Speculation on who will replace Sir David Nicholson as head of NHS England is in full swing
Speculation on who will replace Sir David Nicholson as head of NHS England is in full swing
What do you make of Sir Bruce Keogh’s ambitions? I don’t mean the one to be chief executive of NHS England, although I personally think he should be. What better way to demonstrate and encourage clinical leadership in the NHS than having… um… a clinical leader. And Keogh, the brightest surgeon I’ve ever met, has learned lessons from the child heart surgery debacle and speaks with both wisdom and compassion – something Sir David Nicholson has struggled with.
Indeed, Keogh’s review of the quality of care in 14 English trusts is the best NHS report I’ve read. Clear, concise and unafraid to speak the truth to power. Sadly power, in the form of Labour and the government, decided to politicise the findings in one of the most pathetically childish and unconstructive Commons’ spats of recent times. That politicians are still stuck in the blame game is yet more evidence for clinicians and patients to reclaim the NHS. In doing so, Keogh sets out eight aspirations which deserve to be aspired to.
1. We will have made demonstrable progress towards reducing avoidable deaths in our hospitals, rather than debating what mortality statistics can and can’t tell us about the quality of care hospitals are providing.
2. The boards and leadership of provider and commissioning organisations will be confidently and competently using data and other intelligence for the forensic pursuit of quality improvement. They, along with patients and the public, will have rapid access to accurate, insightful and easy-to-use data about quality at service line level.
3. Patients, carers and members of the public will increasingly feel like they are being treated as vital and equal partners in the design and assessment of their local NHS. They should also be confident that their feedback is being listened to and see how this is impacting on their own care and the care of others.
4. Patients and clinicians will have confidence in the quality assessments made by the Care Quality Commission (CQC), not least because they will have been active participants in inspections.
5. No hospital, however big, small or remote, will be an island unto itself. Professional, academic and managerial isolation will be a thing of the past.
6. Nurse staffing levels and skill mix will appropriately reflect the caseload and the severity of illness of the patients they are caring for and be transparently reported by trust boards.
7. Junior doctors in specialist training will not just be seen as the clinical leaders of tomorrow, but clinical leaders of today. The NHS will join the best organisations in the world by harnessing the energy and creativity of its 50,000 young doctors.
8. All NHS organisations will understand the positive impact that happy and engaged staff have on patient outcomes, including mortality rates, and will be making this a key part of their quality improvement strategy.
I like Keogh’s approach and I hope it inspires others, particularly commissioners, to do likewise. He also practices what he preaches. If I get serious safety concerns sent to me at Private Eye, I pass them on and he acts on them quickly, something that the regulators I’ve contacted over the years simply haven’t done.
But I remain an optimist, particularly if Keogh’s power is devolved down the line. His review emphasised the “central role” that patients and members of the public played and “the fresh insights” that lay panellists, paid £100 a day, brought to the process. In contrast, Price Waterhouse Cooper, who won the contract to support the review, received £2,773,614. I’m not sure how many people were involved but I suspect they earned more than £100 per day, while the 150 NHS people working on the review received their normal salaries.
I do worry that the biggest beneficiaries from the massive reforms of the NHS and its inevitable failures will be management consultants and lawyers rather than patients. So commissioners, please spend every penny wisely and don’t be bullied into very expensive advice you don’t need. Trust your instincts, expertise and honest, open communication skills!
