Intended for healthcare professionals


Is quality of care improving in the UK?

BMJ 2011; 342 doi: (Published 03 February 2011) Cite this as: BMJ 2011;342:c6646

Deaneries have an important role in improving the quality of care: Forget this at your peril.

Pronovost et al rightly highlight the importance of a number of
elements necessary to improve patient safety in UK hospitals. Training and
support to doctors are identified as two of these critical factors.
Postgraduate Deaneries have a vital role to play in contributing to this

Deaneries are responsible for the foundation and specialist training
of all UK doctors and therefore have a vital role in overseeing any
Serious Untoward Incidents (SUI's) involving their trainees which pose a
risk to patients.

Currently, great variation exists between deaneries in their approach
to monitoring, reporting, and supporting trainees involved in such
incidents; any comparable data available at present is likely to reflect
reporting practices rather than anything deeper. This in turn makes it
difficult to pinpoint where extra training and support should be targeted.

As the author stipulates, human error is indeed a contributing factor
to many serious incidents. However it remains important to highlight the
responsibility of individual Trusts, particularly those involved in
training of doctors, to ensure that causative factors in incidents are
established and systems and processes strengthened to mitigate against
future events.

In Yorkshire and the Humber, work is being undertaken by Public
Health Specialty Registrars in partnership with the Deanery, to improve
reporting and analytical processes providing detailed evidence relating
to doctors in training and Serious Untoward Incidents. The Yorkshire and
Humber experience will be presented at the National Association of
Clinical Tutors (NACT) spring meeting in May 2011.

As with any changes to systems or processes, these will take time to
begin to deliver the high quality intelligence necessary, and as Pronovost
points out, such changes involve working closely with local Trusts, the
Quality Observatory and others. Improvements in communication remain vital
if a culture of transparency, learning, and accountability is to be

We hope that the role, contribution and potential of a regional level
body, currently provided by Deaneries in conjunction with Strategic Health
Authorities , in contributing to the patient safety agenda in the UK is
not devolved by the imminent re-structuring of the NHS. It is equally
imperative that the contribution of public health professionals is
highlighted and continues, alongside the other professionals mentioned by
Pronovost. This will help ensure patient safety remains high on the agenda
in terms of regulation, training, and support of doctors within health
care teams as the NHS changes over the coming years.

Competing interests: No competing interests

15 February 2011
Matthew S Day
Specialty Registrar in Public Health
Rachel Weston, Specialty Registrar in Public Health and Sarah Thomas, Postgraduate Dean.
Yorkshire and the Humber Postgraduate Deanery