Intended for healthcare professionals

Editor's Choice

Are you ready for “collaborative health”?

BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3257 (Published 06 July 2017) Cite this as: BMJ 2017;358:j3257

Diffuse is really 'awkward' for 'the NHS' Re: Are you ready for “collaborative health”?

I have been writing about similar themes within the context of end-of-life for several years. It is definitely true that in 'this internet age' laymen can relatively easily discover what the professionals are writing and doing, whereas previously it was virtually impossible to acquire that knowledge. The NHS uses the internet and similar systems for a different purpose, of recording and disseminating information about individual patients, and the NHS still clings to 'paternalism': for example, the recently-developed 'ReSPECT' persists in placing the clinician 'front-and-centre for the decision-making' (1). I have pointed out more than once, the issue which Fiona Godlee describes as 'most challenging of all, shared accountability (replacing medical authority with mutual trust)' (2).

This is a deeply difficult transition for 'the NHS' to come to terms with: because to a significant extent, 'shared' equals 'diffuse', and 'diffuse' means that things such as clarity of decision-maker, hierarchy and 'easy descriptions of decisions' are no longer available. Which means, of course, that they cannot be easily recorded on those 'electronic databases' so beloved of NHS policy creators.

It is easy to see 'where we need to get to' if you study recent laws such as the Mental Capacity Act, and recent court rulings, which place the stress on 'the individuality and autonomy of the patient', but it is much less easy to argue that real-world clinical and NHS behaviour will reach that destination any time soon.

1) http://www.bmj.com/content/356/bmj.j876/rr-7

2) http://www.bmj.com/content/350/bmj.h3181/rr-2

Competing interests: No competing interests

10 July 2017
Michael H Stone
Retired Non Clinical
None Private Individual
Coventry CV2 4HN