Friday, 20 May 2011

NHS Future Forum ‘engaging and listening’ seminar (3)

My report from the event held on 18th May continues..

Niall Dickson: The Chief Executive of the General Medical Council, in my opinion, provided a comforting voice of reason and mediation after the GP, Dr Michael Dixon’s polarised views (see previous blog). I was encouraged and impressed to hear Mr Dickson’s (confusingly similar surname to the previous speaker) clear summary of the priorities to be addressed – namely ethical issues, quality and safety, and structured ongoing education. Hallelujah! At last someone speaking specifically about the key elements of patient care needed to deliver tangible improvements. He outlined the concerns regarding conflict of interest with GP consortia having to balance use of resources and desire for profit with best practice and the impact in patient care. I agree absolutely that a worrying skills shortage within these consortia may be financial management and leadership.

On the issue of quality and safety, the GMC insists that effective regulation and possibly incentives have a part to play in maintaining standards. Niall outlined plans for re-validation of doctors. All doctors. Possibly controversial but highly desirable. Mr Dickson intimated that this personal and professional accountability would be measured through a five yearly process and patient feedback may play a part in the revalidation system. Tricky to implement but potentially a useful channel for patient power.

I was particularly pleased to hear that a need has been identified for improved professional development for junior doctors, seen as a priority in the ongoing education of the medical workforce.  This is something that I have found when creating patient pathways aimed at improving safety – so often a key skills gap emerges in this group of clinicians.

Perhaps the most potent sound bite of the entire event came from Mr Dickson’s presentation: ‘Doctors have the capacity to do enormous harm and enormous good’

I would have happily spent the rest of the morning taking part in a discussion with Niall Dickson and Michael Dixon. The apparently opposing views of the organisations that these two influential individuals represent epitomise everything that I believe is wrong with the Health and Social Care Bill. It is proving to be diversive by creating conflict between clinicians working at different stages of the care pathway. Regular readers of my blog may be sick of me continually stressing the point, but every clinician at every stage of the patient treatment pathway has a voice that needs to be heard. And I’m not just talking about doctors.

David Worskett: The Director of the NHS Partners network made a good point saying that the NHS may be in the brink of ignoring one of the levers that can help achieve the challenge of improved efficiencies, i.e. competition from the private sector. He spoke in support of the increased powers of Monitor, the NHS Regulatory body currently at the centre of heated debate within the coalition. Mr Worskett believes that Monitor could be ‘the solution and not the problem’. In order to minimise the danger of ‘cherry picking’. He stressed that expert understanding of tariffs was required as a generalist regulator, such as the Office of Fair Trading would not be helpful.

I got the impression that, like so many other elements of the Bill, the public perception of the government’s aims differ from the intent. Reasonable competition, effectively monitored can, in my opinion, be a very positive force in enabling cost-effective, high quality delivery of care.
The commentary on this forum is turning into a bit of an epic, but there was much to be reported.

The last gripping instalment will be posted tomorrow. In the final episode I’ll summarise the good, bad and ugly, comment on the way Liz Kendall, Shadow Secretary for Health constantly fiddled with her hair during her presentation (maddening) and attempt to predict whether there will be a happy ending to this intriguing tale……


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