We thank Dr Menon for her appreciation of our study, particularly the evidence we give of the twin threats to good patient outcomes: constant redisorganisation of services and independently, within the resulting ephemeral ‘teams’, declining continuity of care for this very vulnerable group.Reference Macdonald, Adamis, Craig and Murray1 It seems to us likely that, as she says, burnout is responsible for the latter. It seems unlikely that our findings only relate to one particular National Health Service (NHS) trust. The local response to our work – in the Trust and among commissioners – has been handwringing. So, what is to be done? We suggest the following.
(a) Let everybody in the NHS – from top to bottom – use honest language. The title of Dr Menon and her colleagues’ own work on this topicReference Menon, Flannigan, Tacchi and Johnston2 contains the latest of a long list of Orwellian words – ‘transformation’. If we are instituting or participating in a redisorganisation that is primarily stimulated by (if not likely to accommodate) declining resources, let us all say so. If we cannot bear to use the C word, let us call redisorganisation ‘retrenchment’, ‘strategic withdrawal’ or some such, and not pretend that it is a great leap forward.
(b) Let everybody in the NHS – from top to bottom – acknowledge Dr Menon's point that relationship continuity of care is at the heart of what we do. It is time that it is routinely measured and monitored, especially during redisorganisation, whatever the stimulus for this.
(c) Let everybody in the NHS – from top to bottom – stop paying lip service to routine clinical outcomes measurement and devote resources to it. In this way the impact of interventions at every level – from patient treatment to redisorganisation – can be monitored so they can be modified.
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