
    David

    Sometimes a government may start out with the best of intentions but then reality sets in. The incestuous relationships which exist in in a small country and the supported by practices which have become routine overtime will make the task of running the QEH a nightmare challenge for Estwick.

    We do not wish this job for our enemy. We wish him all the best.

  3. The scout Avatar
    The scout

    Dealing with the QEH is a complexed issue that needs to be handle with deplomacy. I’m not sure Dr Estwick method will work.

  4. JC Avatar
    JC

    I agree totally with David! Good luck Mr. Estwick you will have a tedious task ahead of you.

  5. Bush tea Avatar
    Bush tea

    Scout,

    Which other approach has worked?

    I fully support Dr Estwick strong stand for what is right. It is obvious that any other approach at this time is give us the same results that we have been seeing for the past 20 years – gradual decline in the service offered.

    …Sometimes leaders NEED to put their foot down for what is RIGHT.

    I was impressed by his intensity and passion for doing what is needed for the QEH.

    ….and if his ‘facts’ are indeed correct, I think that it is time for a heavy hand in dealing with some of these sordid messes that the new government has inherited.

  6. David Avatar
    David

    Members of the BU family should factor that the Chairman of the QEH Board is Mitch Codrington who is a former Chief Labour Officer and the Deputy Chairman is Eddie Corbin an HR practitioner. These are the two people heading the Board which indicates one thing to the BU household, the government anticipates that HR ‘issues’ would be a priority at the hospital.

  7. boredickey Avatar
    boredickey

    Body Slam! You are an arschloch a real Big arschloch. Are you a Barbadian? Do you care about our country? Do you want to have and to see an efficient QEH. You sick bastard

  8. Avatar
    Anonymous

    Hear,hear Bush Tea.

    I don’t know why Scout seems to think that ‘diplomacy’ – whatever that might be in this case – is required in this instance.

    The QEH doctors have long been known to steal the equipment brought in to the hospital and take it to their private practice.

    In addition they collect money for ‘supposedly’ doing work for the QEH while in fact they hardly turn up and leave all the work for the junior doctors who have to work very long hours.

    One wonders that we haven’t seen more accidents at that institution.

    Then we have brian charles -who was given the position of medical director of services,yet holding down his private practice,as well as being the vice president of the inurance brokerage firm that provided insrance coverage for the QEH,as well as having a position with CERO,and with the prison and with the defence force….

    Cuddear man,be reasonable -you say scout that dr estwick should exercise diplomacy – I in fact was rather surprised that he was so diplomatic in presenting some of the facts.

    Imagine hiring a human resource director who turns out to be a former research officer for the NUPW – hence dennis clarke fixation with the issue – but most unbelievable of all you hire this person without a contract.

    It seems the BLP was averse to giving contracts – no contract for the ABC highway,no contract for the H.R. Director at the QEH . Wow!

  9. boredickey Avatar
    boredickey

    Dr Estwick does not need to be a Minister to make a living here. His heartfelt passion to help improve our lot sometimes seems unauthodox but that’s his way. Public support for his efforts is much needed at this time. The rebels involved CANNOT rule and MUST be publicly condemned.

  10. David Avatar
    David

    Healthcare delivery is a plank upon which a successfully nation is built. This is not about liking a person’s style. This is about the fight to keep the QEH from going down the toilet. For so many years we have heard the complaints in the media and no one up to now has tried to deal with the fundamental problems at the QEH, at the top of the list are the many factions and interest groups.

    The BU household pledges its support to Estwick or any servant of the PEOPLE who is trying to do better!

  11. Wishing In Vain Avatar
    Wishing In Vain

    I fully agree with you David, Dr Estwick not only needs the support of the Gov’t but he needs the support of every Barbadian as he tries to clean up the mess that exist at the QEH.

    This type of corruption cannot and will not continue to happen, this is a new dawn a new Gov’t and most importantly A NEW MINISTER IN DR DAVID ESTWICK, let him do what he needs to do and allow him to deliver us from the evil of the BLP corrupt regime.

  12. YOU ALL ARE SO FUNNY Avatar
    YOU ALL ARE SO FUNNY

    ANNONYMOUS

    You better believe That Big Mouth David Estwick will need real ‘diplomacy’ to deal with the QEH doctors, because if the doctors close ranks, and if BAMP closes ranks, his balls will be squeezed real hard!

    Now let us understand that all QEH doctors are not in the same category. For example junior doctors DO NOT HAVE PRIVATE PRACTICES. They work full time- and that means FULL TIME & OVERTIME! For some of this, they are poorly paid, and for the rest they are not paid at all.

    Annonymous can you provide evidence to support your claim that “The QEH doctors have long been known to steal the equipment brought in to the hospital and take it to their private practice?” You are off course referring to the specialists or consultants.

    You show your ignorance – abject ignorance when you write “they collect money for ’supposedly’ doing work for the QEH while in fact they hardly turn up and leave all the work for the junior doctors who have to work very long hours.”
    1- All over the world junior doctors have to work very long hours-
    2- QEH consultants work. They see new patients in out patients department, assist in teaching medical students in these clinics, in operation theaters and on ward rounds. It is absolutely unnecessary for QEH consultants to come to hospital to do the “donkey work” as it is called. This is done by the junior house staff, and is adequately supervised by the Residents or Registrars as we call them. Registrars at QEH often have the same qualifications as the consultants.

