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One year on from attempting to reduce waiting lists at a Rotherham hospital, business guru Sir Gerry Robinson is back. Rebecca Coombes reports
Despite its grandiose title, Can Gerry Robinson Fix the NHS? was a surprise hit on British television at the beginning of 2007 (BMJ 2007;334:124-5, doi: 10.1136/bmj.39097.690428.59). Its premise was simple: challenge a management guru to reduce the waiting lists at an NHS trust within six months and with no extra funds at his disposal.
What Sir Gerry Robinson, who has made a career out of reviving failing companies, found at Rotherham General Hospital, South Yorkshire, were warring clinicians and managers, entrenched opinions, and a struggling chief executive.
Robinson was “stunned” by the waste in nearly every department. There were lingering shots of theatres lying empty on a Friday afternoon. He was shocked by the animosity between clinicians and managers. Surgeons and anaesthetists behaved like children and threw regular tantrums, according to managers. The consultants emerged as the bogeymen of the series. Feisty, resistant to change, unmanageable, were the accusations. Manjit Bhamra, a consultant surgeon, complained that it was impossible to deal with managers because they had only “three O levels, and they are trying to manage staff with five or six degrees.”
Robinson’s tactic of getting staff to talk to each other, to come up with shop floor initiatives, had some success. But the pace was glacial, compared to that of his world.
Now he’s back. Back to Rotherham after a year’s absence to see if the ideas and initiatives he developed were still in place and if they had made a difference.
Some things, at least, never change. Robinson is still clad in designer black, a sort of high finance Johnny Cash, and rolls up to the hospital in the same chauffer driven Mercedes. But even the suave Robinson bears the scars on his back of the public sector. He is “dreading” returning to Rotherham—“it’s like being posted back to the front again.”
But what a difference a year makes. Robinson stalks the theatre corridors at 3 40 pm on a Friday, and the place is humming with activity. Every theatre is in use. All lists are full.
The major cause of inefficiency had been the battle between the theatre managers and the surgeons. In the initial series, one manager said it was “like running a school for delinquents.” Now the same manager beams, “We’ve gone from the Marie Celeste on a Friday afternoon to the Copacabana!”
All this washing of dirty laundry in public has been cathartic. A year ago, managers used to ask themselves of the consultants, “How old are they behaving today?” Good humouredly, after the programme had aired the consultant surgeons made up t shirts with the slogan, “I am ? years old today.” The atmosphere is now more relaxed. Chief executive Brian Jones seemed less cowed, buoyed, no doubt by the conversion of a £1.5m (€2.1m; $3.1m) trust deficit to a respectable £600000 surplus. His humility now seems like an asset. Waiting lists are down in all the areas Robinson looked at, paediatrics, orthopaedics, ophthalmology, and endoscopy.
So far, so positive. “I’ve become so passionate about the NHS,” says Robinson. “Success doesn’t come out of great picture stuff, but small success everyday. If you haven’t got people feeling good about what they do, then you are failing to manage.”
But no matter how well things go in hospital, the hand of Whitehall never goes away. Robinson picks up the Guardian, announcing yet another NHS review. “They must be so sick of reviews. Chopping and changing all the time. What they need is a steady course.” As one might expect from a capitalist like Robinson, he is no fan of centralised management. If consultants were the villains the last time around, it is the government that now gets it in the neck. Robinson is especially angry about polyclinics. A planned £12m polyclinic down the road will see Rotherham General Hospital’s efficient diagnostic department lose an estimated 25% of GP-referred activity. The clinic is part of the reform agenda to move services out of hospitals and into the local community. “I just despair of this stuff,” sighs Robinson. “Here you are in a well run unit with a good record, the money had been sunk, you have expensive equipment, but the NHS is going to build something just two miles up the road to do it again?
“It reminds me of Russia, 800 million light bulbs but no shirts. You have the central dogma driving everything, but no logic.” The primary care trust chief executive haplessly defends the polyclinic as a godsend for those patients who feel a bit “iffy” rather than seriously ill. “£12m for the people of Rotherham who feel a bit ‘iffy’?” asks Robinson.
It would be easy to knock the programme as sensational television—a superficial Changing Rooms quick fix by a business expert that falls apart before the ink has dried on the Radio Times. Except, it isn’t that kind of programme. Fully funded by the Open University (www.open2.net), it doesn’t set manager and clinician up against each other Punch and Judy-style. Each side is accorded respect and understanding. There are shots of an awe-struck Robinson watching orthopaedic surgeon Bhamra perform a knee operation on an arthritic patient. There is plenty of footage of doctors getting their hands dirty. Although you would expect Robinson, one-time chief executive of Granada, to side with managers, it is not necessarily so. Yes, Rotherham chief executive Brian Jones did have a lot of feisty clinicians on his hands, but it is still his job to manage them. It tries to present as complex a picture as possible that you can in 59 heavily edited minutes of television, and there are several shades of grey in its depiction of the NHS. Furrowed brow, finger on lips, Robinson is the thinking man’s Alan Sugar. He doesn’t shout or bully. In his pieces to camera he has an alluring confessional air.
His conclusion is to separate the NHS from government control. Whitehall makes life harder for the NHS, holds it back. “I’d love it if the government had an overall plan for the NHS but there isn’t. It knows nothing about management—just policies. The NHS has to be separated from government. Then, you would see something truly wonderful here.”
Can Gerry Robinson Fix the NHS? One Year On
BBC 2, 12 November, 9 pm