Organising care at the NHS front line

This content relates to the following topics:

Part of Frontline clinical care in acute hospitals

The highly regulated and centralised nature of the NHS in England means that trust leaders are preoccupied with responding to external demands.

One of the consequences is that these leaders find it difficult to find sufficient time to work with clinical teams to improve how care is organised at the front line. This results in wide variations in how clinical teams deliver care on hospital wards and in clinics and reflects the absence of deep and sustained engagement in frontline care by leaders in most trusts.

Don Berwick and I have become increasingly aware of these issues in work we have been engaged in in recent months. Our work started on visits we made on separate occasions in 2016 to Worthing Hospital which is part of the Western Sussex Foundation Trust, rated as outstanding by the Care Quality Commission.

We took the opportunity during our visits to shadow one of the general physicians on his ward round and witnessed the frustrations he and his team experienced, even in a high performing trust with a strong commitment to quality improvement.