    The QEH consultants are more effective and proficient than the average MP and Minister of Government……….and big mout David Estwick

    The reason why “we haven’t seen more accidents at that institution” is because we usually have good doctors, and the system works.

    Well Brian Charles is a different case all together- HE IS A POMPOUS ASS.
    But if he is a QEH consultant he is entitled to have a private practice.

    Take a way the private practice from the consultants, and you will not have the level of expertise, supervision and teaching of the junior doctors that is required.

    Tell me how much is paid to visit the prison or the defence force weekly- very little! These are inconveniences that very few doctors in Barbados love to do. These jobs were taken away from a Bajan who used to do them cheerfully and well, and given to Charles who is not a Bajan. Nobody complained when the Bajan doctor was displaced who was faithfully serving his people.

    Periodically you people will talk shite about things you do not know. When you are supposed to open your mouths you say nothing. There have been threads on this forum this year to which few have contributed. Now you guys want to support big mout blabber mouth estwick in his brawling?

    I predict that if he approach esthe doctors that way he will lose- and lose badly. When the consultants leave and expand Bayville Hospital then you will see.

    It is easy to write shite on BU without possession of the facts!

  13. J Avatar
    J

    Give Brian Charles a break and stop calling him a foreigner. He has been here long enough to be one of us. He has looked ofter my elders in A&E and did a fine job and was courteous too and not at all pompous. But that was years ago. I hope that success has not spoiled him.

  14. Adrian Hinds Avatar
    Adrian Hinds

    I maintain that the problems at the QEH are the fault of the Doctors and other staff, enabled by their respective bargaining bodies. I was probably the only non-partisan person in Barbados who did not agree with the vilification of Jerome Walcott as the reason for all that is wrong at the QEH. A new government and new minister of Health and strike action and same lack of service and amenities are still with us. How could this be if the Minister was/is at fault? Sooner of later Estwick will be force to admit that which Walcott did.

  15. Why he suh damn ugly doh? Avatar
    Why he suh damn ugly doh?

    BU,

    Perhaps you could find another photo of Dr. Estwick to publish.

    Or was he born wid dah naturally damn ugly look?

    Talk ’bout Frankenstein!

  16. Why he suh damn ugly doh? Avatar
    Why he suh damn ugly doh?

    Please change dah photo fuh real.

    You are FRIGHTENING MY CHILDREN!

  17. Georgie Porgie Avatar
    Georgie Porgie

    Adrian wrote
    I maintain that the problems at the QEH are the fault of the Doctors and other staff, enabled by their respective bargaining bodies.

    How can this be? The doctors do not run the hospital— the hospital is run by a board……….most of whom are medical illiterates!

    How many times has BAMP held a strike in the last 30 years.

  18. Georgie Porgie Avatar
    Georgie Porgie

    Adrian wrote

    I was probably the only non-partisan person in Barbados who did not agree with the vilification of Jerome Walcott as the reason for all that is wrong at the QEH.
    ================================
    Whereas you can not say that Jerome Walcott should be blamed for ALL that is wrong at the QEH in the last 6 years or so, he must be blamed for a lot. Jerome trained and worked at the hospital.

    Therefore, he would (or should) have been aware of the problems such as

    How long does it take to get a routine emergency Xray

    How long does it take to get an operation theater ready for emergency surgery at night

    What are the deficiencies with the Central Supply Department etc
    and other routine important questions that deal with function

    Jerome Walcott was in the unique position (in contrast to many previous Ministers of Health) in having experienced the defects and deficiencies of the QEH in many facets of its operations. He had the opportunity to fix them.

    If not allowed to do so, he should have rebelled and told the people that he was not given the permission or the funds to do the necessary.

    Jerome Walcott because of his unique position was a failure. To whom much is given, much is required.

  19. Georgie Porgie Avatar
    Georgie Porgie

    David wrote that at the centre of Minister Estwick’s frustration appears to be two core issues:
    1- The Queen Elizabeth Hospital Board is being undermined

    Perhaps he needs to get a board that knows what it is doing.
    Man I am sure the Board at Bayville on top of things.

    David wrote you point out that the Chairman of the QEH Board is Mitch Codrington who is a former Chief Labour Officer and the Deputy Chairman is Eddie Corbin an HR practitioner. Do these guys have any knowledge or experience or experience in running a hospital. Or are they just party pimps?

    2- Some Doctors at the QEH appear to be shortchanging the PEOPLE of Barbados by ‘moonlighting’ on the job. Consequently the core medical pool which is required to ensure an above adequate healthcare delivery is under threat.

    Is he saying that the junior doctors don’t come to work, and are doing private practice? If so that is illegal, especially since most junior staff are not fully registered.

    Is he saying that the Consultants should come to the QEH everyday all day and do what?
    If he doesn’t like the terms under which the Consultants work, let him fire them! Don’t bark, bite! Fire them and see what will happen next?

    David ma boy Minister Estwick will need a steep learning curve soon..

