A question of accountability

by Arun Baksi and Parag Singhal

Patients are often shuffled between wards in which staff feel little sense of belonging. Two doctors from the campaigning group Our NHS, Our Concern make the case for strong and effective ward-based teams  

Location: UK
Published: Friday 30 August 2019

It is a frequent practice that patients are moved from ward to ward during a single admission. This leads to not just disorientation of the patient but also results in loss of continuity of care. Patients do not know who the members of their care team are.

Apart from the ward sister/charge nurse, there is rarely an identifiable team in a ward. The loss of teams is a serious concern of clinicians. As well as affecting patients, health professionals often feel that they do not belong, leading to low morale.

A widespread feeing among all sections of the workforce is that they do not count as relevant and have no part in the planning of services within the hospital. This perception is also due to the management style that pervades the system.

With some exceptions, the working environment does not allow the development of leadership. This requires a stable environment that allows development of ideas and the ability to change practice.

We believe that a way to counter all of these problems would be the establishment of ward-based teams.

So what would such a team – which would include all health professionals and support staff - look like?

Firstly, it would be under the administrative control of the ward sister or charge nurse, who would report to the director of nursing. This does not mean they would interfere with the doctors and other health professionals discharging their professional duties. Instead it is a recognition of their role, and a reallocation of appropriate status.

Each ward would have a recognisable team of senior and training-grade doctors. While it’s possible that those doctors might be assigned to more than one environment, they would be identifiable by the patients as ‘belonging’ to that ward.

Patients, for whom every single clinician on the team would have a collective responsibility, would not be transferred to another ward unless it was necessary for the management of their clinical condition.

With these changes would be a much greater emphasis on regular and transparent communication. There would be regular team meetings, where all staff would be encouraged to speak up. And meetings at every level would be properly recorded, with the minutes available to all.

Patient and staff satisfaction would be measured, and each ward would publish the data. How this is measured could be formulated locally but it may be better to work to national indices. This practice may well lead to a healthy competitive environment and allow recognition based on facts, a point missing in current practice.

We think these changes would immediately improve patient and staff experience:

  • Patients and their relatives would know the staff who are looking after them
  • Continuity and quality of care would be assured at all hours
  • Accountability and transparency would be obvious
  • Innovation and leadership would be fostered
  • It should be make it easier to allow flexible working.

Improving morale and the sense of belonging that both patients and staff feel – and with no additional cost. Surely this should be considered?


Arun Baksi is an emeritus consultant physician in the Isle of Wight. Parag Singhal is a consultant physician in Weston Super Mare. They are, respectively, honorary secretary and chair of the campaigning organisation Our NHS, Our Concern