Sooner the better…


It’s not a precise science… that’s for sure.

It requires a huge amount of precision, accuracy and exactness but it’s not clear-cut. However meticulous the planning, it is not a definite.

You only have to see one, be there and judge for yourself. It is not to be measured with a slide rule.

You have to witness an operation to understand what happens in surgery.

Sometimes, what starts out to be a simple cut-n-shut, ends up something very different.

Sometimes, things go easier than you can dream of.

Sometimes, you arrive, expecting to work your way through a list, only to find electives are cancelled because surgical beds are full of medical patients, or a patient has a last minute reason to not turn up.

Sometimes, the arrival of patients can be dependent on the porters and the porters can only bring patients whom the ward has prepared and the ward can only work with the staff they have.

Sometimes, delays as simple as the patient getting lost in the hospital or finding a parking place.

Sometimes, the checklist reveals a problem…

As many as there are people and as many as there are techniques, so there are that many interfaces and practicalities that get in the way of a ‘smooth-day-at-the-office’.

Defeated by ‘the sometimes’.

So it is that this headline in the Daily Torygraph is as irritating as it is stupid;

An extra 300,000 operations could be carried out in England if surgeons planned their holidays in advance and managed their time better…

Apparently it comes from NHSI who are increasingly struggling to impress. Locked in a behind-the-lines merger battle with NHSE for jobs and influence.

Let’s do some back of the fag-packet sums;

Let’s say 300,000 operations and all theatres can do elective operations every day of the year, 365, I make that 821 operations a day.

Let’s say 100 Trusts carry out operations, I make that 8 extra operations a day. If an operation takes an hour, we’d have to find an extra day, every day, presumably a night shift?

The hole in my sums is obvious;

• We don’t have 7-day working because we can’t afford it.

• 300k operations; what sort of operations? Cataract or cardio-thoracic?

• Where do the staff come from?

• Who pays for an additional 300k operations; beds, community care, pharmacy, physio, out-patients, imaging, meals and bog rolls.

There are four million people on NHS waiting lists, half a million patients waiting more than 18 weeks for treatment. The total figure is a 66 per cent rise from the 2.5 million waiting in 2011.

Every day, plans are decimated by unplanned admissions and delayed transfers of care.

Reviewing efficiency must be part of a concerted effort to reduce the time people are left managing with the help of carers and pain killers.

Just how do the big-brains at NHSI think a pejorative headline in the media is going to make anyone’s operation come any quicker? What are they trying to achieve, other than to look busy.

They are under pressure to bring down waiting lists. What better way to shift attention from themselves than dump it all on the providers, gift-wrapped and tied up in implications of inefficiency, time-wasting and holidays.

The GIRFT programme continues to enjoy broad support across the NHS. That is because it is run by medics, for the benefit of medics, endorsed by medics.

Actually it is a management programme based on data analytics, but it works because management keeps out of it.

The NHSI study of operating theatre efficiency is purported to have been carried out with the Royal College of Surgeons.

I find it hard to believe anyone from the RCS would have put their name to an approach so crass.

Be that as it may… NHSI managers seeking self-aggrandising headlines in the popular press is the absolute wrong way to go about winning the hearts and minds of people who do the most excruciatingly difficult work, in the most difficult of circumstances.

How dare they…

I fear NHSI is dragging us back to the days of grip, league tables, blame and bullying.

I can’t help thinking the quicker they are subsumed by NHSE, the better.

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Reproduced at by kind permission of Roy Lilley.