Continuity of Care in the NHS (Joined up Medicine).

This tenet of Health care has long been regarded as the ideal, by most if not all Practitioners. It is the best way of safeguarding the patient from errors and mismanagement, be it in Hospital or the Primary Care Unit, such as the GP's practice. Most Trust's trumpet it as the pathway they all adhere to, but the reality is far from the rhetoric.The Kings Fund views it as being essential to the patient experience, whatever that is, and is researching and asking for input to achieving this goal. So what is it that is going wrong that prejudices patient safety and causes the almighty 'cock ups' that occur with alarming frequency in some of our alleged 'best' (sic) hospitals?

Well we do not have enough good Doctors or probably not enough Doctors at all. That is Doctors, who are either prepared to follow a patient through treatment to discharge, or ensure an adequate handover to another at the end of shift. And by good I mean adequately trained and motivated, not some 'wet behind the ears' youngster, virtually straight from medical school, tasked with the job, of taking care of numbers of wards, and patients on the night shift, with only a 'phone number to obtain Consultant backup. And of course with the knowledge, that it would take a major disaster to drag him/her off the Golf Course or away from the dinner guests.

Not 'joining the dots' seems to be the biggest problem. Looking at symptoms in isolation without looking at the history, making judgements about treatment, without reviewing the notes and tests, that some lab technician has worked through the night, to deliver in time for the operation to be scheduled, or not? Not bothering to see the patient prior to treatment, and failing to provide sufficient information for patients to provide informed consent, due to the unbridled hubris that many display in their protocols and procedures. It is this lack of a continuous care pathway that leads to the sort of disaster that has befallen heart patients at the Nottingham University Hospitals NHS Trust, who failed their patients due to lack of diligence, in ensuring that information about serial episodes of endocarditus was not passed on to others, which in turn allowed lives to be lost without need.

It is far from the first time that this Trust, which is a major Teaching Hospital with intake of 500 F1's per year, has made the headlines. It is in fact rarely out of them, as my friends at National Death Service will attest. This is just in one week! Joining it all together, so that bewildered patients actually get to see a Doctor more than once, during their Hospital stay would be a first step. Actually reading test reports prior to giving dangerous general anaesthetics to people without first knowing, if that act alone might kill them might be the next. Acting on the results of tests, with knowledge of the patient history, is the foundation of treatment. It is not something you should leave to some half baked F2, at midnight on a Friday, whom you have conversed with on your mobile, and directed them to list a trauma patient,  for operation, without seeing them, reading the notes, reviewing the tests and discussing informed consent. Yet it happened. And lives were irretrievably changed, and one almost lost.

Was there any contrition, any meaningful attempt at redress or even candour. Was there even any honesty in providing a prognosis for the future or information of any improvement intervention. Was there b******s. The attitude seems to be, that one should be grateful for having one's life threatened, when you entered their halls, without a life threatening injury; be grateful for surviving. Such compassion. Such empathy!

And there was Peter Homa, standing in front of his Gulag, apologising profusely for the death of the innocents who consigned themselves, to his and others care at his Trent Heart Unit. Only he doesn't care and he never will. Otherwise he would resign, and let someone else take the helm of this graveyard of unnecessary deaths.

So far as the NHS is concerned, it is getting worse as the statistics for Complaints attest. And the bulk of most harms are down to errors. And errors occur most of all when the simple stuff goes wrong. Not the heroic interventions, the open heart surgery, because it was not that, that killed the patients. It was a simple bacteria, that could have been guarded against by protocol. But only if the information had been pieced together. The evidence chain is important, but it is not being given the emphasis needed in today's NHS. Everyone is so busy filling in the screen, the report, the check sheet, that they then fail to read, or take action about. The Doctors can all howl as much as they like, but they are too callow and spineless to do anything about it. They are usually too busy working out the superannuation, and the date of their retirement.