Moving forward in the right direction

I do hope this issue of the FHJ above all else stimulates debate. The main theme is provided through a series of articles on quality and service improvement in England written by champions of quality improvement programmes including Getting it Right First Time (GIRFT). I am hugely indebted to Dr Sarah Clarke for her guest editorship. She herself has championed quality and service improvement in her roles as a clinical cardiologist, clinical vice president of the Royal College of Physicians (RCP) and president of the British Cardiovascular Society, and current co-lead for cardiology GIRFT.

Do first read her editorial to introduce and contextualise the articles.¹ My hope is that you will then read the articles critically. You will all have awareness of NHS long-term plans for service and workforce, and perhaps direct experience of the GIRFT programme. Given the resource invested in these programmes, they must be critically appraised. Please provide feedback via letters to the editor (instructions at www.rcpjournals.org/content/submit-future-healthcare-journal), Twitter (@futurehealthj) or email (fhj{at}rcp.ac.uk).

My personal experiences of quality and service improvement this month have been positive. While I usually despair of being asked to use yet another software package, a radiology reporting system and an advice and guidance web-based system for primary care both seem simple and effective. However, my greatest successes have been with the use of Google Translate, which facilitates consultations in a way that is simple, free, very effective and, no doubt, breaks a myriad of rules. Our clinical leadership, managers and information communications technology teams must make our lives easier. We must rebel against clunky unreliable software or those who deny us pragmatic IT solutions, because the pressures continue to mount. My own trust is seeing the acute medical take about 5% busier than in 2019. That may not seem so much, but if I take the analogy of an underground train, squeezing 5% more passengers onto an already full train just delays people getting off and on and then takes two or three attempts to close the doors. The service then slows down just when it needs to speed up.

I'm back to attending conferences in person. I am fascinated by what will be the new reality of medical conferences. In coping with the pressures of our work, networking at conferences is an important supportive resource. But how can one make the educational experience richer and different to virtual attendance? I am sure subject of healthcare conferences in the future should be a topic for the Future Healthcare Journal but perhaps it needs a round of meetings before we can have a truly informed debate.

In addition to the themed papers, this issue as ever contains a great spectrum of articles under the umbrella of future healthcare. They range from the intensely practical to the rather more futuristic.

Grace Pearson et al from Bath report using a checklist to improve junior doctors' confidence in ward rounds.² The checklist is simple, visual and reproducible. It's worth also recommending the RCP's own report, Modern ward rounds, in this context.³

We continue to champion digital health and, in this issue, Anmol Arora et al explain the use of synthetic data in education and research.⁴ They describe using generative adversarial networks to derive fake data by learning from real data. These fake data can then be used positively, eg to enlarge research data sets. However, they also allude to the challenges, both ethical and practical, to be overcome before the full potential is realised.

Integration is a key word now and enshrined in future healthcare services in the latest Health and Care Act.⁵ Learning from history is also important, so Edward Maile and colleagues' article on learning from the history of integrated child health services is timely and thought provoking.⁶ Integration is challenging and identifying what works and what doesn't is essential for success.

Cameron Swift has provided us with an exceptionally useful encapsulation of the ground-breaking joint report from the RCP and the British Pharmacological Society: Personalised prescribing: using pharmacogenomics to improve patient outcomes.^7,8 His summary emphasises that this will be impacting on us more and more in coming years.⁸

In finding the right way forward, we sometimes need to take a step back. Our next issue will have as its theme ‘Value and values within healthcare’. We need to understand what we want and value from our lives and our health service if we are going to design and resource healthcare effectively. Equally, we need to ensure that we value from the resources allocated to healthcare. Looking further ahead, we plan an issue in early 2023 focusing on mental health of the public, of healthcare workers and of patients. While we will include a number of commissioned articles, we would welcome additional submissions on either of these topics.

I hope you find all the articles in this issue of the FHJ interesting, and perhaps even provocative. The question we pose is: ‘Are we moving forward in the right direction?’