{"id":36246,"date":"2016-02-26T17:01:07","date_gmt":"2016-02-26T16:01:07","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=36246"},"modified":"2016-02-26T17:01:07","modified_gmt":"2016-02-26T16:01:07","slug":"tony-delamothe-in-search-of-joinedupedness","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2016\/02\/26\/tony-delamothe-in-search-of-joinedupedness\/","title":{"rendered":"Tony Delamothe: In search of joinedupedness"},"content":{"rendered":"<p><a href=\"https:\/\/blogs.bmj.com\/bmj\/2016\/02\/22\/tony-delamothe-dreaming-at-ted\/tony_d\/\" rel=\"attachment wp-att-36215\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-36215\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2016\/02\/tony_d.jpg\" alt=\"tony_d\" width=\"160\" height=\"160\" srcset=\"https:\/\/blogs.bmj.com\/bmj\/files\/2016\/02\/tony_d.jpg 160w, https:\/\/blogs.bmj.com\/bmj\/files\/2016\/02\/tony_d-150x150.jpg 150w\" sizes=\"auto, (max-width: 160px) 100vw, 160px\" \/><\/a>The stated aim of the recent King\u2019s Fund conference, \u201cIntegrating care throughout the patient\u2019s surgical journey\u201d was to align the objectives of the NHS five year forward view and the Royal College of Anaesthetists\u2019s Perioperative Medicine Programme.<\/p>\n<p>For me, the message was that trying to see things from the patient\u2019s point of view gave the best chance of success. That\u2019s because the individual patient experiences healthcare as a single journey, even though it\u2019s doled out in disconnected lumps, by a bewildering array of people.<!--more--><\/p>\n<p>Patients Dr Kate (\u201cHello, my name is\u2026\u201d) Granger and Fiona Carey were on hand to testify to that, and to argue that so many of the problems they faced in their interractions with doctors centred on communication. That, and \u201cwe see things you don\u2019t see, and know things you don\u2019t know,\u201d in Carey\u2019s words.<\/p>\n<p>It was hard to ignore the current financial context. In the opening session, every statistic that Celia Ingham Clark (National Director for Reducing Premature Deaths) reeled off was going in the wrong direction. Just one: hospital waiting lists up to 3.25m from 2.5m in the past few years. A physician at a DGH thought there were no longer any surgical patients in surgical beds; they\u2019re full of medical patients. A consultant surgeon said that healthcare used to be delivered by trainees. \u201cNow they\u2019ve taken the trainees away without putting anything in their place.\u201c During her ITU stay, Carey could see a special air mattress intended for her for a day and a half until the frazzled nurses had time to replace her uncomfortable one.<\/p>\n<p>And yet, and yet. Steven Reid, a liaison psychiatrist at St Mary\u2019s discussed the Mental health Concordat, involving a multiplicity of agencies, that seems to have made giant strides in a short period, without a massive infusion of money. Most of the initiatives that have collectively improved survival from emergency laparotomies cost peanuts, although they mean consultant surgeons and anaesthetists have to get out of bed in the middle of the night.<\/p>\n<p>Various promising new initiatives were described\u2014PQIP, ELPQuic\u2014all of which had the collection of data at their heart. \u201cAny business that doesn\u2019t monitor its quality will fail,\u201d said one participant, the point being that the NHS behaves towards its outcomes insufficiently like a business.<\/p>\n<p>Another quote from Fiona Carey: \u201cWhatever is being done is being done brilliantly somewhere.\u201d The funnel plots of survival vs surgical volume in several presentations backed her up. If brilliance is possible in just one place, here and now, it should be possible elsewhere. It\u2019s a variant of the meaning of black swans: if you see one on somebody else\u2019s pond, there can be no insurmountable reason why you shouldn\u2019t be able to coax one on to yours.<\/p>\n<p><em><strong>Tony Delamothe<\/strong> is editor, scholarly content, BMJ.\u00a0<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>The stated aim of the recent King\u2019s Fund conference, \u201cIntegrating care throughout the patient\u2019s surgical journey\u201d was to align the objectives of the NHS five year forward view and the [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2016\/02\/26\/tony-delamothe-in-search-of-joinedupedness\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[116],"tags":[],"class_list":["post-36246","post","type-post","status-publish","format-standard","hentry","category-editors-at-large"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - 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