Now, the obvious answer is "no, he can't." As The Englishman points out, the NHS is fucked up beyond repair, with operations already being cancelled and the introduction of "fines for hospitals that operate too fast."; and we still have at least two months to go in the fiscal year. The Englishman is pretty definite about what should be done.
This is mad beyond the madness I can imagine. A system this wrong is beyond reform. The whole stinking pile must come crashing down and central command and control eradicated, the NHS offices razed to the ground, no stone to be left upon another, the sites to be ploughed and strewn with salt....
Of course, there is an alternative, as I have blogged before: demolish the monolithic NHS ziggurat, and privatise all of the hospitals. There really isn't any point in introducing privatisation to the NHS piecemeal, as the utter fuck-up that is the Private Finance Initiative has shown all too well.
Gerry Robinson is essentially attempting to run an NHS hospital as though it were a private company; inevitably, he finds himself up against all of the problems that you would expect, i.e. endemic buck-passing and entrenched laziness.
The troubleshooting business guru has agreed for this series to take on his biggest challenge yet: an NHS trust. Two days a week, he visits a hospital in Rotherham, South Yorkshire, to attempt to shorten the waiting lists. And, judging by his face (he spends most of the programme wearing a grimace somewhere between horror and torment), he soon regrets it. Robinson stumbles on a streak of entrenched tribalism that is depressing. Managers, consultants and nurses all disdain one another. Even the simple question "Who is in charge here?" brings a confused set of answers. "It's laughable!" he cries, though the lack of leadership is no joke. One scene, where he paces round operating theatres that are empty despite huge demands on their precious time, speaks volumes. "At the end of the day, nobody wants to work on a Friday afternoon," is the depressing explanation, or part of it.
There is an interview with Robinson in the Radio Times [not online (that I can find)] and there are a few choice snippets. When asked what the biggest obstacle to improving the hospital was, Robinson's reply was absolutely no surprise.
"Nobody felt that they could actually change anything. This can't go on for long in the commerical world as, if a company isn't working properly, it can't compete. But in large, government-funded organisations, inefficiencies can continue for a long time without thhe shit hitting the fan."
This is, of course, because they will always be bailed out by the poor, fucking taxpayer. But it is possible to change this culture of sloth and inefficiency. [Emphasis mine.]
"In child health [Rotherham General Hospital]'d been trying to cut the waiting list for 15 years. I got it down from eight weeks to two without spending any extra money. We got the consultants seeing one or two more patients per session, while still working within their contracts. It took two months, but in NHS terms, that was an instant result."
So you see, it can be done if we employ half decent managers into the NHS. Unfortunately, the public sector (in particular) seems to be dogged by the piss-poor, the feckless and the stupid. A couple more snippets from Robinson...
Didn't you feel like banging heads together?
"Definitely, but you have to work at it. You have to get on the shop floor and ask, "What's the hold-up?" Often I'd go back and nothing had happened. It was hard to pin down responsibility.
So who's in charge—the managers or the consultant doctors?
In theory, the managers, but most of them have come up through the Health Service and they're in awe of the consultants. That has to end. Managers have to tell consultants, "Your contract says you start at 9am; you can't continue to come in at 9.30."
Which is interesting, given the number of articles that you see demanding that the running off the NHS should be put in the hands of the clinical staff. I have never subscribed to this idea at all; the clinical staff should be doing clinical work, not trying to manage a hospital. Just because someone is a good doctor does not make them an efficient manager.
Unfortunately, the NHS seems to be utterly devoid of efficient managers amongst the management, and hence the utter bollocks that we see today; hence this fucking useless cesspit in which, despite the doubling of the funding to £2 billion a week, the median waiting time has actually increased (from 43 days in 1999–2000, to 51 days in 2005–2006).
So, good luck to Gerry Robinson, and I shall watch this programme with a good deal of interest (and so should every fucking politician and NHS manager for that matter; I bet they won't be though, the workshy cunts): 9pm, Monday–Wednesday on BBC2...
UPDATE: some more on this over at Strange Stuff...