IT can be both alarming and exhilarating to be trusted by patients. A couple of months ago, I agreed to do a two-week locum on Alderney, the smallest of the three main Channel Islands.
Although I arrived well-equipped and well-prepared, I didn’t expect to be single-handedly managing an 85-year-old lady with a bowel obstruction. But when I outlined the rather tricky situation to both the patient and her relatives their only response was that they trusted me “to do what was right”.
Such trust can be daunting, but it also encourages you to try to do your very best. I had not put in an intravenous drip for over 20 years, but I knew I had to in order to save my patient’s life – there was simply no alternative.
There is no question that there is a growing crisis of confidence among politicians and the public concerning the NHS, its doctors, nurses and managers.
Throughout 2013 we saw a constant stream of worrying stories – from high mortality rates at a number of hospitals such as Stafford to the alteration of cancer records at Colchester.
Many of us in general practice are losing respect for some of our local hospitals and hospital colleagues too; to me it often seems that some doctors working in the NHS just cannot be bothered any more.
Back in 1985, when I was a junior hospital doctor, I was severely reprimanded by my consultant as I had not phoned the GP of a patient who had died. Nowadays it’s difficult enough to get reliable information on patients who have survived a stay in some of my local hospitals, never mind those who have passed away.
During the course of 2013, each doctor in my practice was assigned a personal assistant to help address inadequacies in communications from NHS hospitals – the private sector seems to do much better.
The solution to the various problems within the NHS always advocated by politicians – from all parties – is enhanced regulation.
As a GP, I now have the National Institute for Health and Care Excellence developing guidance and quality standards for me, the Care Quality Commission inspecting me, and the General Medical Council revalidating me. I also have to make annual declarations concerning my health and my probity.
Revalidating a doctor includes a review of their educational record over the previous year, any work they have done to improve quality and feedback from a small number of patients and colleagues.
Each revalidation costs the NHS in excess of £1,000 and takes two doctors (the appraiser and the appraisee) away from clinical practice for half a day each. But is the NHS really much better after the £25m that was spent on revalidation during the course of 2013?
Moreover, will the appointment Sir Mike Richards as Chief Inspector of Hospitals (with a deputy and an expensive cohort of inspectors) really bring an end to the erosion of care within the NHS?
Previously Professor Richards had been responsible for NHS cancer services, but we still seem to perform consistently badly in terms of cancer death rates compared with the rest of Europe.
Ten years ago, in her Reith Lectures, the crossbench peer Baroness Onora O’Neill warned against relying on regulation and ignoring the critical importance of trust. Each of us, in every profession and every institution, needs trust. On my part, I would argue that trust enhances good quality clinical practice, whereas mistrust can prove corrosive.
In an NHS where doctors and nurses are no longer trusted, professionalism is lost. We end up seeking to satisfy simplistic regulatory targets rather than the needs of patients.
My own research has revealed that clinicians also practise defensively – with the ordering of some risky tests being influenced more by concerns about complaints than patient care.
One other worry is that mistrust is disheartening, with a number of dedicated senior doctors now taking early retirement or moving abroad.
I believe that all doctors and nurses entered medicine to care for patients, but it seems as if we are now assumed to be seeking to practise badly.
It is certainly the case that some of us have lost touch with our core values. But I believe restoring trust and pride is a much better way to address any shortfalls than yet further regulatory burdens.
As professionals we had all been taught to seek to keep ourselves up-to-date, to treat patients with courtesy, to communicate effectively and to use investigations wisely. We can also all identify people who have inspired us in the past and who we would like to emulate.
On their part, politicians and the public must also acknowledge that, even with the best of intentions, mistakes sometimes do happen and we can never insure ourselves against everything. As Baroness O’Neill pointed out, there is no way to eliminate all risk of disappointment.
Trust and commitment between patients and those who care for them is the glue that has always held the NHS together – not guidance, regulations and managerial edicts. The care of people is just too complicated to be distilled down into a few simple performance targets and occasional inspections.
The one NHS priority for 2014 should be to rebuild professional pride among those working to care for patients and, as a result, restore wider public trust.
* Dr Nick Summerton is a GP in East Yorkshire.