Intended for healthcare professionals

Rapid response to:

Observations NHS Finance

Balancing budgets or protecting patient safety

BMJ 2013; 347 doi: (Published 22 November 2013) Cite this as: BMJ 2013;347:f6943

Rapid Response:

Re: Balancing budgets or protecting patient safety

We would like to write in support of Mr Ham’s concern of the potentially irreconcilable tension between balancing the books and the delivery of high quality healthcare. During an NIHR-funded Safer Delivery of Surgical Services (S3 Study) we have been fortunate to work alongside front-line nursing, medical and managerial staff in a variety of NHS hospitals (district general, teaching and specialist centres) as they attempt to improve their working systems using a number of different quality improvement techniques (standardisation of work, lean process engineering and crew resource management). We will be reporting the effects of these interventions in the near future, however one overarching finding is the universal lack of time in the system for front-line staff to undertake pro-active service evaluation or to recommend, implement and evaluate change. This is in stark contrast to most successful industrial and manufacturing organisations. We postulate that the availability of this time may in fact form a suitable marker of the effect of real-term spending reductions, as the wider NHS seeks to utilise all staff time for the direct delivery of clinical care. We are concerned about the possibility that focusing on this noble aim without thought to the consequences may in fact be to the detriment of service improvement and quality maintenance, as well as the training and investment in the next generation of clinicians.

This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research programme (Reference Number RP-PG-0108-10020). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

Competing interests: No competing interests

28 November 2013
Eleanor R Robertson
Clinical Research Fellow
Dr Lauren Morgan, Miss Lorna Flynn, Dr Steve New, Prof Damien Griffin, Mr Peter McCulloch
Quality, Reliability, Safety and Teamwork Unit
Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Headington, Oxford, OX3 9DU