May the force be with you. A walk on the dark side.

There’s a wonderful article by Richard Collis in this month’s IPU Review.  I would love it if the IPU would make a pdf of it available and I could post it here.  (Or maybe they might post a copy on line themselves.)  He writes about his experiences on the PSI Council and the dysfunctional attitudes that seem to hold court there.  Things like despite the Corbally judgement the reluctance to use mediation because they want to be seen to be tough.  No regard to costs.

I am impressed by one of the closing statements.  “One final reflection: could it be that the culture of control among the Executive also reflects a lack of confidence in their ability to sustain their own views in a more open and combative forum?”

If you have a copy of this months Review I would recommend reading and studying it.  If not, get a copy.  It vital to all of our professional futures that we understand what is going on in Fenian St.

Advertisements

3 thoughts on “May the force be with you. A walk on the dark side.

  1. Having also walked ‘on the dark side’ I have to agree with every word in Richard’s article. The staff in the PSI are very committed and work very hard but there is a disconnect with the real, very messy, world we work in.When dealing with real, often very vulnerable, patients who don’t fit into neat pigeon holes no amount of guidelines or SOPs can turn grey areas into black and white, right or wrong.

    We need a degree of flexibility and trust to do our job to the best of our ability, often in very challenging circumstances. The public trust us. The PSI need to follow their example and loosen the control a little.They might get a pleasant surprise and find that we all want the same thing,even if we won’t always agree on the best way to achieve it.

    Like

  2. Shortly after being elected
    to Council, I met an old
    friend at the annual IPU
    conference. Tongue in
    cheek, he expressed
    surprise at seeing me there
    . . . “Now that I had gone
    over to the Dark Side”.
    The remark neatly
    summed up
    the ambivalent
    attitude of
    pharmacists to the
    PSI: a recognition of the need
    for regulation, tempered by
    the reality of high registration
    fees, police-type inspections
    and a Fitness to Practise
    regime not fit for purpose.
    All these issues, plus some,
    have cloaked the PSI with a
    mantle more Terminator than
    Regulator.
    My first Council meeting
    dispelled any impression of
    Fenian Street as a dour and
    Spartan place. Far from it, the
    building is modern, bright
    and replete with all mod
    cons. Executive and Council
    members alike were friendly
    and welcoming. The mood
    exuded bonhomie and ease.
    To this new member, it jarred
    somewhat, given that the
    general view of the PSI was
    one of an unsettling presence,
    wilful and intent on its own
    purpose. The induction
    process was, however,
    reassuring. Induction was
    the process whereby new
    members were briefed on the
    “Dos and Don’ts” of being on
    Council. It was like learning
    the old Catechism. Most
    readers won’t have had that
    experience so for Catechism
    they should substitute the
    OPINION Richard Collis MPSI
    Ten Commandments. Thou
    shall not do this, thou shall
    not do that . . . the system
    was sacrosanct. “R” is not
    the only thing religion and
    regulation have in common.
    What gradually became
    apparent on each and every
    issue was a culture of control
    within the PSI. This became
    tangible as a number of
    situations developed. A
    proposal early on to give a
    24-hour notice of inspection
    to community pharmacies
    was defeated. The defeat
    in itself was not the issue
    but the efforts on the part
    of the Executive to kill the
    proposal went beyond what
    was acceptable. A 24-hour
    notice would give pharmacies
    an opportunity to ring fence
    the dispensing process
    during an inspection. The
    proposal was made on the
    basis of public safety, making
    Executive opposition hard
    to comprehend and a little
    worrying. A new model of
    inspection involving selfaudit
    has been subsequently
    introduced. This was an
    initiative that originated from
    the Executive and from start
    to completion was very much
    its sole preserve. Knowing
    one’s place in the hierarchy
    was no longer implied, it was
    explicit.

