We are almost coming to the end of 2013. It has been an eventful year for NHS and in some ways for me too. After 8 years of working in a single emergency department, through certain unexpected circumstances I had a chance to work in a variety of emergency departments in the Greater Manchester area. Soon I shall be starting a new job in a different emergency department down south.
In the preparation for the new job I had another closer look at what these three gentlemen have been saying. I can clearly see that these three landmark reports are going to change the future of emergency medicine, acute care and the whole NHS over the next 10 years. This is irrespective of whether the NHS survives in its current form, which I very much doubt.
For those who have not yet looked into what these three reports are all about and just want an idiot's guide- Bruce Keogh's report is all about 14 individual hospital trusts and their unusually high mortality rates. Francis report is all about the mid Staffordshire debacle. Berwick is all about improving patient safety. The core message is the same in all three reports and most health care professionals with a few years experience and some common sense would have been able to give these answers even without a detailed investigation/review.
So what exactly is the core message
1-Put the patient first.
2-Do not get blinded by targets
3-Look after the health care professionals
4-Robust clinical governance and commitment to training and education
5-Have the right type of Leadership
There are going to direct and indirect implications for emergency departments in UK as a result of these reports and the current push for changes in the way urgent care is delivered and managed. There is an urgent need for emergency physicians to change the way they work currently. I can clearly see that the departments where senior emergency physicians(consultants and SAS doctors) work more flexibly and deliver actual clinical care will survive as emergency departments and the ones which are stuck in the old ways of crowding during office hours(mostly inside offices!) and disappearing afterwards will just slowly degenerate into glorified walk in centres.
There is also a need to work closely with our acute medicine colleagues to ensure that our patients get the highest quality treatment they deserve. The future hospital commission has tried to address the complex issue of delivery of acute care and has projected the need for clinicians who are trained to deliver acute care in a variety of settings. Any budding emergency physician( and current ones with more than a decade of working life left) will do well to read this report as well.
Further reading
http://www.nhs.uk/NHSEngland/bruce-keogh-review/Pages/published-reports.aspx
http://www.kingsfund.org.uk/projects/anticipating-francis-inquiry-report
http://www.kingsfund.org.uk/audio-video/don-berwick-improving-safety-patients-england-full-presentation
http://www.rcplondon.ac.uk/sites/default/files/future-hospital-commission-report.pdf
