Several people have contacted Baybuzz Thursday evening with the information that Ron Hall, chairman of the board of Presbyterian Support (PSEC), has resigned.

We presume this is in connection with the Cranford Hospice situation.

We see this this as the first step in the separation of PSEC from further involvement with the management of Cranford Hospice.

Here is a DHB media release from Thursday afternoon that implies as much. In part it says:

“Dr Snee [CEO, DHB] said it was critical to the future of Cranford that it had a robust governance structure to make sure it could provide the excellent service the DHB and the community required of it. The DHB is committed to ensuring that the Hawke’s Bay community has an integrated palliative care service, where, depending on the patient’s needs, quality care was consistently and seamlessly provided, be it in the home, hospice or hospital.

“It’s imperative the public remain confident in Cranford and its palliative care service. It is also essential at this time, particularly as emotions are running high, that the DHB ensures the work that has started is undertaken thoroughly and with some urgency.

This will involve changing Cranford’s governance arrangements as well as reviewing the organisation and management structure. We expect this process to be complete within six months.” Dr Snee said.”

Things are looking up for Cranford!

Tom Belford

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28 Comments

  1. CRANFORD HOSPICE

    If you or your family ever require the care, compassion, empathy and support that the staff at Cranford Hospice invest on a daily basis in their patients, ask yourself – were you there for them in their hour of need? Read on…

    In summary, a highly respected individual with a long association with Cranford was so concerned with the extremely poor management and governance by Presbyterian Support East Coast (PSEC) at Cranford Hospice. They felt it was their duty to the Hawkes Bay public to make a complaint to the Health and Disability Commission (HDC) only after exhausting all other avenues. They did this on behalf and with the assistance of the frontline staff (nurses) who over the preceeding 3 years had followed proper process in attempting to address those concerns. They were all the complainants

    The complainant(s) requested that their privacy and anonymity be maintained. An e-mail sent by them to the HDC went from the HDC to the CEO of Hawkes Bay District Health Board (HBDHB). Inexplicably this in turn ended up with PSEC and Cranford management. PSEC in turn confirmed the identity of the complainant to Hawkes Bay Today. Hawkes Bay Today (the Ron Hall connection) not surprisingly misreported what the Cranford issues are really about. That PSEC and Cranford management in a memo to staff stated, “..we must strive to preserve the trust and confidence of our patients with regard to privacy of information.” and then leaked the identity of the complainant(s) is astonishing hypocrisy. It is also a breach of the Protected Disclosures Act 2000 Section 19(1)(a) + (b)(ii).

    PSEC instigated a private investigation by Abraham Consultants Ltd ( ACL) to attempt to elicit the identity of the staff who were supporting the original complainant. They informed the frontline staff at the hospice that their investigation had been sanctioned by various bodies, including the audit body – Central Region’s Technical Advisory Service (CRTAS), HBDHB, the HDC and the Nursing Council of New Zealand. A memo (dated 1st April 2010) from Barry Keane (Executive Director of Cranford Hospice) informing staff of the impending investigation by ACL was attached to an e-mail from the original complainant to the HDC. What does it tell staff when they find private and confidential correspondence to the HDC attached to a memo from Hospice management announcing a further investigation. It confirms the intended impression, that the HDC were sanctioning this further investigation. Hospice management never informed their staff of their rights not to be interviewed or to have counsel with them. Compare how PSEC/management acted with Shaun Robinson’s statement in the media release dated 10th February 2010, “A formal process such as this is the right way for people to raise concerns.” There is a stench of hypocrisy about this statement.

    Not surprisingly the HDC have confirmed that nobody in their office knew about the investigation and have stated that nobody would have sanctioned it. The Nursing Council of New Zealand have confirmed they knew nothing about this matter and would not have sanctioned it.

    Section 73 (d) of the Health and Disability Commissioner Act (1994) states “Every person commits an offence against this Act……..who, represents directly or indirectly that he or she holds any authority under this Act when he or she does not hold that authority.”

