Report comment

"For instance, social entrepreneur Sala Uno Salud in Mexico is able to do high-quality eye surgery at a third of the market price by only using highly skilled (and therefore highly paid) ophthalmologists for the most complex parts of the procedure, whilst junior staff carry out the repetitive elements."

That will never be allowed in the NHS. Jealousy and other petty clinical hierachical turf wars make such a system of a supreme clinical skill being rewarded and respected, even revered, a complete non-starter. The last few decades have been marked by a systematic denial of the clinical authority of doctors, let alone highly skilled surgeons. Reduction to the lowest common denominator rather than celebration of the exceptional individual has been the order of the day. We now reap what has been sown, whilst the Third World teaches us lessons in more areas than just healthcare. Until NHS managers of the type that read HSJ abandon the bullying control of Whitehall and start respecting, really respecting, the clinical abilities of their local staff, nothing will change. By the way, why are there almost no clinicians on the boards of NHS Trusts? Would you expect a large successful engineering firm to have almost no-one with a background as an engineer on the board?