Waking Man's Dead

One hopes and expects that Gerry Robinson's television foray into the NHS will prove fruitful, offering genuine insight into what can be done to improve the management of the service for the benefit of people and patients.

His previous outings in "I'll Show Them Who's The Boss" were entertainingly full of pertinent - not to mention on occasions wonderfully impertinent - apercus regarding small businesses that were heading for big falls. Not quite in the hectoring class of a Gordon Ramsey but equally nailed-on revelations of where people were going wrong.

But will he do it this time? The portents are not good, though one ought in fairness to wait for the show before final judgement is given. The pre-broadcast blurb and the early Telegraph interview are not encouraging. 'Fix the NHS' is the headline. Well, no it is not the 'NHS' as a whole he is looking into, just one example of a hospital offering secondary medicine to the already sick.

And is it to be management and leadership of the whole of the hospital? Not apparently. The task - whether given or self-selected - is to reduce waiting times, which is known not to be the heart of the matter. Good outcomes for patients is what is required and the length of wait, though important, is but a too readily visible sign and symptom of a wider, deeper problem.

Even allowing waiting times to be the chosen focus, is it just surgical through-put that counts here? Not at all. Opening operating theatres on a Friday afternoon will have implications for the whole system, both pre- and post-operative that will need to be managed. No point at all in increasing the numbers of operations if there are not the staff and other resources to help complete the entire patient journey.

Will there be extra physiotherapists, occupational therapists, nurses and even beds to take the extra load? No value in pushing through half a dozen more fractured neck of femurs if the nurses and allied health professionals are not on hand to optimise recovery and rehabilitation.

Let us follow this thought further. Orthopaedic surgery is mainly mend and repair. It's bust so it needs fixing. There is more of course, but that is the bulk of that work. And so who are the people most in need of fixing? Mainly older people who have fallen and fractured a leg or hip. Would it not be better if they didn't fall in the first place? Clearly so. So what might be done to prevent such occurrences: is it possible to reduce the numbers of people who end up in theatre? You betcha. More chiropodists for better more stable feet, more district nurses to manage troublesome leg ulcers. More dietitians detecting diabetes, more GPs with a grip on depression in older people.

But even more. If one is going to indulge in a little light 'root cause' analysis of the problem of high demand for orthopaedic services, why not ask older people themselves what they consider to be the greatest risk to their health. 'Broken paving stones' was the answer they gave when polled some few years ago. Trip hazards in the street - that's what they knew from experience was the most common cause of their literal downfall. Deal with those and the wards begin to empty. The well-ness system as a whole needs more than health or sickness services.

By all means, Gerry, let's have a leader supreme in a hospital who can boss the doctors around, who can tell the politicians to take a hike and who has the proper care and welfare of hospital patients at the very heart of their every waking moment. We used, indeed, to have such a person in every hospital and we called her Matron.

As for kicking out all management consultants - many of whom are actually ICT consultants and a very different kettle of fish altogether - that's a bit rich coming from a man who has just spent six months working as a pro bono publico management consultant himself!

I'd love to find out what he has to say, but sadly I shan't as I'll be on the other side with my favourite 'Waking the Dead.' Now DI Boyd - he'd be a great boss.