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It's all about patients... isn't it?

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It’s all about patients... isn’t it?


Having just returned from the first academic module of my clinical leadership fellowship, this is the conclusion that I have drawn.  I know that this may appear to be an obvious statement but, after listening to some quite prominent speakers, it became clear to me that the NHS has sometimes quite literally lost the plot and forgot about the patients; mid-Staffordshire is an example of this.

While most of the module was about academic stuff, the speakers really made me think deeply about what we are doing in the NHS particularly how we are reacting to the Health and Social Care Bill, the Nicholson challenge and QIPP.

Let me introduce some of the speakers... Andrew Lansley (Secretary of State for Health), Sir David Nicholson (CEO of the NHS and NCB), David Colin-Thome (ex-National Clinical Director for Primary Care) and Anthony Sumara (ex-interim CEO of mid-Staffordshire NHSFT).

Let’s start with Andrew Lansley.  He talked about clinical leadership and how it will be important in the new NHS in managing the change programme, he talked about patient centred care and how the patient will be at the centre of the NHS, he talked about how, when he was an opposition MP, doctors were complaining that they could do a better job with the NHS without managers and bureaucracy but when given the chance to do just that have come out in opposition.  What he did not talk about was structure and systems and how they would work and this is exactly what we all seem to be focussing about.  His vision for any qualified provider is perhaps not how we are perceiving it in that he did not want this to be privatisation through the back door but only to be considered in terms of benefit to patients and quality of service.  Of course we all have our own opinions on this and I have mine but the overriding vision that Mr Lansley has is that this will improve the quality of services provided to patients... you cannot argue with his vision, the strategy for implementation can be argued but not the vision.

Next up was Sir David.  He explained some of the recently history in the reforms and how they knew about 4 years ago that something needed to be done to change the way the NHS works as a system.  The system needed to be more streamlined with the patient at the centre of this.  He even admitted that, at times, senior management had lost the plot when thinking about the finances.  The leaders at the time were skilled at meeting targets but now, in the new NHS, they may not have the visionary and perhaps leadership skills required.

David Colin-Thome was an exceptional speaker and he described his role as a GP for over 30 years and then as a Clinical Director for Primary Care.  For him, it is indeed all about the patient and how commissioners then and now have to remain focussed on this.  His advice was to forget about the structures and concentrate on the patients and their needs.  Clinical leadership is all about the patient and focussing peoples mind on quality and not the cost will be an essential leadership skill in the coming years.

Anthony Sumara, another exceptional speaker, explained his role at mid-Staffs and what he saw and experienced while he was there.  He explained his strategy for dealing with some of the problems and how successful or not he was with this.  He explained that he was genuinely upset when he heard some of the patient experiences of the services provided by his hospital; many of these focussed on patient dignity and showing respect.

Now, what about us in pharmacy?  Where are we focussing in these challenging times?  The cost efficiencies (or should I say savings?) or improving the quality of the patient experience through innovation and prevention to increase productivity... I hate to say it but it seems to me that it is the former.  Cost cutting will achieve short term savings to balance the books and reduce the deficit but what will the unintended consequences of this be in the longer term?  Is the patient really at the heart of these decisions or is it all about us, and by ‘us’, I mean the healthcare system?

When are we going to learn that restructuring with the same senior staff being badged differently is only going to provide similar outcomes and not radical change because their experience tends to lead them to the same decisions?  When are we going to stop working in silos and protecting our own territories and start focussing on what is really best for the patient?

I have gone on too long already but let’s not forget that this is all supposed to be about the patient... isn’t it?

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