Vital communication between NHS clinicians and incurably-ill patients remains poor – and risks getting worse

Andrew McDonald, who is living with incurable prostate cancer, tells personal story as Marie Curie launches new campaign to ensure patient’s voices are heard.

In a speech to be delivered on Tuesday evening, Andrew McDonald, formerly the CEO of the Independent Parliamentary Standards Authority (IPSA), will give a stern critique of the way people with incurable diseases – and in particular cancer – are handled by the NHS.

McDonald, who was forced to step down in April because of the effects of incurable prostate cancer and of Parkinson's disease, will focus on the way clinicians discuss bad news with their patients.   He will warn that the problem risks getting worse as funding pressures on the NHS increase, with the already inadequate training in communication skills having been cut back.

In his speech, McDonald will say: “The technical care I have received for my cancer has been excellent. But, taken as a whole, the quality of conversations I have had with clinicians have all too often been disappointing, with too little emphasis placed on emotional well-being.

“I do not claim to have all the answers to solving this deep-seated problem, but I am clear that my experience is one shared by many incurably-ill people in the NHS.

“This is a problem which the NHS has been trying to crack for decades now. We need to be clear on two things. First, the evidence is overwhelming that the quality of conversations with clinicians matter enormously to patients. Second, the obstacles to improving those conversations seem to be peculiarly difficult to overcome. Why is that? Is it a lack of leadership by clinicians? Is this issue simply not taken seriously enough? We need to start by having a proper, robust discussion of the causes of the problem.”

McDonald will point to three possible solutions: more effective leadership by clinicians of their teams; a more prominent role for nurse practitioners to help their patients navigate through the system; and greater continuity of care so that individuals are better able to develop a relationship of trust and understanding with their doctors.

Dr Jane Collins, CEO of Marie Curie, adds: “Andrew is pointing us to an issue of fundamental importance to patients. That's why we are going to launch our “What About Me” campaign on 30 June.

“Its objective is simple: to focus the attention of all clinicians on the needs of their patients. And so we were going to begin by asking individuals what they want from their clinicians.  And then we will work with our partners – including patients and their families – to formulate robust solutions. We will never achieve personalised care unless we have richer clearer conversations between clinicians and their patients.”

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