Continuity – our Achilles' heel

Your editorial, examining healthcare's Achilles' heels, failed to identify discontinuity of care.¹ The article describes a ‘healthcare team’ but where are those teams that used to manage emergencies? Now it is easier to pass the patient than take the over-arching responsibility for those admitted when we are holding that emergency baton. Healthcare has become a relay race. The least expensive junior doctor emergency rotas usually have the participants out of sync with the senior members of the team to which they have nominally been seconded. Continuity of learning has been superseded by clockwatching.²

While a minority of emergency admissions require the expertise of a specific specialty, most patients have multiple co-morbidities and are best cared for throughout their hospital stay by the ‘generalist’ and his/her team who were holding the baton on the day of admission.

We might look to the universities and Royal Colleges to sort out this mess but that thread of continuity has been passed on to the GMC which has no track record in anything other than disciplinary matters. Alternatively, our politicians could intervene and legislate to put continuity of care at the heart of healthcare and then mould the infrastructure around it. But politicians and their parties are as ephemeral as the succession of management executives imposed upon us and whose only concern is the minimization of their loss-making emergency services.

The inherent risk in healthcare is so patently obvious but no-one appears to be able to see the wood for the trees. An onlooker might see us like a group enjoying a communal bath with the patients the bars of soap. Under the muddied water no one is quite sure who is holding what. When the bathwater has drained away we appear surprised that all the soap has gone down the plughole!

Footnotes

Competing interests None declared