Senior Decision Making – what does it really mean?

In NHS hospitals, the phrase ‘Senior Decision Making’ is now much used when talking about how good decisions are made for patients so that they get the best and most timely care. This particularly applies in the Emergency Department, where the time taken for a patient to meet a ‘Senior Decision Maker’ (be it doctor, nurse or other) is often used as a benchmark. It is worth giving a thought to how that person learns to make good and quick decisions based on what may be sketchy information. Then spare a thought for the London Fire Commissioner (only been in the job for a few months), who had been woken up at 1.00am last week, had driven to West London from Kent, had been faced with the inferno that was Grenfell Tower, and then having to decide whether to authorise firefighters going into the building even though it had not been deemed to be structurally safe, against normal protocol. She did authorise them going in, and many lives were saved. I doubt if any doctor-on-call of any seniority has had to make such a quick and difficult decision, based on so little information. Humbling!