Waiting for Cash...

...Having missed Round One of Gerry Robinson's fight with the NHS tonight I caught up.

Got to love the man for so wanting change to happen, for upping the morale and status of front-line staff with good ideas to offer, for lamenting the endless wordiness, for challenging managers and clinicians alike to do stuff to make the best happen, for being prepared to hector surgical consultants and Chief Executives about their behaviour.

Got to thank him then for acting as a true management consultant - a breed he claims to hate and despise.

However - back to the main premise of why he was there in the first place. This was made shockingly explicit. Because 'Payment by Results' - which is not that at all but merely cash per input never mind the outcome - is the lifeline of revenue that keeps any hospital financially viable these days, it has become the business imperative to move people through hospital ASAP and in as greater number as possible. More operations, more cases, more cash. That simple.

Yes, it is good if someone with a cataract does not have to wait a long time to have it removed. But by simply speeding the flow through one part of the health system in order to make money for that particular service - and possibly bankrupting the PCT in the process - you cannot say you are achieving the best outcome for people, for patients or the NHS.

Hospital managers at war with hospital consultants - that's just one battle to fight. The linkage between primary and secondary medicine - that's a far more significant concern that this series is ignoring.

But letting go of the carping - important context though it is - a hat or two off to a man who can tell a Chief Executive it simply isn't acceptable or even remotely human for his front-line staff to be able to say they wouldn't recognise him if they saw him as they never had.

The Ohno Circle - look it up. It's brilliant. It's simple and it's so, so right.