Matthew Lewis

As a doctor who was recently Group Director responsible for medicine and emergency care across three sites in an inner city trust, I was keen to take up the opportunity of joining The King’s Fund.

One reason for this was to learn about best practice outside my own organisation. For a national health service, it seems strange that the benefits of having a single health care system do not always seem to be evident; examples include variations in clinical practice, procurement of devices and the engagement of staff across different parts of the NHS.

Possibly the culture of competition between neighbouring trusts is difficult to shake off, or perhaps individuals within organisations are reluctant to accept that other people have better ways of doing things. Certainly, there is a need to develop better co-ordination of services between local primary, community and secondary care providers – as recently illustrated in the Fund’s report on place-based systems of care.

No one plays a greater role in the establishment and proliferation of good practice at the point of delivery than those who work on the front line. The General Medical Council advises doctors that ‘whatever your role or level in your organisation, whether you are a junior, non-training grade or other doctor, you should be willing to demonstrate leadership in managing and using resources effectively’ and that ‘you should be prepared to contribute to discussions and decisions about… allocating resources and setting priorities in any organisation in which you work’.

People with clinical expertise should be at the forefront of discussions about which services, procedures and treatments require investment and, at the same time, which ones should be reviewed. However, it is not enough simply for clinicians to demand more support; we should be demonstrating that we understand where our own inefficiencies lie and what we are doing to provide good value to the NHS. Established practices can be challenged effectively by people who understand the services that they are providing – which means doctors, nurses, therapists and others – and The King’s Fund has an enviable record in promoting the benefits of clinical engagement.

At my trust – Sandwell and West Birmingham NHS Trust – we’ve got plenty of interesting ideas of our own and I think it would be helpful to try to disseminate those more widely, even if this means that sometimes we will be sharing our shortcomings as well as our successes. We are working towards the establishment of a new hospital in two years’ time, and to manage the demand on the service it’s important that we change the way that we work across our local community to make sure that patients attend hospital only when necessary (be that for outpatient appointments, procedures or emergency admissions). Our own journey reflects many of the challenges faced by the wider NHS. None of us find the current health care environment easy to deal with, but we need to be as open as possible in discussing what we’re doing to address pressures on finance, performance, quality and workforce.

While professional organisations have been highly effective in influencing some aspects of clinical practice, for instance through the excellent Future Hospital Programme, for me, working with an independent think tank has the advantage of adding a greater level of objectivity to discussions about health and social care. At the same time, I would like to think that the content of these discussions can be influenced by people who have an ongoing clinical perspective, perhaps highlighting areas to work together to address longstanding concerns. One of the most valuable functions of The King’s Fund in the past has been bringing people together from clinical, managerial and academic backgrounds to look at some of the most topical (and difficult) issues, allowing new approaches to be discussed, formulated and shared.

At a time when so many changes in the NHS are being contemplated and planned – not least the development of sustainability and transformation plans (STPs) – it is important that clinical staff have a role in shaping our future services.

• The evolving NHS
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• Find out more about our clinical leadership programmes