Martin McShane: Phoenix – myth or reality?

Martin McShaneI attended, what I think, was the last National Patient Safety Forum last week. I have been a member since it was set up following the publication of Safety First. I was worried that safety was going to get neglected as the National Patient Safety Agency’s abolition was announced in the bonfire of the quangos. The realisation that the forum was being added to the fire added to my worry and perplexed me.

Making sense of what is going on around you, amidst all the current reforms, is made easier if someone can provide a narrative, a framework that makes sense. Bruce Keogh, the chair of the forum did that for me at the meeting.  This is what I heard him say. He said the Secretary of State wants an NHS focused on outcomes with clinical engagement and patient empowerment. He described how the outcomes framework will have five domains and the measures within those domains are intended to shift the system from one focused on delivering targets to one that has the customer as its focus. The domains, the framework for the outcomes, are common sense;

  • To prevent premature death
  • To manage long term conditions well
  • To manage temporary episodes well
  • To treat people decently
  • To treat people safely

I can’t argue with those and they appeal to me as a clinician, as a manager, and as a customer of the NHS. The importance of commissioning, it seems to me, came out as he went on to articulate the role of NICE. The NICE quality standards, designed to be used by commissioners, will create a clear sense of what good looks like. My interpretation is that to justify deviating from the standards, one will need to be achieving equal if not better outcomes than people who are using them.  The quality standards are intended to inform tariff, QOF, CQUIN and the financial and contractual levers i.e. all the levers for commissioning. It reinforces the direction of travel towards one, integrated, commissioning system.

What this does, as well, is put safety at the heart of the system. Out of the bonfire, the functions of the NPSA, the role of the forum, all move to the heart of the NHS. Safety, it is intended, will no longer need championing; it will be part of the essence of the NHS.

So am I no longer worried? In part. I get the vision, but making it a reality, rather than a mythical creature, is going to require changes in attitudes, behaviours, and politics. I guess getting the story clear is a start but there is still a long way to go to make it all work as intended.

Martin McShane qualified in 1981 from University College Hospital Medical School. He trained in surgery until 1990 then switched to general practice where he spent over a decade working in a semi-rural practice on the edge of Sheffield. In a fulfilling job, with a great lifestyle, he decided to give it all up and take on a fresh challenge. He entered NHS management, full time, in 2004 as a PCT chief executive after experience in fund holding and chairmanship of both a primary care group and subsequent professional executive committee. Since 2006 he has been director of strategic planning for NHS Lincolnshire, where there are 5,600 miles of road but less than 50 miles of dual carriageway.

  • Julia K Schofield

    You sound reassured and the rhetoric from the centre is good, that outcomes are key and that quality will be embedded in clinical NHS practice. The reality though is that the development of NICE quality standards across all of clinical medicine will take years to develop and in the meantime it feels as if we are moving into a vacuum. For people with life threatening conditions the standards will come quickly but for other conditions it will take time. It is also not always easy to see how we can link all the important areas of clinical medicine to the five domains.
    On a positive note, the emphasis on quality is already making clinicians recognise the importance of standard setting. The British Association of Sexual Health has already done this and a stakeholder group is working hard to do the same for skin conditions. What we have to do is hope that commissioners will take note of these important pieces of work whilst we wait on the development of NICE quality standards

  • Martin Mcshane

    Thanks. Reassured is too strong, but I found the clear narrative helpful. I agree it is going to take time. However, the point you make about clinicians picking up the agenda is critical. I really believe that the only way we will properly address the challenges health systems face in the 21st century is if clinicians acknowledge and accept the need to lead the system and manage accountability for the effective use of resources, as well as their duty to the individual who seeks their help and advice.
    More and more I see that being achieved by focusing on how patients are informed and involved in their management and the use of compelling information to support quality improvement. The sort of work being done by BASH and for dermatology, led by clinicians, are excellent examples of how we can navigate this uncertain terrain.