    3- You say “He cited the example of Consultant Brian Charles who appear to be a jack of all trades if we are to judge by the number of hats he is currently wearing.”
    Well here is a case of chickens coming home to roost. Brian Charles is a foreigner who has been doing as he likes at the QEH for ages. He has contracts which can be terminated. And if he does not have citizenship, then that is easy. So why bark?

    4- Then there is the matter of the Human Resource practitioner whose contract was terminated.

    Here is an interesting thing. A Bajan Human Resource practitioner’s contract was terminated but foreigners can do as they wish. Does anyone know what she did or did not do? Or is she affiliated to the wrong party.

    It seems that there will be nuff fun down at the “horrrrrrrrrse-pital!”

  20. Adrian Hinds Avatar
    Adrian Hinds

    GP I am going to assume that you are not suggesting that the problems you have highlighted started with the Board! But if you are, can you recall in what year was there a commission of enquiry into the QEH Led by Richie Haynes and a report with their finding and recommendations listed was issued?

    Do you know how many or if any of the recommendations where acted on?

  21. Tell me Why Avatar
    Tell me Why

    I believe in reverse psychology. If you place your party faithfuls in positions and you are still getting strikes and rebellious behaviours, why don’t you use someone from the opposition? We keep hearing that it is your friends that you should be cautious with, since your enemy once given a chance, will ensure that everything done must be perfect since the intentions will be to show that he/she is better than you. With that in mind, your job will be accomplished.

  22. Georgie Porgie Avatar
    Georgie Porgie

    @ Body Slam

    Whereas the Minister appears to be an ole stupid dog who is always barking like a idiot, he really cant shut e damn mout and keep quiet, because he is PAID to deliver in the tedious task ahead of him.

    I predict that if he don’t come down off his high horse, he will get a whipping!

    @ The scout
    I agree with you that the QEH is a complex issue that needs to be handle with diplomacy.

    It must be done area by area and department by department in such a way that success breeds success. I agree with you that Dr Estwick’ method will NOT work.

    If Bajan doctors could defy Tom Adams and could stall the implementation of his precious National Health Service for 10 years, our contemporary doctors can ensure that Estwick becomes a failure.

    @ Wishing In Vain
    How will every Barbadian support Dr Estwick as he tries to clean up the mess that exist at the QEH. Tell us how man. Tell us how.
    How will he deliver us from the evil of the BLP corrupt regime?
    This is good emotional rhetoric, but tell us how?

    @ David
    Do you think that that Dr Estwick’s fight to keep the QEH from going down the toilet will be accomplished by barking and hollering, and ignorance? What has he accomplished in six months? Pray tell?

    Does the former Chief Labour Officer Mitch Codrington or the Deputy Chairman Eddie Corbin – the HR practitioner have any training or experience in Hospital Administration or Healthcare delivery, or are these party pimps who are essentially square pegs in round holes?

    Is not Hospital Administration and Healthcare delivery areas of health that in other countries people study and work before getting these positions?

    You write “Sometimes a government may start out with the best of intentions but then reality sets in………….the pactices which have become routine overtime will make the task of running the QEH a nightmare challenge for Estwick.”

    Estwick should go talk to Kieth Simmonds or Branford Taitt- who had the best approach to the job IMHO. They spent a lot of time working with the persons involved

    @. Boredickey
    Whether Dr Estwick needs to be a Minister to make a living here is irrelevant. Your emotional outburst “The rebels involved CANNOT rule and MUST be publicly condemned” is very interesting. But
    TELL ME ARE THERE REBELS AT THE HOSPITAL ON ST PAULS AVENUE?

    HOW IS IT THAT THERE ARE NO PROBLEMS THERE?

    WHO RULES & RUN THAT HOSPITAL?

    CAN WE LEARN ANYTHING FROM THE MANAGEMENT PRACTICES THERE?.

    @ Bush Tea
    Intensity and passion for doing what is needed for the QEH is ok, but that wont do the job. Standing for right is great rhetoric, sounds good…….but how will he translate that into positive, practical action. Will his present ploys give us better results? If he indeed has the facts will shouting and barking do the job?

    If he has really dissected out the real maladies at QEH, how will he perform the necessary surgery by himself? He needs co-operation from the major players. If he has the facts he should stop barking and do something positive!

    If the trouble trees are not contracted workers but appointed civil servants, how will he easily get rid of them. (Please note that the doctors are now all under contract and can easily be dismissed when their relatively short contracts are up.)

    We are in for some………cant say fun……..cause it aint going to be funny.

  23. Georgie Porgie Avatar
    Georgie Porgie

    Adrian Hinds

    NO NO NO I am NOT at all suggesting that the problems that I have highlighted started with the Board!

    NO I do not recall what year the commission of enquiry into the QEH Led by Richie Haynes was held or if a report with the findings and recommendations listed were issued, or any of the recommendations where acted on.

    I sincerely believe commissions of enquiry in Barbados are designed primarily to give lawyers money.

    But I also believe that the issues at the hospital and other factors that affect the health institutions paid out of the public purse can be solved.

  24. Georgie Porgie Avatar
    Georgie Porgie

    Adrian

    Maybe you should be on the Board! At least you have the administrative sense to review the pass in order to see what you can take from that to go foward.

    I think that you are alluding to the idea that if the findings of the Haynes commission have useful ploys that have not been implemented, that they should be examined and modified as needed and implemented.

