LETTERS
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From: Mr Simon Dodds, Clinical Director for Outpatients, Access, Booking and Choice, Heart of England NHS Foundation Trust Subject: NHS reform – the opti- mists, pessimists and wait-and- sees
The division into three camps is called the Adopter Curve, as de- scribed by Everett Rogers dec- ades ago – and is expected group behaviour. The error is to see this as a ‘right-dunno-wrong’ score and to attempt to have a debate between the optimists and pes- simists with the fence-sitters watching.
To achieve cooperation and en- gagement the early adopters (the let’s give it a go group) need to do just that, but in a defined context, such as a pilot and using the ap- propriate tools.
Research methods and compara- tive statistics are the wrong tools because they are not designed to measure change-over-time. This gets us to the root of the problem that is fuelling the unproductive debate; neither NHS managers nor clinicians are aware of or have been trained in Improvement Science or to use the tools re- quired for specifying, designing, testing and implementing the processes and systems required to support a massive change in productivity. This unintended skill gap will need to be recognised and addressed before significant and sustained improvement can be achieved. I know because I have experienced the paradigm shift from blissful-ignorance via painful-awareness to know-how.
From: Dr Jonathan Sheldon, Medical Director, Burton Hospitals NHS Foundation Trust Subject: NHS reforms
The NHS has never been in better health and whilst I subscribe to the concept that clinicians know best, the PCT system was beginning to work and only needed clinicians
the expense of service provision – the NHS is over-managed.
Just to play devil’s advocate; is there a real need for General Practice as we know it? Walk-in centres can provide primary care at the cost of continuity.
From: Dr Stephen Kirkham, Poole Hospital NHS Foundation Trust Subject: GP commissioning
(and I don’t mean just GPs, but hospital consultants and nurses and paramedics) to be within the decision making process instead of excluded. The GPs have a very definite conflict of interest and no experience nor governance structure to run the new commis- sioning service.
I am more worried about the con- cept of any willing provider. Any private company can deliver the straightforward medical services e.g. hernia, varicose vein repair, cataracts, and hip replacements; that is, most day case work. But this then leaves an understaffed hospital to deal with expensive emergencies, loss-making servic- es and rotas for out of hours care. Heaven help the frail elderly, as I really don’t know who will care for them.
I would work for any solution that protected our patients against ri- diculous political agendas.
From: John-Charles Valerie Subject: NHS reforms
It is essentially right that there should be change within the NHS and how the cake is sliced. I find
too much ideology based on an old fashioned system that is more to do with needs of government and the political system, inclusive of some health professionals who are unwilling to be more flexible in their approach to care. The result is quite often not dealing with the real issues as we see ill-health still rising, with screening not aimed at the ‘right people’.
Although there have been many improvements, I have witnessed so much waste over and over again within the NHS, together with endless service redevelop- ment and the never-ending flood of consultants who come in and repeat bits of work already under- taken.
I strongly believe that primary care is the base of the health service and should be maintained but modernised with real outcomes based on patient outcomes. Incentivise the real providers of primary care and listen to them – the clinicians (do not forget the nurses). But they cannot just be concerned with their practice; they must see the health needs of the whole community as impor- tant. We need change, but not at
With regard to a National Health Service, it is not the possibil- ity of private providers which is frightening, but that GPs (who are independent contractors, albeit fully funded by the NHS) are quite likely to draw the man- agement support for their con- sortia from the private sector, so that we will be subject to private commissioning. If so, the NHS will be fully privatised, and thus motivated by profit, irrespective of the nature of the providers.
From: Rita Lewis, ES Downs & Weald PCT Subject: Patient safety
Should there be a Statutory Duty of Candour?
Is it not imperative for all doctors and clinical staff to inform pa- tients when an error in their care / treatment has occurred, however seemingly minor, to the staff in- volved?
Currently, it is up to the individual clinicians to decide whether to inform the patient and there are substantial variations in practice across the country.
Patients are usually pleased to be told, and to be told of action to ensure that steps have been taken to avoid repetition. Very few patients, statistically, take further action.
If no decision is to be taken with- out the patient consenting, then how can non-disclosure of an er- ror in patient care be justified?
national health executive Mar/Apr 11 | 13
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