Derek Bell: A blame approach will endanger the future of the NHS

Both the news headlines and the staff working in healthcare report real pressures within the NHS. The reasons for this are multifactorial and include recruiting and retaining a high quality workforce, financial constraints, and increased demand, combined with an ever increasing availability of effective treatment and diagnostics. Add to the mix the challenge of winter and the strain on the system increases.

Today these pressures are played out in real-time on social media, in traditional media, and within governments, with the finger often being pointed at one group of professionals. Blaming one group, rather than having a systematic approach based on best evidence and practice, aggravates the problem and leads to attempts at quick fixes or unhelpful sound bites.

Blaming junior doctors in relation to seven day working or General Practice for the pressure on patients attending A&E fails to recognise the complexity of healthcare and merely adds pressure to the system. Don Berwick warned only last year of the dangers of being in conflict with the people that will make up the workforce of the future. This must not become a reality.

A clear plan from the government working with all relevant professionals is now needed which has short to medium term objectives in the first instance. This must be informed by data and evidence and designed to alleviate the pressures over the coming months.

As a College with members working in hospitals across the UK, we see that the pressures in elective, acute and emergency medical care are similar throughout the country, but the approaches taken by the devolved health systems are increasingly divergent and require further study and shared learning. The NHS in England has a very complex management system and is plagued by too many costly initiatives.

The winter pressures this year were predictable based on the trend data from the last five years. As such, solutions need to reflect this and understand the problem to provide a more pro-active plan. Attempts to over simplify the complex journeys that patients undertake—often spanning weeks or months and requiring multi-disciplinary input—will not resolve the problems. Simply relocating patients to different parts of the system does not remove them from the service.

We need to build trust and optimise each stage of the patient journey. The four-hour “A&E” target is not simply a target for one department but for the whole system. Properly understood and used, the target provides a wealth of information to help plan services and assess the stability of the system as a whole. When labelled merely as an “A&E” target it compounds the problem.

Scotland has had similar pressures this winter but has consistently performed better than other parts of the UK over the last 18 months. This is in part due to the National Programme, “Six Essential Actions to Improving Unscheduled Care,” which shares best practice, and will require continued development to improve patient care—in other words it is a starting point not an end point.

Our Fellows and Members wish to be part of the solution which is why we fully support calls for a cross-party agreement on the future of health and social care, including funding, to ensure we provide a sustainable health and social care system for the future.

To this end, we are actively involved in several pieces of work.

One of the important ways of improving the patient journey is to address capacity and patient flow through primary, secondary, and community care. The College has been working in partnership with the Helen Hamlyn Centre for Design at the Royal College of Art, to consider how design solutions can be applied within the hospital context. This has resulted in the development of both digital and analogue design solutions visualising the patient journey, which we hope will benefit our colleagues across the UK.

In order to move away from a blame environment and towards a learning culture, the Academy of Medical Royal Colleges and Faculties in Scotland’s “Prevention through Learning” initiative—undertaken with the Institute of Healthcare Management Scotland—is looking at how radical changes in healthcare culture and systems can deliver greater openness, innovation, and a reduction in serious failings in care.

We wish to see a genuine dialogue and sharing of best practice between the UK Government, the devolved Governments and those delivering care to create an environment that supports all those working within the health service. If we adopt a blame approach we potentially endanger the future of the NHS through lack of good planning and failure to retain high quality professional staff to deliver the best quality care safely.  In addressing these issues we must look at service, teaching, and research collectively to encourage progressive thinking rather than enforced solutions.

Derek Bell is President of the Royal College of Physicians of Edinburgh.

Competing interests: None declared.