    Your approach must be commended because rather than an emotional outburst it suggests that you have thought about the issue at least for a minute. Lol

  25. Adrian Hinds Avatar
    Adrian Hinds

    Georgie Porgie // July 10, 2008 at 1:33 pm

    Adrian

    Maybe you should be on the Board! At least you have the administrative sense to review the pass in order to see what you can take from that to go foward.

    I think that you are alluding to the idea that if the findings of the Haynes commission have useful ploys that have not been implemented, that they should be examined and modified as needed and implemented.

    Your approach must be commended because rather than an emotional outburst it suggests that you have thought about the issue at least for a minute. Lol
    =================================
    ha ha ha please don’t put me in the mist of the solution. I will not be visiting the rock anytime soon, and at this time have absolutely no intent of returning for any permanent or long term reasons. I will continue to serve my country voluntarily via ideas and suggestions. I have nothing more to give.

  26. Georgie Porgie Avatar
    Georgie Porgie

    Adrian
    I was giving you a complement not sentencing you to hell! I aint got nuttin against you man to wish upon you such evil LOL

    Working with these politicians is hell, and fixing the mess in Health is………only God knows.

  27. Adrian Hinds Avatar
    Adrian Hinds

    The following was written by Bajan blogger Stephen Mendez back on Sept 20th 1998

    “HOSPITAL HORROR
    —————
    The QEH commission of inquiry has now gotten under way… here are a few
    of the stories told to it by patients.

    – One patient was about to have his foot amputated, when it was discovered
    that his non-recovery was simply the result of a deficient diet.

    – A disabled patient who was unable to use her hands had a meal placed on
    her bedside table, but since there was no one to assist her in the eating
    of it… it remained untouched and was eventually taken away.

    – One daughter, with the help of untrained family members, looked after her
    sick mother and she did not develop one bed sore, but after two weeks in
    the QEH she had bed sores all over her.

    – A former QEH worker said, staff often referred to the place as “Hollywood”
    because there were so many “acting” employees !!

    so people.. be warned… with your last breath, say to the medics… “take
    me to the Airport… take me to the Bayview… take me anywhere
    BUT NOT THE QEH !”… and pray you are never in that situation.”

  28. Professor la la Avatar
    Professor la la

    mr rah rah

    david estwick is so noisy that i call him mr rah rah.RAH RAH RAH RAH RAH RAH

    i do not like how things going in barbados under this government. this is the worse government ever in the history of barbados over a six month
    period. —– I AM NOT HAPPY———–

  29. anotherview Avatar
    anotherview

    Problem under the Bees now problems under the Dees. What does this say?

    The problems are mainly institutional.
    Solution: heads will have to be crushed!!

  30. Adrian Hinds Avatar
    Adrian Hinds

    anotherview // July 10, 2008 at 3:48 pm

    Problem under the Bees now problems under the Dees. What does this say?

    The problems are mainly institutional.
    Solution: heads will have to be crushed!!
    =================================

    indeed, a change of scene and charaters, but the pantomime continues the same.

  31. JC Avatar
    JC

    Every body I find (excepting Adrian Hinds and BU) have not given any positive hindsight into this delicate and serious issue.

    I have a friend in hospital right now and I am scared for her!

    You think anyone in Barbados in 2008 should have to say that they are scared to go into the hospital. Most bajans do not have money to go overseas like Glyne Clarke and crew;

    We need to correct this nasty situation. If we as the citizens of this country keep on saying that this wont work and that wont work it will not manke the situation any better.

    We need to get this thing right for my friend’s sake, for our children’s sake but most of all

    FOR ALL BBARBADIANS SAKE!

    We need to assist oursleves.

    Forget about how ugly or how loud the minister is. (I dont think he cares how we feel anyway.)

    Let’s unite and make Barbados’ health system the envy of the world.

  32. Georgie Porgie Avatar
    Georgie Porgie

    JC
    Don’t expect me to tell Estwick how to do his work from exhile.
    I will never forget the day 9 years ago, when my brother who is a BLP stalwart, told me GP you better leff de island , there aint nuttin here for you.

    The DLP cronies will give the little insight that they have- if they have any.
    It is a natural fear for anyone to be scared if they have to be admitted to hospital- if they are unaware of what is happening.

    Re Most bajans do not have money to go overseas like Glyne Clarke and crew;
    We need to correct this nasty situation. If we as the citizens of this country keep on saying that this wont work and that wont work it will not make the situation any better.
    We need to get this thing right for my friend’s sake, for our children’s sake but most of all FOR ALL BBARBADIANS SAKE!We need to assist ourselves. Let’s unite and make Barbados’ health system the envy of the world.

    All this sounds so sweet but how will the citizens help themselves. You voted out the quiet amphibious minister and you vote in the impotent boisterous minister. What can the citizens do?

    I know what I was able to influence in 1985. I know too how I begun to advise the incumbent imbeciles.

  33. Georgie Porgie Avatar
    Georgie Porgie

    JC

    Suppose you had a old wooden house with wood ants in it…………….and you didnt have no lot of money, how would you fix it?

    Would you keep nuff noise in the village? Would you burn down the ole house? Would you go into debt in a big way to replace the ole house?

