The difference now, 13 years on, is that those working in the NHS have already seen the failure of numerous other attempts to reform its structure-18 since 1980, according to Kieran Walshe, reader in ...public management and director of research at Manchester Centre for Healthcare Management (Journal of the Royal Society of Medicine 2003;96: 106-10 Politicians show no signs of learning the most important lesson: stop fiddling about The Labour party had 18 years in opposition to think about its favoured structure. After more structural lurching, and an obsession with waiting list targets that has poured millions of pounds down a private sector drain, we are now presented with foundation hospitals as the saving grace of the NHS.
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One of Raymond Tallis' "enemies of progress" is the denial that there was anything good about the service before whatever is the latest political reform. But "One of the most spectacular examples of ...this" came not from a politician, but from Donald Irvine, who Tallis suggests divided "the history of UK medicine into two unequal halves": before and after he became President. Using phrasing that Irvine, wittingly or not, echoes, Tallis wrote: "The story of gradual, incremental improvement in both the technology of health care and the user-friendliness of its delivery over the preceding years seems to have passed him by."
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Summary
Clinical governance was intended to ensure clinical quality in the National Health Service. Its first full description, in the British Medical Journal in 1998,
seemed to some to be more ...rhetoric than substance. Now, 3 years on, its proponents
believe it is starting to achieve its purpose. The British Medical Journal has again published a paper, this time subtitled ‘turning vision into reality’. Expectations might have been that this paper would present evidence of how clinical governance is changing practice to ensure quality, but analysis of the paper shows that it does little more than repeat the rhetoric of the earlier description. It describes how clinical governance might be organized and what it might do, but not what it has done. Its authors repeat the idea that everyone can be ‘the best’ and achieve ‘excellence’, which is not reality at all. Anyone introducing a new method of managing the National Health System has the same obligation as those who introduce new treatments to provide evidence that the method works, and that the financial and non‐financial costs are not too high. The new paper fails to provide that evidence.
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There but for the grace Goodman, Neville W
BMJ,
07/2001, Volume:
323, Issue:
7303
Journal Article
Peer reviewed
Given the litany of large scale medical disasters over the last few years, and the introduction of clinical governance and clinical risk committees, it is far more likely that there are now fewer ...harmful incidents than before, even if the media slaver over the rapidly increasing number of complaints. Mr Milburn last week joined forces with the medical royal colleges in signing a seven-point pledge for quality and an end to the blame culture in the NHS.
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The number of autopsies is a worry in the United Kingdom too, but this is not because doctors are wary of them in case they reveal mistakes that lead to media exposure and litigation-it is because of ...the Alder Hey affair and the other events that led to the Human Tissue Bill, but these are not mentioned.
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