    Like

  3. Sometime later, in April of
    that year, relationships on
    Council came very close to
    being shredded. This was a
    consequence of the infamous
    email affair. It lasted for
    over a year and interrupted
    the normal flow of business.
    Rather than bore you with the
    details, suffice it to say, the
    whole affair was complicated
    and contrived. The Executive
    sought to control and shape
    the outcome of events,
    regardless of some very
    uncomfortable facts. What
    emerged during this period of
    turmoil was the crystallising of
    a complex set of relationships
    in the Council room.
    Normal relations gradually
    improved as these episodes
    receded. Central control,
    however, never diminished.
    The structure of Council
    meetings facilitates the
    Executive grip on proceedings:
    mountains of information
    and jammed agendas, with
    no attempt to prioritise for
    efficiency and effectiveness.
    Space for debate and
    discussion contracted before
    our eyes. Subcommittees
    are now the fulcrum around
    which policy is advanced
    and developed and Council is
    morphing into a rubber stamp.
    It is reasonable to ask
    whether this control
    undermines the quality of
    what the PSI does. July 2016
    saw an item on the private
    agenda that was openly critical
    of the process associated
    with Fitness to Practise. The
    complainant was the former
    chairperson of Fitness to
    Practise in the PSI. Again, to
    cut a long story short, suffice
    to say, the issue was buried,
    despite the pedigree of the
    complainant. The PSI is in
    denial; it fails to recognise and
    accept that Fitness to Practise
    is not a process where one
    size fits all. A footnote to the
    handling of this agenda item
    was the putting to one side of
    the issues surrounding conflict
    of interest.
    Contrast this with the
    way the Future of Pharmacy
    project was dealt with;
    dark and light. This was an
    updating, but in essence a
    bells and whistles version
    of a document called
    Pharmacy 2020. Such was the
    eagerness to progress the
    project, no regard was given
    to why Pharmacy 2020 failed
    to achieve any of its goals.
    Without reflecting on the
    failure of the old document
    to impact on health policy,
    what are the chances for
    success with the new project?
    However, for the PSI, there
    is a cachet to be associated
    with producing such a wellresourced
    paper on pharmacy
    practice. It was hard to escape
    the sense that image appeared
    more relevant than substance.
    Image also looms large
    in consideration of Fitness
    to Practise. The process in
    place is time-consuming,
    costly, stressful and often
    disproportionate as a
    consequence. However, the
    resulting enquiries attract the
    media and, through this lens,
    the PSI hopes to be seen as a
    tough robust entity, stoutly
    defending the public interest.
    Yet, uniquely among health
    regulators, the PSI has the
    capacity to comply with the
    instruction of the Supreme
    Court Justice, the late Mr
    Justice Hardiman. In his
    judgement on the Corbally
    case, he asked regulators to
    seek less adversarial methods
    for resolving Fitness to
    Practise issues. In section 40
    of the 2007 Pharmacy Act, the
    first option is mediation. It has
    been used once in 10 years
    and even then there was an
    ulterior motive. Mediation can
    achieve the same remedial
    outcomes at a fraction of the
    cost, in a fraction of the time.
    Much waffle and wind has
    been expended explaining to
    Council members why it is not
    used. The original excuse was
    that it is not in the right part
    of the legislation; the ultimate
    excuse was just plain “Shut
    up”. There was a four-year
    gap between the two, with
    many opaque explanations in
    between. A suspicion lingers
    that mediation is where it
    is because it would not be
    an attractive option for the
    media. It lacks the ‘gravitas’,
    or maybe ‘drama’ is a more
    accurate word, of a court
    setting. The upshot of this
    for the PSI is that the less
    adversarial approach provides
    no lens for the public to
    appreciate their sterling work.
    In being critical of the PSI,
    it is only fair to outline the
    space it occupies and the
    environment it operates in.
    The PSI’s remit is to protect
    the public interest, having
    responsibility for registration,
    education and inspection. The
    PSI is funded by the profession
    and is accountable to the
    Minister for Health. This is the
    relationship that has priority.
    On the plus side, however,
    there are signs of change
    as was evidenced by the
    creation of the Nominations
    Committee following a
    recommendation from a
    governance report. This
    is a positive development
    as membership of
    subcommittees will be more
    focused on required skillsets
    in the future. It is now on the
    public record that mediation
    can be used in “Certain
    Fitness to Practise cases”. This
    emerged from a report by a
    subcommittee set up in July of
    last year, again on the back of
    the governance report. There
    is, at the moment, one case
    being dealt with by mediation.
    That, finally, is progress.
    It needs to be said as well
    that pharmacists’ attitude
    to the PSI, “keep the head
    down and hope they go
    away”, is not helpful. For
    such an organisation to work
    effectively, there needs to be
    a productive tension with
    its stakeholders. That is not
    the case at the moment.
    Significant funding from
    pharmacists and pharmacies
    makes its way into Fenian
    Street every year – €7.3 million
    last year. We, as a profession,
    do the Regulator no favours by
    our apparent passivity. If we
    don’t ask the hard questions,
    no one else will.
    One final reflection: could it
    be that the culture of control
    among the Executive also
    reflects a lack of confidence
    in their ability to sustain their
    own views in a more open
    and combative forum? Now
    wouldn’t that be ironic.
    There is new leadership in
    Fenian Street. It’s to be hoped
    that a greater self-belief
    will take root, bringing the
    organisation out of the dark
    and into the light.

    Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s