    What would you do?
    Same way the hospital can be fixed?
    Remember a lot has been done with the original structure opened in 1964.

    Maybe you might start in the back in the corner where the library and chapel and physiotherapy used to be? Maybe you would come across quietly piece by piece, thinking consulting. Changing things slowly quietly.

    Maybe you would do this by having all departments submit there ideas and you would LISTEN well to see if there are any merits in what they are saying,

    Maybe you will ignore what the medical illiterate civil servants in the ministry have to say, and listen more to the department hospital heads. Maybe Maybe Maybe. I dont know. I am far away in exhile. LOL

  34. Animal Farm Avatar
    Animal Farm

    Every time there is issue with the QEH, people villify the doctors…surely, they cannot be the ones that have run the institution into the ground. From my personal experience with a relative there as a patient, I can say that certainly the ‘junior doctors’ run that place. I watched them work day into night and then day again. Up and down….worked to the bone, trying their best.When could they have time to have the private practices people suggest? Perhaps those comments are aimed at the Consultant level staff. …
    It may be useful in the investigations and fixing of the QEH that a closer look at the ‘junior doctors’ and how they work relative to the Consultants. From where I sat next to my mother’s bed, something just is not right.

  35. Georgie Porgie Avatar
    Georgie Porgie

    Of course the junior doctors run the place- i.e they do the donkey work. That is how you get experience.

    You cant expext Consultants to continue doing the donkey work, because there wont be any work for the juniors to do to learn. The Consultants are there to keep them on tract.

  36. JC Avatar
    JC

    That is what I wanted to hear GP, suggestions!

    We have to try some where in order for things to work. There have been too many ministers of health!

    maybe if politicians start listening to persons who seem to have an idea and a very good one at that like yours then maybe just maybe they will be hope.

    Hopefully, I hope that the press secretary and crew of the pm are reading these blogs because most of the times

    the people are always right! I like your suggestions!

  37. Animal Farm Avatar
    Animal Farm

    I hardly think that caring for the ill and infirmed can be considered ‘donkey work’….
    While I agree that Consultants should ‘keep them on track’ and provide guidance, I question a system in which they appeared (to me) to slip in for a few minutes here and there leaving the juniors to struggle alone most of the time

  38. Bush tea Avatar
    Bush tea

    GP,
    For a man who admits to running from bout here due to professional pressures that were brought to bare on you, you certainly seem to have a lot of advice on this matter…LOL

    For those of us who have never had to manage a large complex organisation, we cannot even begin to imagine the difficult decisions that must be made on a daily basis.

    Many of these are HARD choices. The absolute worst kind of manager is one who cannot make hard decisions – who try to please everyone…. you can rest assured that his business will fall to pieces.

    Obviously the union is committed to proving that their position on creating a Board at the QEH was right, and are determined to frustrate the Board. …That they are also destroying our most important institution seems to be secondary.

    In the absence of working cooperation, the Board would be foolhardy to just sit back and allow the union to wag the dog.

    Sometimes, it comes to the point where there must be a clear battle -and let the best man win. Then we can move on. This is not a job for a sissy or coward – at last, Dr Estwick seems well suited to save this country’s health systems in the current circumstances.

    Those of us who operate in the fairy tale world where everyone smiles and shake hands to resolve all their problems and where there are no saboteurs, should make an effort to awake from our dreams…..

    With respect to the Doctors;

    I have said before, doctors are in the interesting position where they make more money when more people are ill;
    They make more money when the QEH is inefficient;
    They make more money when national health management is in shambles.

    It therefore takes a special doctor to truly put aside his personal affairs, his private practice, his ownership of his private clinic and investment in his pharmacy and lab – to work for the success of the QEH which, if successful, will erode his customer base….

    Why is it hard to understand the difficulty that the Board has in managing the QEH?

    Unless the environment is created where Doctors can win, where the QEH wins, and where patients win; then we will continue to have challenges -no matter WHAT anyone says…

    The solution?

    Somewhat like what was done to the PSVs.

    Unless the QEH improves in one year:
    1) Massive increased taxes on private clinics
    2) Use proceeds to pay high salaries to full time QEH doctors
    3) Create an INDUSTRIAL COURT NOW.

    …one of the things we do not have a lot of, are effective leaders, so I am surprised that so many of us know how Dr Estwick should proceed…

  39. Georgie Porgie Avatar
    Georgie Porgie

    Ok JC
    Just to please you!

    When Thompy selected Estwick to be MOH he should have applied a classification he must have learned in medical school for managing the post op patient.

    Immediate post op period ie first week after elections in this case

    Early post op period ie first six months after elections in this case
    Late post op period ie first year after elections in this case

    I would have put those headings each on a sheet of paper and I would have written down all the things that I thought that I should do in each of these time periods.

    Immediately i.e on the first day I sat at my desk, I would have summoned the consultants for the emergency room at the QEH and ask them to submit in one week thier suggestions for the staff and equipment they thought they should have to effectively improve the QEH ER.

    In addition I would have asked them to submit thier ideas of what proper and realistic triage systems should be put in place in the peripheral public clinics to enhance the delivery of emergency care, and simultaneously take the weight of the QEH ER.

