Quality of care
Editor – I am moved by Professor Allan's elegy to bygone NHS virtues of ‘calm caring and gentle pace of clinical life… and all the time in the world to deliver compassionate care' (Clin Med October 2009 p 407). One's immediate instinct would be to say ‘Ah, but times have changed' – only to find the Editor extolling the same high level of care in a hospice in present-day England.
One can attempt to blame the unforeseen rise in the level of patients seeking emergency medical care and requiring acute hospital admission; the physical limits to what one can do with an outmoded hospital infrastructure; inadequate handover mechanisms; over-politicisation and micro-management of the delivery of patient care; and the list goes on.
I wish to argue that this regrettable gear shift in patient care is in no small part due to a disenfranchised clinical workforce in general. We are urged to explore new ways of working and improve efficiency in order to provide care for an ever increasing number of patients by a depleted workforce. Of course efficiency must be increased, but a workforce that is plagued by low morale and a poor sickness record is in no position to do such a thing.
I plead with our clinical leaders and politicians to work hard to re-energise our clinical workforce. The professional hierarchy must no longer delay tackling the sickness record in the NHS head-on, improve staff recruitment and retention, reward those who work hard, retain good senior nurses on the ward rather than an automatic channel to management and re-empower ward senior nurses (can we stop calling ward sisters or matrons ‘ward managers’?).
A new hospital can address many of the shortcomings mentioned by Professor Allan. But a caring environment is still a numbers game: a small handful of nurses, however good they may be, cannot emulate the level of care recalled in the editorial when asked to look after a busy ward of more than a dozen of the infirm. Likewise, a dizzying day-to-day shift of a medical team provides only fragmented care. Things must be going wrong when I found myself presenting the case history of every patient on a Monday morning ward round to my foundation doctors and registrar who had all come back from various leave and shifts, and that was not the August changeover! How do we restore the firm structure and team spirit in the shadows of the European Working Time Directive and budget cuts without increasing the number of doctors? I do not think we can. We create rotas of complex shifts for our doctors, and that is what they will continue to be, shift workers.
Footnotes
Please submit letters for the Editor's consideration within three weeks of receipt of the Journal. Letters should ideally be limited to 350 words, and sent by email to: Clinicalmedicine{at}rcplondon.ac.uk
- © 2010 Royal College of Physicians
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