15.08.17
BMA warns of ‘complete disconnect’ between management and staff in Scotland
Doctors have slammed the government in Scotland for too often taking a “top-down” approach to risk management, leading to important decisions being “foisted” onto staff without proper consultation.
Giving evidence to the Scottish health and sport committee, the British Medical Association (BMA) said there is also a “near complete disconnect” between high-level risk management activities and staff on the ground.
The committee itself is looking into clinical governance in the Scottish NHS, and whether services are safe, effective and evidence-based as well as whether patients are treated with dignity and respect.
The BMA added that failing to involve those actually delivering a service at an early enough stage runs the risk of a “draconian interpretation and implementation of new rules” that can end up having an adverse impact on patient care and staff morale.
“Invariably this results in time spent trying to negotiate a “reinterpretation” of what was meant and protracted efforts to find a workable solution – all of which adds to a sense of frustration and confusion for those caught in the crossfire as well as time wasted,” the BMA argue.
It also states that there is a conflict of interest in having health boards act as their own safety and quality controllers, especially when systems are under immense pressure.
“The pressure for “only good news” to be escalated is worryingly prevalent and may mean that areas of concern are not always raised because of a perception they will not be well received by senior management.”
The organisation also raised issues around staffing. “The ongoing issues around recruitment and retention of medical staff mean that those working in the system are under more pressure than ever as they deal with the difficulties caused by unfilled posts and the commensurate rise in already unsustainable workloads,” the statement continued. “Inevitably this will have an impact, not only on patients’ safety but also on staff welfare and well-being.”
“The BMA believes that quality of care, effectiveness and efficiency drive decision-making in the NHS, saying that for the most part, quality still trumps efficiency, but warns that the very significant financial stringencies now faced by NHS boards throw that into sharp relief.
“There are plenty of examples where we are increasingly forced to make difficult decisions that risk compromising the clinical needs of patients because of the pressure on resources. Implicit rationing is all too common and directly opposes the principle of equity for all patients.”
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