What immediately struck you as being wrong at the hosptial?
I think one of the things which is clearly not right and isn’t acceptable is the fact that this sense that we have that the NHS doesn’t have enough facilities is just wrong. Theatres, which are often the absolute key to waiting lists because most waiting lists are to do with elective surgery, things like knees and hips and eyes and, those kind of simple repetitive surgeries that are not life threatening, those are the things that waiting lists are made of, and all of those depend on a good throughput through the theatre. And there we were with a lot of spare capacity in theatre. And it’s a bit like having a hotel of 800 rooms and having 400 of them simply not being used because you just can’t quite get around to planning it, it’s all a bit difficult, and it’s difficult to get everybody in and get the chambermaids in and to make things happen. It really is like that.
And if you think about that in a hotel, how extraordinarily stupid that is, but that’s exactly what was happening here. Doctors had their ways, and they didn’t always want the theatre on Friday afternoons, and nobody really wanted to do Friday afternoons, quite extraordinary. And getting, just coming in from outside calmly and coolly saying “hey, God, what the devil is going on here?”, because if you think about how little cost it would take to gear up that existing capacity, and what that would mean in terms of delivery of procedures that would reduce the waiting lists rapidly, it’s extraordinary. It’s extraordinary that it doesn’t happen, but it doesn’t.
What was your greatest frustration during the first couple of months?
The thing that infuriated me most was what we tried to carry out in ophthalmology, where in any other organisation that I have been part of, people wouldn’t put an idea to you until they themselves knew it could work, but actually, in that particular project, all sorts of ideas were thrown up where nobody had really thought it through. And that’s particularly frustrating if you’re coming in from outside where you don’t actually know what works, but you sure as hell expect those who are in it to know what works. So we went down any number of blind allies on ophthalmology, eventually getting there but getting there in a way that frankly we could have got there in a week rather than wasting four, nearly five months on it.
Why was that? Was it to do with the culture?
I think there is a sense that somehow management is some kind of mysterious thing, and that when people, who don’t really understand management, come up with ideas, they think it might be the magic ingredient, whereas nearly every solution is something very basic, very straightforward, doing something that you already know, and whether it’s doing an extra shift or taking on an extra person or just slightly altering the way that you plan the day’s layout, all of those simple things are the things that make a difference, but somehow people think that a change has to be some kind of magical solution, and it almost never is.
Although there was a good management team in place, why do you feel it wasn’t really delivering what you thought it should be?
There was an intelligent group of people in place but, it’s like everything else, if you’ve not experienced the fact that you can run things in a particular way, that you can have structures that very quickly come to decisions, and I certainly was, I was never talking about in any way compromising the clinical care that was given. That was never a debate, it was always about how you got top-quality care more efficient, just more quickly to the individual patient. But it just wasn’t in the psyche. It’s actually quite hard to explain, the psyche was that you discussed it, and you had any number of people saying well we’ve been talking about this for two years, or I’ve brought this up with this committee for the last 10 years. There was just a kind of sense that what you did was you talked about it; you did everything but actually change it. And that whole thing about changing the psychology is always the most difficult thing, and this was very, very deep rooted psychology in the sense of it felt to me like the Civil Service, it was safer not to do something than it was to stick your neck out and take a chance.