    I would have done this very quietly, by letter email, telephone whatever on day 1.

    If I had not worked for the rest of that first week, man I would have accomplished more than the incumbent twit has done. Dont you think?

    BY NOW THESE IDEAS WOULD HAVE BEEN IMPLEMENTED PARTIALLY AT LEAST DEPENDENT ON AVAILABLE FUNDS. IN OTHER WORDS THEY WOULD HAVE BEEN HALF DONE IN THE EARLY PHASE POST ELECTIONS.

    With such a start, ideally by year end or January 12 2009, the desirable improvement in the emergency services would be well on the way.

    This would certainly involve the planning and implementation of training for all emergency personel in both the QEH ER and emergency personel in all the peripheral emergency centers at the poyclinics.

    Funds permiting, this could probably even include some provision for overseas training for some of the officers.

    See how easy it is JC.
    Would you believe that this info was communicated to the GOB on the same day the ministers were sworn in at the Oval?

  40. The scout Avatar
    The scout

    Any sensible person would realise, the doctor’s profession is like a faternity. Let’s say the minister start getting rid of senior doctors, all those fellows will walk out. What would we be left with junior doctors and interns? Who will suffer? Not the big boys, they can go overseas even by air ambulance if it’s serious or to Bayview or Sandy Crest. It is the average bajan who needs the QEH that will suffer. Even though the minister is a medical doctor, he can’t replace any of those consultants. Maybe he’s trying to prove that he’s bigger than them even though they are more qualified but again who’s going to get hurt in this power struggle. This reminds me I heard the goodly minister while campaigning shout in his unique way ” we want POWER,POWER , POWER”. It’s nothing wrong in wanting power but it is how that power is used that determine the character of the individual.

  41. Georgie Porgie Avatar
    Georgie Porgie

    Bush Tea

    I have not seen on this forum where anyone else has expressed any knowledge or ideas of how Dr Estwick should proceed… but I have read emotional outbursts.

    I might have had to run, but I have an understanding of our Health System and how it works. As a student, for my peculiar interest, I read about the various Health Systems around the world. So when I got the opportunity to opine on what should be done for Barbados, I think I was fairly accurate in my proposals.

    It is not known that the decision to run the National Health Service via a number of polyclinics by the then MOH Obrien Trotman was based on proposals I submitted to PM Adams in 1985. It was not done exactly as I proposed it, but it is a better system than following the original British System that impressed Adams as a youngster in the 5O’s. And it does work, doesn’t it?

    You write “ For those of us who have never had to manage a large complex organisation, we cannot even begin to imagine the difficult decisions that must be made on a daily basis.” But you will run the hospital like how you eat an elephant—- one bite at a time. Or actually a lot of little bites going on simultaneously here and there.

    You write “Sometimes, it comes to the point where there must be a clear battle -and let the best man win. Then we can move on.”

    I say that there is no need for any battles. What we need is a leader with a vision, and one who can communicate that vision. In the early 80’s the doctors had no plans to run a NHS like the British do. They were not going to sign to be in charge of a clinic 24/7 365 days a year; but they were willing to accept the two workers the government were going to give to their practices. At that time BAMP closed ranks, and were phoning around persuading general practitioners not to participate in the implementation of the NHS.

    I sent a note to Tom in early 1985 saying “Why are the Doctors and the Government fighting about the implementation of the NHS. This is what needs to be done.” He answered my note with a thank you, even though he wanted his idea to stand. But he died, fortunately. And we do have the foundations of a practical NHS that works for us. Meanwhile in the British NHS, doctors continue to commit suicide!

    Our NHS works, and it costs the individual nothing at the point of service. It needs only to be improved. You don’t have to have expensive insurance to go. We have a better system and service than the USA or the UK.

    Our system was changed from the old Vestry system etc without A FIGHT! What battle what? (to quote you lol)

    Doctors may make more money when more people are ill; but serious doctors cant be happy when the QEH is inefficient or when national health management is in shambles.

    If you are doing primary or secondary care, you need an escape route for when you cant do any more for the patient, or you don’t know what else to do with the patient, because you don’t have specialist training. You need the QEH to function!

    I never saw the success of the QEH as an erosion of my customer base. I was proud to know, or have been taught by, or have worked with, or gone to school with the specialists in the QEH, since these chaps could take my problems off my hands. The QEH in shambles is no good for a GP.

    Just this morning on the phone my mom told me that a certain old lady in the country called to inquire of me, and to speak favorably of the night I sent her to the hospital in 1981! All I did for that lady was to make a diagnosis and send her to QEH, to have surgery done that I could not do, nor had the facilities to do.

    Bush tea. I don’t find it hard to understand the difficulty that the Board has in managing the QEH. Most of the Board are medical illiterates. And the doctors on the board probably can only doctor— but nothing else.

    Some doctors can only doctor. Dont you know that? They can not think about anything else but medicine. They can not plan. They cant apply principles that they have learned outside of the medical scenario (cf my last post for an example.)

    I agree with you that fixing the health system in Bim is not a job for a sissy or coward but Estwick is not the answer in the current circumstances, as you opine. He has not shown me this in six months. We need someone with a brain. Some one who thinks! Some one who can out thinks the saboteurs, you are talking about! Estwick is definitely not an effective leader in my opinion.

