Doctors may have lost the chance to make a differenceBMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f4200 (Published 03 July 2013) Cite this as: BMJ 2013;347:f4200
- Nigel Hawkes, freelance journalist, London
Former health secretary Andrew Lansley’s changes to the English NHS had at its heart a radical idea, derived (perhaps unconsciously) from philosophical discussions of the nature of trust. Who could best be relied on to put the interests of patients first? Where did trust reside?
In a mistrustful era dominated by ever rising levels of audit and scrutiny, the changes sought refuge in an older concept of accountability: that of professional standards. A system run by doctors would borrow some of the trust rightfully accorded them by their patients and use it to replenish trust in a system shaken by the revelations of poor care at Mid Staffordshire NHS Foundation Trust. The subtext of the reforms, never clearly articulated, was that regulation had failed—and was likely to fail again. At Morecambe Bay, it did.1
We have since heard the usual solemn undertakings that in future things would change: inspections would be tightened, transparency increased, a “duty of candour” imposed on managers, whistleblowers given access to free whistles, and the whole culture transformed into a vision of loveliness and light. This is claptrap, of course, and it misses …