Thursday, 18 April 2013

Robert Francis Has a Point

Two points in this article resonate with me, and I am sure with many of my peers - the first is the one that makes it to the title of the piece - every patient needs ONE hospital doctor who is responsible for their care.
My instinctive response to this is 'absolutely. It's the way it used to be before the wretched European Union stuck their oar in'. The contrary argument is that doctors need to go home or go on leave sometimes, but patients still need looking after. although the system clearly failed at Mid staffs it did not in countless other hospitals in England. The broader point is that the current norm, i.e. the involvement of many junior doctors and consultants in the care of a patient, carries risks. It is also clear to me where the risks originate from - inadequate handover. Sort handovers out (and technology has an important part to play here), and the risks will diminish. The increased use of MDT working in the management of patients may also be associated with a dilution of accountability and responsibility - here Robert Francis has a point.
The other part of the article that really resonated with me was Robert Francis's observation that 'in the NHS, nothing gets done because nobody has been told to do it' - or words to that effect. This must surely be the greatest weakness of the current model that has been chosen for the NHS - the top down, central control model. The QC is absolutely right - nothing gets done, unless there is a carrot or a large stick dangled in front of managers. It seems to me sometimes that NHS organisations have lost the power of independent thought. They only look upwards for guidance, and yet it is patients and their own staff that probably hold the key to the future. This way of working also makes a mockery of all the efforts of the NHS to develop leaders. Progressive patient empowerment will mean the current model is doomed to fail, eventually.