    You err in thinking that the success of the QEH is a function of what happens in private clinics. Private clinics are involved largely in primary care or secondary (specialist )care; the QEH is involved with tertiary care. Massive increased taxes on private clinics is not the solution.

    Bush tea you boil your tea too long, and the tannins gone to your brain man. You will pay high salaries to the junior doctors? Man you need that same money to pay more doctors to expand and perfect the system. You need more Indians not chiefs. Trust me the chiefs are doing their jobs.

  42. Georgie Porgie Avatar
    Georgie Porgie

    The scout

    Sir you seem to have a grasp of the situation.
    If Estwick messes with any consultant, and BAMP disagrees, the doctors will close ranks. Estwick will lose the power struggle and end up with egg on his face.

    Junior doctors and interns can do the donkey work, but they need the expertise and advice of the Consultants. This can often be done by phone- except if it is surgery. And many of our juniors do surgical procedures that seniors do abroad. Ask any one who went to the UK to do their post grad exams.

    It is the average bajan who needs the QEH that will suffer in this power struggle.

    Again the scout you are correct It’s nothing wrong in wanting power but it is how that power is used that determine the character of the individual.

    Estwick needs a PLAN B, or he will have to beat a hasty retreat with PLAN R!

  43. Georgie Porgie Avatar
    Georgie Porgie

    @ Animal Farm
    Re I hardly think that caring for the ill and infirmed can be considered ‘donkey work’….

    Are you a nit picker?
    IT is called donkey work because HARD WORK or the MOST of the WORK everywhere in the world is called DONKEY WORK OK? We call it the same thing in cricket, don’t we.

    You can question a system in which the Consultants seem to you to slip in for a few minutes here and there leaving the juniors to struggle alone most of the time, as much as you like. But that is the system universally. NO junior expects a consultant to come do his work. The Consultants also had their time doing donkey work or “SCUT WORK” as the Americans call it.

    Since you do not know, listen and you will learn. Your questioning will not change it. Are you going to provide more interns? To expect a consultant to come and do the donkey work is hilarious. Why don’t you get the minister to come and do some of the donkey work too. You sound as stupid as David Estwick when he talks.

    Juniors should only struggle on days when their team is admitting. Juniors who come to work at eight and pace them selves , and MANAGE THEIR TIME well should not struggle. Now when you are admitting, that’s another story.

    But thats what you went to study to do- WORK as a doctor. When that chap becomes a consultant you then want to deny him his fees, and expect him to come do donkey work. LOL

  44. David Avatar
    David

    @Georgie Porgie
    We always give way to you on matters the BU household knows very little about but something is missing from your arguments which makes some sense of course. The problem is many of the approaches you have suggested may have been tried by other Ministers before Estwick, and they have FAILED.

    The reality of the small rock is that cronyism exist big time in Barbados. Doctors ‘making-out’ with nurses, patients making out with nurses, doctors and nurses making out, doctors and nurses making out with administrators, medical personal making out with prominent civil servants and politicos and it continues. This is not the USA Sir! This is a little island island called Barbados where incestuous relations exist.

    It is against this background that the complex operation of hospital management at the QEH must be applied. A commenter made the point before that the problems at the QEH straddle both political parties which moves the problem at the hospital into another realm.

  45. Bush tea Avatar
    Bush tea

    Well said as usual David,

    This is not a medical issue, it is a management issue, and the problem stems fundamentally from conflicts of interest of various parties.

    All sorts of approaches have been tried, by all sorts of people. I recall Richie’s intervention and we all expected positive results…

    After hearing Dr Estwick’s rant during the debate many issues finally became clear to me…

    I am more than happy to give him a chance to try his approach.

    GP is to far, to removed, and to much a doctor to understand the problems that the Board, and all the various QEH administrations have been facing….

    There is a time for quiet diplomacy, there is a time for fun, there is a time for listening – but there is also a time for action, for decisiveness – even for battle occasionally… this is the challenge of high quality management.

    … and a people ALWAYS get exactly what they deserve.

  46. Real Ting Avatar
    Real Ting

    Such is the power of a blog. the level of discourse on this topic is simply exceptional. it was a pleasure to read GP and Bush Tea propose rational although contradictory approaches to managing the beast that is QEH. I will say that i lean more towards Bush tea’s ideas but i will caution that if any progress is to be made after a battle then an escape which saves face must always be offered to the loser else he remains hostile, embittered, resentful and uncooperative. I will say to GP that for his proposal to work the doctors and employees have to want it to work and this may not be the case especially when you consider that a high level of apathy and general disinterest in results seems to exist particularly in Public service employees. Not all employees maybe not even the majority but enough to matter.

  47. Georgie Porgie Avatar
    Georgie Porgie

    David
    You and Bush Tea getting on as if 5 years over seas has caused me to forget my roots. You sound as if anywhere in the world including the USA have a better NHS than we do. What we have needs improving. You see, unlike you guys I understand our system.

    I don’t know that any other Minister has tried to improve the Emergency system as I have detailed. Do you? Tell me when. Please tell me when? Tell me when has any minister announced plans to improve on the delivery of health services at either the QEH emergency room or in the peripheral clinics since 1985.

