I worked exclusively for the National Health Service (NHS) for 30 years before combining my NHS post as a consultant old age psychiatrist with a part-time medical directorship in the private sector. Six months ago I joined Red & Yellow Care (R&YC), a private healthcare provider specialising in dementia and other long-term conditions prevalent in old age. Although R&YC and most NHS services provide first class clinical care, there are organisational differences, and none greater than the difference in operational efficiency.
Bureaucracy and excessive recording of data fetters the NHS. When I looked into this in my own NHS practice I found that for each hour a team member spent with a patient, they would spend two in front of a computer. This problem is widespread in the NHS. At R&YC this ratio is reversed, while quality is nothing short of excellent.
Contrary to popular belief, private practice is not fat and happy. It can’t afford to be. Patient expectations are sky high and competition is fierce. It is a matter of survival that quality is world-class and appointment prices are competitive, and to make any profit at all, a private provider must excel in operational efficiency. At R&YC the clinicians also record data, but only data that is clinically relevant. And they record it on a secure web-based system that can be accessed from anywhere, at any time, so that note writing and report dictation is done in the spare moments that naturally occur throughout the day. And R&YC clinicians also don’t waste time writing referral letters, because the in-house team comprises most of the specialists our patients need.
In stark contrast, clinicians in the NHS spend a lot of time recording irrelevant and often repetitive information. Why, for example should clinicians complete a risk assessment form if they have already written a competent risk assessment in the notes? Of course, the data collected for the purpose of clinical delivery and evaluation are part and parcel of good practice. But a culture amongst management to measure everything under the sun and an imperative felt by clinical staff that they must protect themselves against blame, drives a welter of data collection that corrodes morale and wastes time. And this is exacerbated by the duplication of data that results from the numerous silos within the NHS, not to mention the duplications created in the social care and charitable sectors.
All this came to a head at the Alzheimer’s Show in London last week. During a plenary I was speaking at, many in the audience were suggesting that care professionals should keep better records. Yes, but better does not mean more. And I felt like a lone voice saying that we should record less. Although the bureaucratic burden of care has risen substantially, the number of professionals has not (in both the health and social care sector). The consequence is both inevitable and scandalous: we spend less and less time with patients.
I would much rather see professionals providing care than recording it. Otherwise we enter a culture of measuring the quality of care by weighing the care records, much like judging the taste of the bacon by the weight of the pig.
Dr James Warner
Medical Director, Red & Yellow Care
Chair, Faculty of Old Age Psychiatry, RCPsych
National Professional Advisor, CQC