    With regards to the official audit by CRTAS on behalf of HBDHB, can you really label this an independent report when HBDHB is one of the four North Island District Health Boards that own CRTAS. Some important points and questions about the audit;

    1) Its verdict on management is damning. However CRTAS / HBDHB talk about “…change management…”. A phrase that allows more Cranford funds to be wasted on consultants without addressing the problem which is the PSEC management itself. All Cranford needs is decent independent leadership away from the control of PSEC and HBDHB.

    2) The majority of nursing staff at Cranford work 4 days out of 7. This decision was taken years ago by previous management ( in consultation with staff ) who wanted to limit the stresses placed on nursing staff. Its much easier looking after the people who look after the dying than looking after the dying!

    3) Not one of the frontline (non-management) staff are disillusioned with Cranford. However they are all disillusioned with the management of Cranford and PSEC. Nor are they resistant to change, they are just resistant to ill-considered change.

    4) The audit also comments on the nursing staffs limited postgraduate qualifications. The nursing staff at Cranford have had their requests for educational and clinical advancement declined repeatedly by management.

    5) The audit also comments on medical guidelines and nursing documentation. This is the responsibility of management. Quality management is an invogue phrase which management invoke to create more management posts at the expense of clinical staff. It also enables abdication of responsibility by the people at the top, “It was not our fault, we did not have a quality manager.”

    What input did the HBDHB have in the final report? Somebody has included the statement , “..they have discharged their obligations under the ERA.”. There was no legal personnel on the CRTAS team so it can only be assumed that this statement was included at the behest of either the DHB or PSEC. It was particularly foolhardy knowing that PSEC were carrying out its own private investigation into the original complaint.

    • Why were the complainant(s) not furnished with a copy of the report prior to publication?

    • Why was PSEC furnished with a copy of the report prior to publication?

    • Will ACL’s investigation ever be made public?

    • If this truly was an issue about leaking confidential patient information why did they not ask the privacy commissioner to investigate?

    Mr Shaun Robinson (CEO – PSEC) in an e-mail ( 3rd May 2010) stated , ”..the decision taken to investigate was taken by a committee of senior staff and board members.It was decided to use independent people so as to ensure no bias in the process.Proposals were taken from several firms and ACL were chosen on the basis of their proposal at the recommendations of our HR advisor.” For the record every private investigator locally and the larger national firms have been contacted and none of them were approached. Not surprisingly PSEC management have declined to comment. They have also refused to state for the record who was on this committee. However if they are prepared to lie in an attempt to throw some credibility on their flawed investigation you have to ask what else are they lying about?

    Perhaps the most telling response again comes from Mr Robinson (CEO – PSEC). On questioning about the sudden emergence of the Cranford Endowment Trust on 13th March 2010, he stated “It was they that suggested having the ability to apply funds to other areas only in the event that Cranford was no-longer active.”

    WHO THINKS PSEC AND THE HBDHB HAVE ALREADY CHOSEN THE NEW NAME?

  2. What a mess to have had going on around and among the terminally ill. One hopes there will be a broad brush sweep out and public appologies to front line workers. Yeah right.

  3. I agree– one down and two to go.

    Pressure from the public must be kept up.

    We, the public have a stake in this, our hospice, and we must not lose it through apathy.

  4. I have never had an association with Cranford Hospice and I hope I never do, but from reading the dialogue, it seems apparent that there are severe issues with management of this much loved establishment. I have never met Barry Keane or Shaun Robinson, but they sound like cowboys! Get rid of them. It seems obvious that new governace is needed – nurses should not be used as a scapegoat for poor management. New managers, it would seem are far easier to replace than nurses who work in such a demanding job – i can honestly say I have always had the utmost respect for those that choose such a vocation. Pull your heads in PSEC and rid yourselves of these poor performers.

  5. I couldn't agree with your sentiments more Mr Hibberd.

    The only fit place for Keane and Robinson is the rodeo!

