"Realistic expectations from the NHS"

Professor Charles Vincent, in his comments on the 7th day of the Mid-Staffordshire NHS Foundation Trust public inquiry, was correct in identifying a lack of time among hard-pressed and overworked clinical staff to engage in management changes which would improve patient care and safety.

He contrasted the state of affairs in the health service with that in industry where "teams are assembled, taken off their duties and given time when changes are needed to be made in the way they do things. In healthcare, change is ‘fitted in’ or done in the evenings or at weekends."

As one of the overworked staff, I can vouchsafe these remarks because the clinical priority is always just to get on with the ever-increasing workload and cope as best as one can with a chronic lack of staff, resources and time. This is the reality of life as a clinician at "the coalface" of the NHS.

Some of the clinicians at Stafford were faced with a workload more than twice the national average, and so inevitably concentrate their efforts on just getting the job done to the best of their abilities despite the logistical difficulties. There is little or no time left to get involved with service reconfiguration. I do not believe that doctors or nurses deliberately set out to deliver poor care to patients, but the pressures of workload and under-resourcing force them to "get on with it" as best they can while recognising chronic problems of understaffing and underfunding, and feeling unable to address these deficiencies.

Sadly, the users of the NHS have come to expect a first class service from a 3rd or 4th class level of funding and investment in the NHS. While this discrepancy persists, users will continue to be disappointed that care does not match expectations - across the NHS and not just in Stafford.