Abstract
I read with interest your editorial on the change in hospital culture. 1 I share your concern about the impact of that on professionals, patients' experience and clinical outcomes.
Starting with the latter and most crucial issue, would a competitive environment result in better outcomes? Data from the literature remain inconclusive. However, there was evidence to suggest that in some sectors of a market culture, there may be insufficient incentive for quality improvement. 2 More relevant to the UK was the recent mid-Staffordshire affair, with a Trust being pressurized to satisfy the stringent financial targets, at the expense of staffing levels with serious consequences. 3
For most of the last decade, the rhetoric was for more freedom to frontline staff but realistically, the culture has been dominated by top-down approach, ‘Targets and Terror’ 4 as well as transactional interaction with professionals (e.g. the negotiated consultant and GP contracts). The collective negative impact of those on engaging frontline staff, especially doctors, was blamed for the failure of the ‘Big Bang’ health reforms to make a significant difference in the daily running of the NHS. 5
Therefore, it was a breath of fresh air when Lord Darzi announced that there will be no more targets, but more ‘genuine’ frontline engagement.
As you indicated, the only way forward will be for strong clinical leadership especially, having enjoyed seven years of abundance, as we approach the seven years of famine!
The question is, where does Lord Darzi's resignation leave our hopes?
Footnotes