    A palliative care facility should be operated by individuals with a genuine interest in, and passion for the care of those with termianl illnesses and not by those simply "in it" for their own personal gain.

    To Keane and Robinson, dismount your horse's boys before they "buck" you off!

  6. Citing ill health as a cause for you stepping down from Chairman of the PSEC board Ron Hall is hardly surprising, I would would be sick too, if i knew i was a part of leading such an abysmal mess. If you were responsible for authorising a Private Investigater to interrogate nurses – shame of you. I certainly will not be contributing to the coffers of Cranford in the future, if this is how money is spent.

    I have always contributed to Cranford hospice, and willingly so, like so many others in hawkes Bay – confidence is now lost. Who suffers – the poor patients and families. I pray for those in need of hospice care and i pray for the nurses.

  7. Well done Lawrence Yule.More to go. Priority now,ensure Cranford Hospice stays open,

  8. CRANFORD – WHAT CAN YOU DO?

    It is not OK in a community to treat some of your most treasured assets appallingly and then assume the rest of the community will absolve you of any responsibility.

    It is not acceptable to subject employees to an illegal investigation just because you did not like what they had to say.Equally it is not acceptable to be the person doing that investigation just because your being paid.

    It is not acceptable to polish & spin the perpetrators reputation just because your being paid (handsomely).

    Not knowing the full extent of what your CEO is doing on behalf of your organisation if you are a board member is not an acceptable excuse – make yourself aware.

    It is not OK to distort the truth and tell lies just because your editor is beholden to certain individuals.

    "..Times are hard…" is simply not an acceptable excuse for participating in squalid, dishonest and immoral behaviour.

    It is only fair to affect change and hold people to account if they will not change their behaviour voluntarily, So:

    1) Do not buy or advertise at Hawkes Bay Today or any of the smaller papers owned by the same group.

    2) Do not donate or stop donating to Cranford or PSEC until PSEC relinquishes control of Cranford.

    3) Do not use individuals who assist organisations like PSEC, such as;

    – Grow (Design & Advertising)

    – Newland Directions (Change management – ???)

    – Abraham Consultants Ltd

    (PI/debt collection/evictions/repossessor)

    – Any lawyer who decides to represent PSEC

    Instead find other providers of the service you need in the community.

    E-mail not Mr Snee at HBDHB but the board members.

  9. Who is Stephen Fox? He has an alarming certainty about his judgements, and, for all I know he may be right.

    This whole mess is such a sad commentary of the human character. Desperatly craven face saving or vociferous finger pointing by one lot or the other.

    For God's sake, please get Cranford Hospice back into operating order. My love and compassion goes to the terminally ill and their families. It is 'not acceptable' for them to be in this situation.

  10. Amen to the sentiments expressed in your last

    paragraph Kay. What we all pray for will not be delivered until those who created the mess are dispatched as far away from care giving as is possible. Cape Canaveral should be contacted

  11. What alarms you about Dr Fox and his statement Kay – His certainty or the judgements he has made?

    He clearly has taken the time to investigate these issues. He has not mouthed any meaningless platitudes but simply stated the obvious. You can have an operating Cranford if that is all you desire but it has to be operating in the right way.There are many of us who feel that people should be held accountable for their conduct.For the vast majority money is not everything!

    Again listen to the message do not start shooting the messenger.

  12. I am sorry Kay that you feel you can refer to the frontline staff at the hospice as "..by one lot or the other..".

    For the record I have net met or worked with anybody that I have mentioned. I have made it my business to find out relevant facts and ask questions.

    If it is my certainty that you find alarming all I can say is why?

    Would you rather I spout worthless platitudes and half-truths not knowing the facts?

    I personally do not who you are? However I freely concede that does not bar you from expressing an opinion.

    If you want to know who is doing the "…desperately craven face saving." or "…vociferous finger pointing…" ask for copies of all correspondence (under the OIAct -1982) between Cranford and HBDHB. Start asking questions of the PSEC executive & board.When it is clear they are prevaricating, obfuscating or lying you may find you reach the same conclusions as I have.

