Anton Joseph

You can improve services without trashing NHS

If you’ve opened a newspaper this week you’ll be familiar with the latest media craze, the ‘word cloud’ – a computer analysis of the important themes in a document by identifying the most frequently used words, and displaying them in a lexicographical cumulonimbus where the size of each word represents its frequency.

A colleague brought in the word cloud of Lansley’s Equity and Excellence – Liberating the NHS, where there are no prizes for guessing that the largest word is ‘GP’ followed closely by ‘GPs’.  Only slightly smaller are ‘commissioning’, ‘leadership’, ‘change’ and  ‘new’. In the mid-range are ‘primary’, ‘consortia’, ‘financial’  and ‘management’, and I had to get the magnifying glass out to see the tiny letters ‘NHS’ tucked away in the bottom left-hand bit.

However, try as I might I was unable to find the words ‘hospital’, ‘consultant’, or even ‘patient’. Evidently secondary care was not featuring very highly in Mr Lansley’s mind when he was compiling his strategy for restructuring the entire NHS. This possibly doesn’t bode too well for those who imagine that there are opportunities here for consultants.

I wonder if Andrew Lansley actually knows any hospital consultants – I can’t help wondering what the word cloud would look like if Mrs Lansley were a hospital consultant instead of, according to the Daily Telegraph, running a company which provides clients in the drug and food industries with advice on lobbying MPs (but no conflict of interest there, obviously).

Anyway, I’ve just got back from one of those mysterious hospitals which Mr Lansley seems to be a bit vague about, where I’ve been doing the Saturday orthopaedic trauma list, along with my orthopaedic consultant colleague. We now have a dedicated, consultant-delivered orthopaedic trauma list at weekends, and are successfully reducing our pre-op length of stay for trauma. In the last few years we’ve opened a surgical admissions lounge, where patients for elective surgery are admitted on the morning of surgery. It is a stone’s throw from our operating theatre suite, so patients can walk to theatre – and our patients consistently report a preference for spending the night before surgery in their own bed and with own family.

We’ve also set up nurse-led preoperative assessment clinics, so that patients don’t get their operations cancelled on the day of surgery because no-one’s spotted they’re anaemic or have uninvestigated chest pain. Of course there are still problems – sufficient trainees to provide good ward care being one of them.  But the point of all this is that, given the right management team, forward thinking and some resource, it is possible to improve the service we deliver without having to trash the entire NHS.

Anyway, back to my 72-hour weekend on-call. The trust wants us to increase our on-call workload to improve patient care at weekends, which you can’t argue with really – except that  we’re trying to save £15m, so guess what, there’s no money to pay us.

Still, I suppose we could have all done GP training if we’d had the foresight – and, of course, the  required skills in economics and accountancy…

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2 Responses to “You can improve services without trashing NHS”

  1. Malcolm Morrison says:

    Katherine, I think you have missed the point!
    My guess is that Mrs Lansley has ‘advised’ – or should I say ‘lobbied’ – Mr Lansley that GPs see more patients than surgeons (or anaesthetists); so the new GP consortia will commission all the operations to be done in the private ‘palace’ just ‘down the road’ thus elininating the need for all those expensive hospitals!
    Retired Orthopod

  2. Roy says:

    No Katherine did not miss the point. Quite clearly – that is Mr Lansley’s vocation in life.
    If I’m correct, the ‘mysterious’ hospital being described is also making significant headway into providing prioritised call information to their over-worked junior on-call doctors. intelligent bleep systems will have a colossal effect on maintaining quality NHS frontline service without these savage cuts to Nursing (all managed without declaring my interest too, Mrs Lansley)

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