Doctors must be free of the “confetti of interference”

BMJ 2002; 325 doi: (Published 23 November 2002) Cite this as: BMJ 2002;325:1190
  1. Anne Gulland
  1. London

    Professor Ian Kennedy, chairman of the inquiry into the deaths of babies at the Bristol Royal Infirmary, told doctors he had noticed a culture shift in the NHS since the report was published last year.

    Professor Kennedy, who was speaking at a conference in London last week, was asked whether he had witnessed any major change as a result of the 198 recommendations in his report.

    He told the conference—entitled “Beyond Bristol: Improving Health Care” and organised by the BMA, the BMJ Publishing Group, the Journal of Medical Ethics, and Quality and Safety in Health Care—that the change in culture had begun to happen before the inquiry.

    He said: “There has been a change in the mentality and the attitude in the NHS. There has been greater receptiveness to the idea of putting patients at the centre of care and of establishing standards which could be properly monitored. There was no door closed against my recommendations. Rather, there was an open door, and the report was another shoulder pushing on that door.”

    Professor Kennedy also called on the public to have a more realistic view of doctors: “Healthcare professionals and patients must be more grown up about errors and mistakes. We need a system which recognises that accountability is not the same as blame. Blame is a serendipitous weapon used to pillory someone who happens to be caught in its sights.”

    He added that clinical negligence litigation was a barrier to safety because it encouraged defensiveness and fostered a blame culture and it should be abolished. While accepting that the “trench warfare” between clinicians and managers of the 1980s and early 1990s had largely died down, he said that the tribalism between the two groups must end.

    “Clinicians manage, and managers care for and about their patients,” he said. But Professor Kennedy also called on the government to let doctors do their jobs.

    “They must be free of the confetti of interference that rains down on them. By all means have standards—but does there have to be a new one every day? They must be free from the pressure of multiple visitations by a variety of bodies.”

    Professor Cyril Chantler, chairman of the GMC's standards committee, called for lifelong learning for doctors.

    He said that expecting doctors to be trainees until they were nearly 40 and from then on to learn nothing more was not a good way of training clinicians.

    “There is no reason why people shouldn't be trained as a specialist in general practice or hospital work by the time they are in their early 30s,” he said.

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    Professor Kennedy: “There has been a change in mentality”


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