    Finally its all to easy to make blithe statements about a problem it takes alot more effort to do something about it.

    Dr Stephen Fox

  13. This Wednesday, 12 May, is International Nurses Day, a time to recognise the huge and important contribution of nurses to so many aspects of the health of our communities. Way to go, Presbyterian Support!

  14. A recent posting to http://www.baybuzz.co.nz by Stephen Fox in response to your item “Presbyterian Support Chairman Resigns” contains a number of inaccuracies. While opinions may, and clearly do, differ around the rights and wrongs of this issue it is important that all commentators ensure the information they present is accurate.

    The DHB responded to the HDC complaint around care at Cranford Hospice in line with its Complaints Management Policy and did not disclose information to PSEC which was requested to be held as private and confidential. Furthermore, HBDHB does not consider that it breached the Protected Disclosures Act 2000. HBDHB advised PSEC against instigating an investigation by a private investigator and did not in any way sanction this investigation into the breach of confidentiality by PSEC staff. Finally, and in regards to the audit process, as is standard practice, both HBDHB and PSEC were provided an opportunity to correct any errors of fact prior to the final report being released. The audit team included legal expertise (one of the team members was a barrister, solicitor and accountant).

    We are keen that the Hawke’s Bay public has confidence that, while this process is clearly causing some anxiety and distress, we are taking all possible steps to move Cranford forward and return inpatient services to the Hospice as soon as the right structure and systems are in place to ensure safe, quality patient care.

    Kevin Snee

    Chief Executive

    Hawke's Bay DHB

  15. Hi Mr Snee,

    As you would rather answer questions in the public forum;

    1) If this indeed was an independent audit, why was it only the HBDHB and PSEC executives had a chance to view the report prior to publication?

    2) As you are aware I have requested the preliminary reports under the OIA(1982).Until then give us all a heads up – what changes were made to any "…errors of fact.." under request by the PSEC or HBDHB executive.

    2) Can you actually state for the record what my inaccuracies were?

    3) How did the original complainant(s) e-mail travel from your office to the PSEC executive? (I know how you are goung to try and defend this by the way – it wont wash)

    4) What is the "…breach of confidentiality by PSEC staff…" that you refer to? (identifying concerns to the HDC?)

    5) Can you tell me which one of the audit team sanctioned the phrase "…have discharged their obligations under the ERA…"?

    6) Was this phrase inserted at the Behest of either PSEC or the DHB?

    Thanks

    Now that you have confirmed that the DHB advised PSEC against Abraham's investigation.

    6) Who at HBDHB advised against Abraham's investigation?

    7) On learning that PSEC were carrying out an illegal investigation (rugby tackling the Protected Disclosures Act) did you inform the HDC?

    8) What action is going to be taken against the PSEC executive by the DHB for the way they have treated their staff ?

  16. A well written clarification Kevin, good on you!

    However, you are allowing the restructure of our valuable community service (Cranford Hospice)to commence at the point of "nursing care" rather than the point of Cranford Management, (more specifically Keane and Suanderson).

    What couldn't be any worse is that the same incompetant management is currently steering the reemployment/ redundencey of the nursing/palliative care staff, which by one way or the other will see a considerable loss of experenced Palliative Care providers within Hakes Bay. I do not agree this is what the community would see as acceptable.

    Where do you or PSEC beleive they will get repacement staff, Nursing or otherwise from.

    This is Hawkes Bay not New York!

    Current Hawkes Bay Medical staff wont apply or reapply, as the case may be, for any position as they will not work in the same building as Keane or Saunderson.

    Wake up man, show leadership and manage the change by starting at the top not the middle or bottom.

    The top is where the problem has surfaced from. Cranford leadership has been non exsistant. Make PSEC and its current Cranford management responsible. It would happen in any other business when the busniess that receives an Audit as daming as all involved have highlighted!

    Give the community something to be proud of. A Cheif Executive that can not only see deficencies where they lie, but also governs this Hawkes Bay Icon with sound leadership and determination so that the total "Best Practice" service can be provided back to "your" community.

