A friend told me recently that Heretic was written by Leicester Royal Infirmary trust chief executive Peter Homa. I was flattered, given the impressive results of the pioneering business process re-engineering initiative he drove at LRI. But that mould-breaking effort's multi-million pound price-tag has deterred other trusts from challenging traditional practices. In his new role as waiting list buster, he should desist from hiring expensive management consultants. When provided by your own staff, applied common sense comes cheap, particularly when augmented by insights from elsewhere.
Leicester's use of a spreadsheet-based approach to scheduling operations shows how little real analytical attention this issue has received. Terms such as 'capacity', 'flows' or 'pinch points' - the building blocks of scheduling systems outside the NHS - are absent from hospital discussions. I once won a wager with a trust chief executive after suggesting that his operating theatre utilisation, based on a 40-hour week, would be significantly less than the 100 per cent everyone imagined it to be. What is it in your trust? There it was 72 per cent.
Some surgeons have always booked all their patients for surgery at the original outpatient appointment, effectively eliminating a traditional waiting list. Others have made full use of theatre sessions by insisting that patients positively confirm their appearance. Both devices benefit from the existence of 'hot' and 'cold' waiting lists. This means gaps in theatre lists can be plugged even in unpredictable circumstances.
I had naively assumed all trusts adopt this commonsense arrangement. They don't. They should.
Amazingly, some surgeons are still disinclined to provide adequate notice of their absences. This antiquated practice should cease immediately.
Giving priority to emergency medical admissions blocks surgical procedures. Why not build a Chinese wall between the two, forcing doctors to resolve their own problems without recourse to surgical resources?
These ideas have all worked somewhere. Peter Homa might assemble a compendium of 101 similar simple but proven list-busting ideas. Organised through the Internet, it could be developed within a month. Trusts could then report to the NHS Executive on which they had not tried - and why not.