Tuesday, June 19, 2007

Spanish Practices Stump Francophile Italian


If only it was that simple

You will recall Gerry Robinson's reality TV series, where he attempted to sort out the problems of Rotherham General Hospital. Sir Gerry reckoned the lengthy waiting lists were largely down to the Spanish practices of consultant surgeons. But he found such practices are much more complex than the mythical afternoon on the golf course, and he expended much effort even trying to understand them, let alone persuading the consultants to work more efficiently (see this blog).

Gerry would have loved John Petri. He's a consultant orthopaedic surgeon who came to Britain from Italy and decided he could slash NHS waiting lists at the James Paget Hospital in Norfolk by switching from Spanish to French practices:

"He began to employ French working methods by starting to operate earlier in the day, extending shifts by up to two hours, and introducing a "production line" system. He uses two anaesthetists, which means that there is always another patient ready to be operated on.

"People were waiting a year to have a hip replacement," he said. "By the end of the pilot scheme, they were waiting three weeks. Under the standard method, you wouldn't believe how badly things were organised. We have to find a way of surgeons not wasting their time. A surgeon is the most important link in the chain."

Hurrah.

Well, no. Not hurrah.

Despite being feted by everyone from Tony Blair down, he's met so much opposition to his methods among other NHS consultants that he's jacked it in and gone to work in Switzerland. He told the Norwich Evening News:

“When I started all this I was a bit na├»ve in thinking that other people would take it on and do the same. I thought it was very desirable thing to cut waiting lists. I thought I had found the solution. Then I found that no one was interested.

I wanted this to go around the NHS and be taken on by other surgeons but not a single surgeon came to see me. They said I do conveyor belt surgery and that I treat people like objects not people.

The problem is that the bigger waiting lists you have, the more private patients you will also have so the incentive is actually to have waiting lists. I proved the point that you can cut lists, but I also cut my private patients by half.

People in the NHS are not paid by results. If you do five operations or 500, you are paid the same. The Government needs to create incentives."

He's reportedly taken a hefty pay cut to work in Switzerland (£70,000pa from £125,000pa). That's how bad it was.

The relationship between the NHS and its consultants has always been poisonous. Bevan hated them and reckoned he only got them to go along with the NHS by stuffing their mouths with gold; Babs Castle hated them and tried to bludgeon them into giving up their private work; doubtless the 10 (yes 10!) Health Secretaries we've had since 1985 have all hated them. And we may be assured the feeling is entirely mutual.

Poor old Petri sided with the enemy and paid the price.

There are clearly major problems with the way out hospitals are organised. Sadly, our blundering guargantuan pea-brained NHS doesn't have the faintest prayer of addressing them. (htp HJ)

PS I've just been refreshing my memory of James Bartholomew's excellent The Welfare State We're In. As he reminds us, most of our hospitals pre-date the NHS and were actually working pretty well before 1948. Indeed, in terms of results achieved, there was little contemporary criticism of them. How different we feel today.

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