I am reminded this morning as the new structures of the reformed NHS take up the reins of the opening sentences of A Tale of Two Cities by Charles Dickens "It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness … " . To paraphrase, Dickens concluded that, in short the period was much like any other period; An age of hyperbole. And we are not short of that in the health system. For all the rhetoric and all the ink used in describing the NHS changes that apparently can be seen from Mars the challenges in clinic this morning will be much like those last week and I dare say those next week .
For those of us working in the kidney world quite a lot of what we need to do remains the same . Shared decision making was on the agenda last term and it remains a goal to strive for . I was doing some spring cleaning over the Bank Holiday weekend and came across Rob Elias and Eleri Wood from Kings item (link below). Isn’t it great to find such jewels when you are supposed to be clearing out . This one is definitely not for the bin. Indeed thinking about this morning’s clinic I thought I might add the youtube link to the list of web addresses to append to letters going out so that patients and our public have an idea of what we are trying to achieve with shared decision making and supported self care. It irks me a little that we still send out paper copies of letters rather than e-copies to those who would prefer electronic comms. Most, however, can access the letters via renal patient view.
Dickens was of course writing about the French revolution in A Tale of two Cities and we would be foolish to underestimate the impact the Health and Social Care Act might have – the good , the bad and the unpredictable . As Nigel Edwards of the Kings Fund said this morning on Radio 4 – it’s a big untested experiment . Let’s be alert for the opportunities to make improvement that will no doubt occur. Let’s be vigilant about problems that might develop – not to blow them out of proportion but to ensure corrective action is taken . Mainly let’s not be passive – it’s our NHS and its shaped by the values and behaviours of the NHS staff . Quality can only be delivered in clinical encounters, it should be delivered in every clinical encounter.