Intended for healthcare professionals

Rapid response to:

Feature BMJ Round Table

After Francis, what next for the NHS?

BMJ 2013; 346 doi: (Published 10 April 2013) Cite this as: BMJ 2013;346:f2074

Rapid Response:

Re: After Francis, what next for the NHS?

Bruce Keogh was right to identify the provenance of poor quality healthcare on the shop floor. It is salutary to learn that a substantial body of doctors appear to have failed to recognise the perils, or lacked the necessary sense of professional accountability to confront a management that prioritised process and targets to the detriment of health outcomes.

When I trod wards in the seventies, a medical firm comprised two housemen, perhaps an SHO, a registrar and one or more consultants. Junior doctors were on call every other night, ensuring they knew their patients, they rapidly acquired the necessary skills and experience, and that the consultant was involved at a strategic medical management level as necessary. It was tiring and sometimes scary, but it ensured almost continuous informed medical accountability wherever and whenever needed.

Contemporary secondary care is more sophisticated, and tired doctors cannot perform optimally, but doctors must abjure the imposition of systems that preclude the robust exercise of medical accountability in day to day patient care in acute settings. Happily the revalidation process, with its relentless focus on the obligations doctors have towards patient care, will empower doctors to influence hospitals' priorities.

Competing interests: No competing interests

17 April 2013
Peter Lawrence Hall
Doctors for Human Rights
91 Harlech Rd, Abbots Langley, WD5 0BE