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----- Original Message ----- From: Jonathan Benger > I'd be delighted to see a real emphasis on quality, but I've never met a > hospital manager with the catchphrase "hang the expense, if you say that it > improves the quality of patient care we'll buy it!" (if anybody does know a > manager like this can they tell me so I know where to apply for my > consultant's post). No really Jonathan, this sort of attitude is already appearing in some NHS managers, and I'm not kidding! And I think it's going to get more common in the next few years. Look at it this way - Government are giving DoH billions of increased funding over the next four years and saying, "give us improved quality with this money". In other words, we will soon be in a situation where our managers have sufficient money/funding, and they'll come to us asking what we can do with this to improve things. OK, they'll still be interested in value for money, but to a much lesser extent than before. And if we as a specialty say that things won't improve until we have sufficient senior staffing, for example, who happen to cost so much, then management are unlikely to quibble under the current climate. After all, it's public money, and the public are really pissed off with emergency services as they stand at the moment. I think we've got to move our mindset away from the "saving money" philosophy of the Thatcher/Clarke era, which infected clinicians as much as managers, and start thinking along the terms of "improved quality, hang the expense" as you put it. There are managers out there who simply want to provide a good service, but happen to be constrained by funding. If you remove those constraints, their ideas and enthusiasm about how to improve your service can be quite impressive. And we must harness that momentum, as all the other specialties will be doing just that over the next four years... Adrian Fogarty %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%