'Change is no less difficult when our intentions are absolutely right and serving patients' best interests.'.

Discussion at a recent dinner with fellow board members inevitably turned to the troubling question of NHS reforms and Tony Blair's achievements as prime minister.

There was a lot of debate as to whether we needed politicians to set us in the right direction on patient-centred care. There was general agreement, regardless of.political affiliation, that this had been a cultural change for the better - and that it would not be reversed by any future administration.

Throughout my career, I have been dedicated to ensuring everything the health service does.is about the patient. So I am.particularly interested in the concepts of patient focus and patient-centred care.

Blair's legacy is an NHS of patient satisfaction surveys, public and patient involvement.forums and other means of involvement, together with more honesty when we get things wrong.

A question of priorities

Patients tell us they want empathy and understanding; they want to be treated as individuals, not processed in a sausage machine. In the past, we have questioned whether this is really what patients wanted most, or whether safe, high-quality care was more important. In our more patient-centred world, we are growing to understand that they expect safe, high-quality care as a given, and want individual care and understanding as well.

For our part, human resources practitioners translate this into a number of interventions. We focus on education and learning, the knowledge and skills framework and performance appraisals, creating the environment and culture that supports, develops, encourages and rewards staff for meeting patients' needs. We also consider how we can recruit staff with a positive attitude and attributes that deliver patient-centred care..

Last year I was delighted to be involved in giving a.national human resources.award for excellence to a trust that had developed a person specification, using symbols to enable patients and clients with learning difficulties to participate in recruitment.

Good intentions

One of the main objectives of Modernising Medical Careers was to ensure all junior medical staff are fully competent in all areas of their practice, aptitude, knowledge and.skills, including.softer skills associated with attitude, communications and the personal touch.

The medical training application service was meant to deliver best practice in recruitment, especially equality of opportunity. Despite laudable ideals, the process appears to have gone wrong, causing so much concern that it has even reached the Commons and brought doctors onto the streets in protest - while everyone has forgotten how poor the previous process was.

Even if it had worked as planned, the very things it sought to change would still have been a massive challenge.

What strikes me yet again is how difficult change is for people. And it is no less difficult when our intentions are absolutely right and serving the patients' best interests..I have heard some differential debate as to the responsibility we bear towards individual doctors, and here I think is the interesting question..

The recruitment selection process is just that: it discriminates in the selection of one potential member of staff over another. Competition for jobs produces winners and losers - we cannot always guarantee people what they want.

The size of the task in relation to Modernising Medical Careers.has necessarily left us with large numbers of frontline staff facing uncertainty all at once, with many feeling they will lose out. This unsettling time will continue for many people for some time. Doctors fear difficult decisions will have to be made between finding employment in their speciality of choice and living in their location of choice. Life-changing personal decisions are hanging on the views of an interview panel...

These fears may turn out to be unfounded. After all, it is the process that has changed, not a reduction in the number of posts, but it is the waiting and not knowing that is difficult...

Back to basics

In 1954, Abraham Malsow identified a hierarchy of human needs, the most basic being food and shelter. He referred to these as prepotent needs...

Maslow suggested that the human condition forces us to satisfy these needs before we can turn our attention to much else. Lack of job security is very threatening to food and shelter needs and, if Maslow is to be believed, that insecurity must be threatening to patient care...

While medicine has always been a meritocracy, and we are not in a position to guarantee.all staff the jobs they want, we have a duty to reduce this insecurity in the system as soon as possible...

Great efforts have been made to get Modernising Medical Careers.back on track. The health secretary has set up an independent review under the chairmanship of Peninsula medical school dean Professor Sir John Tooke. He and his team are excellent people who will do a thorough job. This leaves the rest of us free to stop attributing blame and debating what should have happened, and to pull together across professional boundaries to get doctors into jobs and patients treated..

The Department of Health, NHS Employers, deaneries, royal colleges, the Postgraduate Medical Education and Training Board, the British Medical Association and others are working around the clock to ameliorate this situation, but they need support from the front line. First, they need us to recognise the complexity of finding appropriate solutions.

Everyone has their own pet solution, and every single one of those solutions comes with a different set of problems attached. Our job is to get security and certainty back into the system as quickly as we can.

Deborah O'Dea is president of the Healthcare People Management Association. This year's.HPMA conference is in London on 7-8 June.and features Clare Chapman as keynote speaker, an award-winning staff engagement strategy and an up-to-the-minute workshop on Modernising Medical Careers. Book online at www.ahhrm.org.uk