03 Oct 2007
The NHS Confederation and the Joint Medical Consultative Council (JMCC) -two bodies representing senior manager and clinicians - today launch their paper for a clinical vision of a reformed NHS. Drawing on in-depth interviews with doctors, from a wide range of specialisms, who have revolutionised services already in their organisations, it uses their work to set out a future vision of the NHS.
The report comes out just in advance of Lord Darsi's next stage review interim report which is expected to set out a clinically led vision for the NHS.
This joint report produces a set of design principles and policy implications for a better, more innovative NHS that puts patients firmly at its heart and ensures that the leadership role of clinicians is fostered and adequately supported.
The launch represents a first in recent history as the bodies representing NHS management and senior clinicians have worked together to set out what needs to happen to engage doctors properly in improving services.
The key findings of the report are:
Get the basics right - improving care for patients is the starting point of our work. Getting the basics of care right are essential as, no matter how good the clinical result, any hospital visit can be ruined by poor administration, impoliteness or an unpleasant environment.
Involvement - doctors have often felt that they have not been properly involved in previous reforming policies in the NHS - recruitment of junior doctors and the electronic patient record are good examples of this. In return for better involvement with clinicians, doctors should emphasise a positive way forward rather than focusing on current faults.
Doctors are also leaders - doctors have a vital role to play as national clinical leaders to reinforce the message that individual doctors have a significant part to the solution in their hands. Through secondments senior doctors should have roles in policy making or regulatory bodies such as the Department of Health and the Healthcare Commission in order to make the most of their input.
The NHS is a system with shared values - the best patient experience is one that is both organised and systematic. Similarly clinicians see their role as part of a system (as opposed to a set of independent bodies bound by contracts) which links in colleagues and other services. In this context the division between primary and secondary care is increasingly redundant. Underpinning the idea of health services as a system should be shared values. Time and effort must be spent articulating what these values are with quality of care for patients at the core.
More data, better data - all doctors interviewed had set up extensive systems for collecting data to measure and improve services. The NHS needs to make sure that the correct data is measured so that a truly patient focused service is created. As shown by the cardiac and intensive care audit, the quality of this data will be much better if clinicians take responsibility for collecting it.
Complaining culture - many doctors have clearly become frustrated working within the NHS. Addressing this frustration is central to our future vision. However, some interviewees felt that some criticism went so far as to be unprofessional and should be challenged.
Commenting on the release of the report, NHS Confederation director of policy, and co-author of the report, Nigel Edwards said:
"One of the key questions behind this report is, if the ability to change the system is largely in the hands of the people who run it, why have they not taken the opportunity? The answer is not simply to embark on a clinical engagement exercise but to focus on improving the quality of care and the experience of patients. The doctors we interviewed did not accept that change is something that gets imposed from above and that any improvements they made would be either unwelcome or instantly doomed to failure.
"It was remarkable how quickly some of the principles that guided our work sprang up from our interviews. The doctors we spoke to obviously have strong views about what kind of environment they would like to work in and had taken steps to bring that about. There is clearly great potential in getting clinicians to help to create a better, more efficient health service that is able to innovate and fully meet the needs of patients.
"There is currently a great of talk about local engagement and clinical leadership. There has rarely been a better opportunity for clinicians to show leadership in today's NHS. The JMCC and the NHS Confederation are clear that the work of those who are already showing leadership and improving services must be taken forward. This report represents an important and much needed start to this work."
Professor Bill Dunlop, chair of the Joint Consultative Medical Council and co-author of the report, said:
"Doctors often complain that NHS reforms have resulted in incoherent health policies which have not led to the improvements in patient care that the Government envisaged. Too often reforms have appeared to be imposed from the centre without adequate local consultation. Given that reform was necessary, how would these same doctors have gone about the task?
"Our report found that many doctors have themselves initiated change and developed innovative solutions locally. Clinicians want to work in partnership with their NHS trust managers to design better services for patients and to be freed from the policy constraints which so often interfere with their desire to innovate and improve patient care.
"There is a high level of commitment and dedication among NHS doctors and these professional values should be harnessed to further enhance care for patients."
ENDS
1. The NHS Confederation represents more than 95% of the organisations that make up the NHS. Its members include the majority of NHS acute trusts, ambulance trusts, foundation trusts, mental health trusts, primary care trusts, special health authorities and strategic health authorities in England; trusts and local health boards in Wales; and health and social service trusts and boards in Northern Ireland.
2. The Joint Medical Consultative Council (previously the Joint Consultants Committee) brings together the organisations that represent the medical profession in the UK. Membership includes the presidents of all of the medical royal colleges, the chairmen of each of the craft committees of the British Medical Association, the Conference of Postgraduate Medical Deans and the Medical Schools Council. The Council debates, provides advice and takes action upon issues that affect the practice of medicine and the delivery of health care in the UK, with the aim of promoting improvements in quality, safety and effective use of resources.
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Last reviewed 3 Oct 2007