Although NHS policy is devolved, issues of funding, changing demographics, public health, workforce planning are being felt across all parts of the UK.
The RCSEd will therefore concentrate on the following in our public affairs activity.
Encourage the NHS to change – but from within
The RCSEd will lobby health policy makers to encourage NHS staff to lead change and develop new ways of team working within and between the medical specialties. NHS staff are primarily motivated by patient care, so they are best place to devise and implement the ongoing systematic reforms needed to maximise capacity and concentrate primarily on improving patient outcomes. We will do our part by further prioritising leadership, team working and non-technical skills in our own training activities.
However the NHS faces significant external pressures that staff themselves cannot fix on their own. Collaboration, not competition, should be the main focus of NHS policy and we remain wholly unconvinced with NHS England’s assertion that £22bn worth of efficiencies can be found, especially as 60 per cent of Trust are relying on financial support from the Department of Health or planning to drawn down their reserves. As Professor John Appleby, chief economist at the King's Fund said, "there is now a real risk that patient care will deteriorate as service and financial pressures become overwhelming."
Further integration of primary, secondary and community care and more seven day services cannot be achieved without appropriate public funding. We therefore support an ongoing, public debate about the current and future pressures on the NHS, what models will deliver the best care and the how the NHS can be put on a more sustainable footing.
Focus on Improving Patient Outcomes
NHS staff are overwhelmingly motivated by patient care and as the King’s Fund assert, the best performing organisations have a stable management teams and an engaged workforce all with a long term focus on improving quality.
However a system built around targets has skewed clinical priorities, wasted resources and focused energy away from patient care. As we believe that “success” in the NHS needs to be judged solely on the improvements made to patient outcomes, we strongly believe that staff should be primary drivers of change and encouraged to recommend how resources are allocated and services are delivered. We therefore endorse the King’s Fund’s publication of questions designed to help NHS Trust Boards establish the extent staff to which staff are involved in the decisions that are made about clinical practices.
We also contend that many aspects of the NHS’s working culture are outmoded and are in need of reform. Undermining, intimidation and bullying are an unfortunate and unnecessary fact of life for many working in the NHS affecting both medical professionals who suffer from it and patients whose care may suffer as a result of demotivated, distracted staff.
Guaranteed Time for Training
A NHS that offers seven day working services is likely to increase demand on an already stretched service. RCSEd is clear trainees in all medical disciplines should not be used to fill rotas and make up staffing shortfalls. Instead if the NHS is to meet patients demands of having access to named specialists, then time and space must be given to consultants to develop their own expertise as well as have time to provide training.
Surgeons in training are amongst the least satisfied of all medical trainees. Therefore, we firmly believe that training and development should be done within the confines of the European Working Time Directive. We also demand that trainees are not pressurised into opting out of the arrangements and training should not be offered within overtime.