    Have a meeting with the Nursing and other Cranford staff! Ask direct questions to them rather than accept Cranford management answers, I bet they would be more than happy to respond in truth. You just might have your veiws corrected.

    We have read the report also. At no time did it recommened the wholesale removal of Nursing and other staff. It did mention that Cranford requied help!

    Good Luck Kevin, we know you can do it!

  17. Sorry posted it incorrectly.

    Come on Mr Snee – Answer all the questions!

    Clearly and concisely – NO FUDGING

  18. REPLY TO MR SNEE:

    Again Mr Snee – can you detail which assertions that I have posted that you believe are inaccurate?

    In an e-mail to me last week you stated, “I am not aware of anyone leaking the name of a complainant to any media outlet”. We are glad that you are now fully conversant with recent events. You have not denied my assertion that an e-mail from the original complainant to the HDC that was forwarded to your office, somehow made its way to the PSEC executive. Subsequently PSEC confirmed the identity of the complainant to hawkes Bay Today. In your posting today you state, “Furthermore, HBDHB does not consider that it breached the Protected Disclosures Act 2000”. Of course you would not consider that you have breached the Protected Disclosures Act 2000 – you are of course innocent until proven guilty!

    What is your defence going to be Mr Snee;

    a) The complainant was not a current member of staff at PSEC and therefore the concept of protected disclosure does not apply.

    OR

    b) The HDC did not spell out to you that this was a protected disclosure.

    Today you have stated, “HBDHB advised PSEC against instigating an investigation by a private investigator and did not in anyway sanction this investigation into the breach of confidentiality by PSEC staff”. There are two very important points to make here;

    1) You were aware that PSEC were instigating an investigation into a protected disclosure and all you did was advise against it! Why did you not contact the HDC or speak to the PSEC board? Was this formal (e-mail) advice or just verbal?

    2) I assume you mean by breach of confidentiality (by PSEC staff) the patient details that were passed onto the HDC. Are you seriously suggesting that this was a breach of confidentiality?

    It is not actually “…standard practice…” to allow any organisation that you are independently assessing the right to edit your findings.Particularly if you have openly stated that you have concerns about management and governance. I am surprised that you feel using the word audit somehow excuses this! It is blatantly obvious to everyone who has made the effort to find out about PSEC’s conduct that the insulting statement, “…they have discharged their obligations under the ERA.” serves one purpose. It is meant to facilitate the redundancies (“restructuring”) at Cranford. I will be very surprised if any lawyer would put his name to this statement.

    “I’d love it” (Kevin Keegan) if you proved me wrong Mr Snee. I think the DHB wants to restructure (reduce) the palliative care services in the bay as a money saving exercise, so;

    1) Make a pledge that no Cranford nurse will face mandatory redundancy.

    2) Push for Cranford to become independent with its own board.

    3) Make a complaint to the HDC about PSEC’s illegal investigation of a protected disclosure.

    To all members of the Hawkes Bay public contact the DHB Board members directly.Start with John.Anderson@hawkesbaydhb.govt.nz and register your support for Cranford.Tell Sir John “its just not cricket!”

  19. Methinks thou doth protesteth too much, Dr.Stephen Fox !

    You are starting to " damage" a worthwhile cause with your borderline histrionics…..wind back on accessing your feminine side or just take the meds ?!

  20. I hope you don't mind Mr Pharazyn but I will take my cues from the many people who have contacted me.

    Are you hoping that I am hysterical or mentally ill so that I might be a suitable candidate for LOVEONLINE.CO.NZ . I think what the world needs in its present dire situation is more internet dating sites Mr Pharazyn – keep up the good work. Maybe you will provide all those laid off with free membership it will be just what they need as recompense!

    P.S, damnant quodnan intelligunt

  21. Helpfull measured clarification for laypersons like myself. Thank you H.G.Sanders

    I never doubted Cranford front line nursing was good.

