President's Update - March 2013
The Francis Report - would you recommend your own hospital?
I was struck by recent press coverage in connection with the publication of the Francis report, in which it was reported that people who worked at the hospitals involved would not have recommended their hospital to a friend or family member. I suppose, in light of what has happened that is not surprising. I was discussing this with a friend who expressed a similar opinion about aspects of their own hospital, indeed further coverage has revealed that many NHS staff feel the same way: that started me thinking through the consequences of that climate of opinion.
How much do we individually influence opinion? What chance does an institution have if the people working in it do not rate it? What does it say about the people who provide the service that they would not use it themselves or for their families?
As surgeons and as leaders, we have a great effect on the ethos and atmosphere in our hospitals and institutions. Though, inevitably, there will be times and places in any hospital where things will be done that fall far short of the standards we aspire to, there are also times when our teams will achieve amazing things for patients. I believe that we have a responsibility to think about how our words and actions will affect the many people with whom we come in contact each day and how we can influence the way we and others perceive our hospitals and institutions. We can affect how we and our colleagues think about our hospitals: it is therefore important that while working to eliminate the bad things we still recognise and celebrate the good.
Our College works for the maintenance and promotion of the highest standards of surgical care for patients. Being a Fellow or Member of the RCSEd means you are part of a body of colleagues who are similarly dedicated to the highest standards of patient care. That is something to celebrate and gives meaning to our everyday endeavours.
If there is anything good to come out of the revelations of the Francis Report, which affects our daily practice, I suggest it is that we start by celebrating the good that we see done in our hospitals and we encourage a mindset and attitude which is positive and patient-focused, while refusing to tolerate the slide in standards which usually accompanies poor morale. The best thing about this is that it is a personal action which is entirely up to each of us as individuals.
Patient Safety, Human Factors and Progress
Any discussion about patient safety will inevitably come round to considering the relationships that individuals forge in the workplace. Patient safety is intensely important for staff as well as for patients. Good working relations are a major part of the patient safety agenda and where communication is poor, relationships break down and patient safety is put at risk. It is, in my view, essential that clinicians are not so busy delivering patient care that they have no time to stand back and consider how they deliver that care. Contracts which consistently maintain nine sessions of direct patient care on one SPA (supporting professional activity) will work against the interests of the organisation, let alone individual clinicians and the patients. It is the view of this college that all surgeons must engage in regular appraisal as the vehicle for revalidation. Appraisal involves discussion about job plans. Realistic job plans are essential for patient safety, progress and innovation and research, all of which favour the development and progress of the National Health Service into the 21st Century.
The Future of NHS Commissioning in England
Against this background there are many challenges facing the Health Service in the British Isles in its different forms. In England, the prospect of commissioning will be occupying the thoughts of many of our Fellowship. I expect that many feel a sense of impotence about this: a sense that change is happening over which we individually have no control. While this may well be the case, I strongly encourage all Fellows of this college who are in any position to influence how commissioning works in your particular area to get involved to the fullest extent. Years of experience developed in delivering patient care is surely a vital ingredient in the roundtable discussions that will inevitably take place in the process of commissioning. I know that our Fellows are interested and active in these areas and I encourage you to participate in the debate at every opportunity.
Ian Ritchie PRCSEd
25 March 2013