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Dr Devlin and her colleagues (May 2002 JRSM1) ask what mechanisms have been used in Dorset to achieve a sustained reduction in waiting times. The answer is many.
First, Dorset is a pleasant part of the country. As a consequence many of the people who chose to live here can afford private health insurance, which takes a load from the NHS. Because it is a nice place to live, there is competition for medical posts leading to the appointment of general practitioners and consultants of very high quality. This has engendered happy relationships between doctors, without feuds that characterize metropolitan health providers and that so impair efficiency. The best managers are also attracted.
Second, numerous large houses, once family hotels, have been converted to private nursing homes, and the availability of these means that relatively few ‘bed-blockers’ occupy acute medical beds.
Third, the cooperation between the two largest hospitals in Bournemouth and Poole has meant that services can be shared rationally across the county without vain competition. For example, beds for elective orthopaedics are separated from acute trauma. It has thus been possible to avoid wasting money on trying to staff small inadequate units, merely to maintain a presence of that specialty in a district general hospital.
Fourth, the main purchaser has been single-minded in wanting to abolish waiting lists and has spent money wisely to remove bottlenecks, without regard to political dogma. Nevertheless, he has listened to the doctors and always responded to genuine concerns for other parts of the service while not being fooled by ‘kite-flying’ operations.
Fifth, the whole medical community has been visionary in spotting new developments. For example, cancer services were developed and new oncologists appointed while the new drugs had only numbers and had not yet been named, and before the shortage of trainees in oncology began to bite.
Finally, the relative affluence of the community has made it possible to fund from non-exchequer sources a good deal of capital improvement.
Most of these factors are site-specific; they will not work in Croydon or Workington. But several health authorities with similar populations have been much less successful, and the reason cannot simply be that their beaches are covered with pebbles while ours have seven miles of golden sand.