First, do no harm

Civitas, 27 July 2009

Ever since Lord Darzi’s publication last year, High Quality Care for All, all the rhetoric is in the higher echelons of the NHS is that quality is the new organising principle (as if it shouldn’t always have been).  It’s the new ‘buzzword’, replacing ‘tariff’, ‘payment-by-results’, ‘foundation status’ etc., according to the former minister.  Certainly – and to Lord Darzi’s credit – it’s much more on the radar, and clinicians are more engaged than the passengers they have been in recent years.

However, is it really filtering down?  Don’t be too sure.  The NHS is still a very confused, target-driven, place.  A couple of weeks ago the House of Commons Health Committee reported it was ‘saddened by the avoidable harm that so many patients suffer’, pointing to NHS boards ‘too often’ prioritising governance, finances and targets above patient safety.

And now we are treated to an example of such from the coal face at United Lincolnshire NHS Trust.  Its chair, David Bowles, quit last week after being threatened with suspension when he refused to commit his organisation to meeting national waiting targets due to the high influx of emergency patients.  In his resignation letter he wrote: “I refuse to work in a system which seems not to have learned the lessons of Mid Staffordshire [foundation trust] and to have lost sight of the critical issues of patient safety,” accusing the local Strategic Health Authority of “a substitution of bullying for performance management and an obsession with targets rather than safety.”

Now, maybe the trust could look at introducing better processes to speed up throughput (in any case this takes time), maybe there are personal issues at play (though according to an HSJ survey over half recognised Mid Staffs-like failings at their own trust), but bravo.  The NHS urgently needs more voices that are prepared to stand up and be counted.  Quality, as per the government’s definition, is patient safety + patient experience + effectiveness of care.  Let’s just hope the government chooses to back, rather than malign, those that support this.