    The same applies in the Regional hospital where I have been a patient many times over the past 20 years the last 3 in cardiac care one step away from goodbye in 2007 and 2009.

    Public support for our angels is well earnt.

  22. I find it reassuring that the HBDHB recommended PSEC not involve a Private Investigator. Thank you Dr Snee.

    I notice that PSEC and the DHB were able to comment on the audit. I would like to also.

    There is a perception (mainly from newspaper headlines and PSEC statenments) that nursing care at Cranford has been inadequate. I'd like to point out that it is the paperwork that has been found to be inadequate, not the standard of nursing care.

    Lack of continuity. Management appear to be using this observation as an excuse to get rid of nurses who have been vocal patient advocates – now labeled as “resistant to change” and replace them with fulltime staff.

    Earlier management recognised the stress involved in Hospice care and deemed 32 hours to be “fulltime”. Nurses with flexible nursing hours are essential to cover rosters where work load can change from one day to the next, and to cover holidays, sickness etc.

    Where once all nurses on duty involved in a patient's care were part of the planning of the care for day, now it is only the “lead nurse” – hence the lack of continuity.

    Post Grad Qualifications: These are hard to come by when the Nursing Director has been unwilling to endorse applications for such – even though it would have been at no cost to PSEC.

    IV designation for nurses. The then nurses obtained these some years ago, but were not able to keep their designation as they need to do a stated number per year to keep it current, and IVs are rarely used in Palliative Care, except for planned procedures undertaken by Drs. Good Palliative Care intervention is usually less invasive.

    Pharmacists… do not do the work of Drs! Their job descriptions were based on those of Clinical Palliative Care Pharmacists in the USA, where they have always been considered an essential part of the team. With their knowledge of medicines, perhaps it is no surprise that Cranford used different medicines to other hospices.

    Sedation. The aim is symptom control, not sedation. Cranford studies have found that Flunitrazepam is less sedating, leaving patients able to communicate for longer, and patients prefered it. It is used extensively throughout Asia, including in over 50% of Japanese hospices.

    Let's get the findings of the audit in perspective!

  23. Calls for New Trust for Cranford

    Hastings Mayor Lawrence Yule is promoting the establishment of a separate trust to run palliative care in Hawke's Bay.

    This push follows DHB Chief Executive Kevin Snee’s announcement last week that the Hawke’s Bay District Health Board will be reviewing the governance arrangements for Cranford House.

    “I cannot sit back and watch what‘s happening here. Cranford is closing its in-house bed unit on May 17 and it’s a disgrace that it has come to this,” Mayor Yule says.

    “I am doing what I can to stop the closure but I’m concerned it can’t be avoided. A lack of medical staff is the principal reason for the closure and fixing that in the short-term is a difficult task.

    “I’ve had numerous requests to set up a separate trust to solely concentrate on running Cranford, including the outpatient care service. There have even been suggestions an existing trust could be modified to take on Cranford,” Mayor Yule says.

    “As I have investigated the issues involved it’s clear to me that a complete new start is needed at the governance level. Presbyterian support has advanced Cranford in some areas but it’s time for a specialist Trust to take over, similar to the trust which runs the Lowe Corporation Rescue Helicopter Service.

    “A number of people have come to me over the weekend expressing significant concern about the damage to Cranford’s name in the community and the affect that will have on the great fundraising events that support it. I’m confident that Hawke’s Bay people just want to support and fund Cranford.

    “This Trust could work much more closely with the DHB to give the best possible care to our community. It needs to be simple, transparent and clearly understood. I know people will support this,” Mayor Yule says.

  24. You have hit the nail on the head Mr Sanders.

    The only logical deduction is that HBDHB/PSEC wish to reduce the nursing numbers at Cranford. I think that is the point that Dr Fox has made. The audit has been damning on management but the criticism of the nursing staff has been much overblown.Of course they do not have to reduce medical staff at the hospice because they do not have any.Which is probably the reason why medical issues got a clean bill of health

    Mr Snee's post raises more questions than it answers.

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