    Since as you say. the problems at the QEH straddle both political parties, then what is needed is a non partisan rebel WHO HAS VISION to fix it. But Estwick’s rants and braying like Balaam’s ass will not fix anything, I promise you. The men will close ranks and crush him

    Also if Estwick wants the people’s support he must tell the people what he plans to do, and when and in what time frame, as I detailed in my glossing over the surface example of a plan submitted in this forum last nite……which you admit makes sense.

    You must make the jokers in the system part of the solution, and make them think that they are part of the solution. He has to gain respect. He does not have to be friends with them, but they must respect him as being knowledgeable.

    Everything that is complex can be made simple. You have to dissect the parts to understand and execute the whole.

    The hospital is not as complex as the human brain or the human body. In the same way that we can dissect and unravel the mysteries of the brain, we can fix the QEH, if we have the WILL to do so.

    Kieth Simmonds and Branford Taitt had a better approach. Taitt got a whole hospital renovated that the Bees let run to ruin. Taitt got a whole wing added on to the hospital for optometry. Then there were a succession of jackasses who brought or NHS to its lowest.

    In 1985 when I lambasted a certain minister of government about the Bees of that time fighting with the Government he persuaded me to talk with the them MOH. The result is history.

    Kieth Simmonds Branford Taitt and Trotman listened! Estwick is ranting and braying!

    David there is more cronyism in the USA and other places than there is in Barbados. Everything thing that you describe goes on elsewhere.

    David. I can stay here and tell you the wicked mean ugly jackass that Estwick listening too, from the time I read the remarks on Brian Charles.

    I don’t like Charles, but I know that many doctors in Barbados not getting out of their beds to drive to St Ann’s Fort early once a week to see the soldiers for the pittance you are (were) paid. I know also that it was not easy for Banny to get folk to deputize for him at the prison for a few weeks a year (again for a measly sum). And dealing with the prisoners is not an easy thing.

    Bush tea
    The issues at the hospital is both a medical issue, and a management issue, and must be dealt with by a BENIGN DICTATOR WHO HAS VISION!

    You must listen before you act. Then you quietly set things right man. I wish I could show you how I made the last offshore medical school at which I taught close down.

    I am not too much a doctor to be a rebel! And I don’t want no medical illiterates on any Hospital Board. How can medical illiterates decide the direction in which a hospital should go? How?

    Also you guys think too much about doctors and hospital when you talk of health matters. We should be seeking NOT to admit folk to hospitals.

    In the last ten years a lot of our best nurses migrated, or died out. There was a time when we were not training nurses as we thought we had enough, until we found we had none. Rapid training then could not replace those who had years of experience.

    No nurses or poor nurses = poor medical care.

    Richie had a commission of inquiry, but he could not intervene by himself. Politics screw up the hospital. It started with the big mout brawling animal L Thompson.

    After hearing Dr Estwick’s rant during the debate, I cant see how things could have become clear to anyone, except that after six months he still does not have a clue or he still does not have a plan. Fellas don’t get distracted with Estwick’s ranting. …… because the man talking nuff but aint saying nuttin or not reaching the standard expected.

  48. Georgie Porgie Avatar
    Georgie Porgie

    Real Ting

    I got to discourse at a high level on this blog on which David has appointed me the MOH emeritus! So I work very hard to earn my pick and the honor bestowed upon me.

    What Bush Tea what? It is time people stop drinking bush tea. They don’t even use bush to sweep the yard no more- we got patent brooms now for that. What Bush Tea what? LOL

    Don’t worry with Bush Tea Mr Real Thing. He not contradicting me. He and David just trying to force me to bring more proposals to the table. You think these two old fellas are idiots neh? They have the patience and necessary diplomatic skills to get the job done. I would like to appoint them to the ministry of health.

    Your caveat on how to deal with the man beaten in battle evinces that you like psychology.

    I believe that doctors are generally results oriented people. Doctors will go into the OR and attempt surgery on a patient knowing that they have little chance of success, and then come out of the OR vexed and deflated when the patient dies.

    One problem with Public service employees is that they need motivation. There needs to be a system of compulsory on going relevant training and assessment to assist in this.

    However, it has just occurred to me that I might be thinking as folk of my generation think, and maybe the youngsters don’t think like the oldsters do. I hate to think that my younger colleagues are less committed.

    Re I will say to GP that for his proposal to work the doctors ……..have to want it to work
    Well if they don’t you can just not renew their contracts. Simple.

  49. Real Ting Avatar
    Real Ting

    ok fair enough and i like the openmindedness and the willingness to tweak here and there based on feedback and differing opinions. what i will say about Dr. Estwick’s methods is that the big stick achieves the best results if there is a small carrot somewhere in the offing.

  50. Trained economist Avatar
    Trained economist

    I think we are also dealing with some serious issues of governance in Barbados.

    1. Does the security of tenure afforded to “independent ” senior civil servants such as a permanent secretary for example, apply to managers in statutory corporations? If so, what are the managerial type advantages of statutory corporations? How in effect are statutory corporations any different from government departments ?

    2. How is one to assess the performance of say a Minister, if security of tenure for senior employees prevents him from putting in place a management team that shares his vision for the organization and the direction of policy?

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