Driving quality implementation in the context of the Francis report

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hand. The Faculty is working with the Academy of Medical Sciences to help fulfil its recommendations for strengthening academic training in psychiatry (Academy of Medical Sciences, 2013). This includes increasing the exposure of medical students to psychiatric research, fellowships for students to perform electives in research at academic centres, and ensuring an adequate network of research mentors and supervisors nationally for medical students and trainee psychiatrists to link up to perform research. Faculty of Forensic Psychiatry The Faculty considers that patient care in forensic services would benefit from 7-day consultant-led review across a range of forensic services dealing with issues such as community crises, prison transfers, management of risk, seclusion decision and changes in treatment. Many of these areas are already addressed in trusts where forensic consultant psychiatrists share on-call responsibility with general adult services, but this is not uniform across trusts. The Faculty is also considering other developments to address the findings of the Francis report, such as a prison hotline for urgent evening assessments, input to police cells and the probation service. Perinatal Section Members of the Section are advising on the revision of the antenatal and postnatal mental health NICE guideline. The Section is also producing a joint consensus statement with the British Association for Psychopharmacology on prescribing for pregnant and postnatal women, due for publication in 2014. 14 Occasional Paper OP92
| | Principle three: provide high-quality clinical leadership ‘I believe that psychiatrists chose this career in order to lead, and not simply to advise on medication’ (College member). Clinical leadership is essential for high-quality care, and all doctors are leaders. We need to ensure that medical leadership is expected and supported by the culture of NHS trusts, to allow responsibility to go hand in hand with authority. Psychiatrists must play a leadership role in their clinical teams and in their organisations. Good medical leadership demands an enquiring and intellectually flexible mind that is grounded in a thorough understanding of current and future directions of the science of mental illness and its treatment. Sometimes leadership demands courage and, as in science, the ability to communicate the ‘truth’ demanded by evidence, not political expediency. With leadership comes accountability. We must all strive for improvement and be able to challenge our colleagues and employers when there is evidence of poor practice. Many mental health teams are formally led by the consultant psychiatrist. In others, psychiatrists have a de facto leadership role. Junior doctors also have a significant role to play, and must be encouraged to speak out, both to challenge bad practice and to innovate. All doctors need, and have a duty, to develop personal leadership skills at all stages of their careers and to work effectively within multidisciplinary teams, including with non-clinical managers. The College will work to facilitate and support these objectives. Psychiatrists, whether or not in formal medical management roles, must: • z advocate and implement excellent care within their teams • z promote a patient-safety-first culture, and embed this in daily practice • z support and enable colleagues to deliver high-quality care • z promote a culture where colleagues feel safe and supported in raising concerns. We need to be aware that too much ‘top-down’ regulation can impede progress and inhibit free thinking or criticism. Consultants and medical trainees must be empowered to lead and work with clinical and non-clinical management colleagues in the delivery of high-quality care without fear of retribution. The Francis report states: ‘A truly caring culture does not stop at the door of the hospital provider. It should never be acceptable for patients to be discharged at any time without knowledge that the patient in need of care will receive it on arrival at their destination. The emphasis should be on continuity of care to include a follow-up as to a patient’s well-being after discharge.’ Continuity of care is particularly important in psychiatry, whether in hospital or in community settings, but many services have been reorganised so that assessment and continued care are separated, without clear benefits or evidence (Tyrer, 2013). To avoid such changes or untried ‘models Principle three: provide high-quality clinical leadership 15
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Driving quality implementation in the context of the Francis report

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