Do you need to be an NHS Consultant to be respected, like the respected NHS Consultant Andrew Wakefield and all of the respected NHS Consultant co-authors of his MMR paper? As far as the public is concerned a doctor is a doctor, and the damage is the same.

It seems rather simplistic to suggest that the solution is just more beds or just less attendances. More beds won’t achieve much if they are immediately filled with people who can’t be discharged because the care they need in the community isn’t there or who will rebound straight back into ED.

More sophisticated methods can give you a better understanding of the system but can be really hard to explain (e.g. Functional Resonance Analysis Method) and present the organisation with far more problems than solutions - this can make them a unpopular with people who want to hear things are fixed

RCA is attractive because it will always give you a nice simple answer. The answer will be incomplete at best and entirely wrong at worst, but it will be relatively straightforward to understand and generally conform to the preconceptions of the people that have to sign off the report.

The problem is that the skills you need for investigating complex systems aren’t something you can pick up in a few days. Doing it well is a profession in itself - it takes a lot of training and experience to even know what the best tools are for a given situation, let alone use them well.

It can be effective when looking at simple systems and processes - my widget machine is making square widgets instead of round ones. Once you get into complicated systems it‘a going to start showing its limitations. In a complex system like healthcare it’s just the wrong tool for the job.

Hi, Chartered HF Specialist here. Used to work in Patient Safety at a Trust, now in a national role.