Rotherham chief executive Brian James on why Gerry Robinson can't fix the NHS

You would have been hard placed to miss all the media hype surrounding the TV series Can Gerry Robinson fix the NHS?

Many will question why we agreed to undertake the programme, and whether or not it has given the public new insight into the NHS. Time will tell.

Although hosted by Sir Gerry I'll Show Them Who's BossRobinson, and using the same production team that produced Back to the Floor, this was to be a more serious programme, showing the potential impact of running an NHS hospital more like a business. It was sponsored by the Open University, and targeted at a more discerning viewing audience, being shown on BBC2 at 9pm.

The Rotherham foundation trust was established on 1 June 2005, and since then we have set a clear direction of travel towards becoming more business-like. Three hospital consultants have been appointed as executive directors, with responsibility for finance and performance of clinical services. Waiting time reductions are well ahead of target. We are financially sound without compromising our primary care trust, and we have an excellent track record of delivery over several years.

The board was keen to learn from someone of Sir Gerry's stature and decided that the benefits of producing a truly informative piece would outweigh any possible adverse publicity.

This was a good news story for the NHS - a high-performing hospital seeking to get better. Or so we thought.

Obstacles and frustrations
In order to ensure that the scope of the programme would make sense to the viewing public, we suggested that Sir Gerry focus on reducing waiting times, within existing resources, in four specialties.

Sir Gerry quickly discovered that we had spare theatre capacity. While this presented an obvious solution to eradicating waiting times for elective surgery, it clearly did not do so without additional investment which our PCT could not afford. From a business perspective, our inability to use these empty theatres was madness, especially when the amount required to clear the waiting list completely -£3-4m - was so small. Yet it presented a huge hurdle in terms of PCT affordability.

His attempts to reduce ophthalmology waiting times were constantly thwarted as each avenue explored resulted in new issues emerging that compromised patient safety. Sir Gerry was convinced that his direct approach was essential to getting things done quickly, and he found the need to consult with so many different professions before a decision could proceed deeply frustrating. After a few months it was clear that too many obstacles prevented progress within the timescale of the programme, and while implementing change in the NHS is never straightforward, this would neither make compelling viewing nor deliver a triumphant result.

Sir Gerry then changed tack and focused on a group of consultants who were unhappy with the NHS reforms, and with 'the management' for introducing them. This appeared to be a much more interesting story from Sir Gerry's perspective. Here was something he understood well - staff complaining about management. The programme took a completely different turn after that - he was now in much more familiar I'll Show Them Who's Bossand Back to the Floorterritory.

Disappointingly, Sir Gerry never seized the opportunity to explore and challenge consultants as to how they could be more efficient and productive, which is ultimately the key to eradicating waiting times. The opportunity was sacrificed for a much simpler story of consultants versus managers, with both sides presented as stereotypes.

To his credit, some improvements in waiting times were achieved with Sir Gerry's help. Waiting times in paediatrics dropped from 11 weeks to two, and in endoscopy from seven weeks to three. Sir Gerry's direct approach did speed up implementation in areas where staff had more ownership and control over the variables, albeit with some uncomfortable compromises having to be made.

It is disappointing that the programme never got to explore the difference between being the manager of a business, and being a manager in the NHS. Sir Gerry felt that they were one and the same. While there are some common elements, there are also some fundamental differences. Would Sir Gerry ever have been successful in a business where he had no real control over the wages of his staff?

On the shop floor
In his post-production reminiscences, Sir Gerry concludes that there is a real problem in holding consultants properly to account in a business sense, including removing them from their post when necessary as would happen 'in business'. He argues that NHS chief executives should be paid significantly more half a million - to attract the calibre of individual who would exercise such accountability, implying that existing NHS chief executives are too institutionalised to grasp the nettle.

While this may be manna from heaven for the tabloids, the many constraints under which managers currently operate severely undermine a faster pace of change, even in a foundation trust. The biggest failure of the programme, and my deepest regret, is that it makes no attempt to explain what these are.

From a personal perspective, I learnt from Sir Gerry the importance of the chief executive driving the reform message out on the shop floor. This works in a much more profound way than I had appreciated, although as Sir Gerry also discovered, a more direct approach to changing systems can also result in a lot of wasted effort.

Rotherham will continue to drive down waiting times using the hard work and expertise of our staff, aided by the best advice we can get, including Sir Gerry's. Waiting lists were falling before and during Sir Gerry's intervention and they continue to fall. We are on the verge of great achievements at Rotherham. Should we invite him back to review the results? Ask the audience, or phone a friend!

Brian James is chief executive of Rotherham foundation trust