During the first programme of Can Gerry Robinson Fix The NHS, Gerry seems to be struggling to make sense of some of the apparent complexities that are causing stagnation and feelings of negativity throughout the hospital system. What needs to shift in order for some simple things to happen? How can patient waiting times be brought under control if everything drifts on in the way that it always has? Who is managing the system?

Although these problems seem to be specific to the hospital in which the series has been recorded, there are features that may well be generalised throughout the NHS. In his attempt to understand what is going on within this hospital in Rotherham, Gerry has discovered that there are powerful interest groups involved in running the organisation. Surgeons and anaesthetists in the operating theatres and clinical consultants in the paediatric department seem to be pitted against the managers when it comes to attempts to implement change. Initially members of these powerful groups seem keen to protect their own interests and defend the status quo.

"there are people prepared to use their personal energy to advocate change"

However, it is not as simple as a battle between potentially competing interest groups. In each of these groups Gerry has identified individuals who do not conform to type. Within each group there are people prepared to use their personal energy to advocate change, and who have developed ideas for improving the system. Gerry seems to sniff them out and let them have their say. These ‘champions’ need encouragement and rewards for bringing about change. But there are also individuals who tend to block every suggestion and spread feelings of negativity.

Are the situations and complex problems that Gerry Robinson has uncovered deep within Rotherham General Hospital unique to that organisation, or are they typical of what happens throughout the NHS and within all large organisations? Obviously the individuals who were brave enough to be recorded going about their work in the bowels of the hospital are unique. But I found myself stimulated by the programme to think how similar the problems faced by the people featured in the series were to those I encounter in every corner of the NHS. In my experience of working in the NHS it does seem difficult to change things for the better.

"in my experience it does seem difficult to change things for the better"

The dead weight of routine and ‘usual practice’ can suppress innovation and squash the energy out of people of good will who are committed to finding ways of improving the system. It is too easy to say that ‘too much bureaucracy’ is the problem… because pitfalls and reasons to revert to the way that things have always been done can come from many different quarters. It might be that powerful interests are involved, such as the doctors or other professional groups… but often it is just a rather general lack of motivation or imagination, or the intervention of one difficult character, that keeps things the way they have always been. Of course, in times of financial growth new services can be added to the old, but in the current climate this is impossible and any new ways of working will be in direct competition with the powerful status quo.

Although the first programme in the series does not deal with the problem of targets and financial imperatives that are imposed from higher up within the NHS, or from central government, these are real issues for people working in today’s NHS. Many units at all levels of the NHS seem mesmerised by the need to meet increasingly impossible financial targets. Managers, such as the Chief Executive of Rotherham General Hospital, Brian James, appear to be overwhelmed by pressure from above, to meet those targets, and pressure from below, attempting to respond to the concerns of people providing front-line services. But the way managers respond to these pressures is crucial. They are responsible for bringing about change within their organisation and the personal skill and style they bring to the task is the single most important factor that determines whether the culture of their organisation will be one in which change is encouraged and rewarded… or not.

"the programme presents real challenges to people working within the NHS"

The programme presents real challenges to people working within the NHS. Do you want to be part of an organisation that has the ability to change and develop? If so, are you prepared to be flexible and perhaps look again at some of the time-honoured practices to which you are currently attached? And, if you are a manager, do you want to take the risk of listening to the concerns of people employed within your organisation and support them in the process of innovation and change? Can you spend some time focussing on issues that are not simply concerned with balancing the books?

These and other issues will be tackled by Gerry in the next two programmes.

Content last updated: 03/01/2007

About our expert

Tom Heller is a senior lecturer in Health at the Faculty of Health and Social Care at the OU. He has been an academic advisor for several BBC/OU collaborations including Gerry Robinson’s series on the management of the NHS, Anna Ford’s radio programmes on Complementary and Alternative Medicine, and two Kathy Sykes TV series on the science behind CAM therapies. Most recently he has been working as a general practitioner in a deprived area of Sheffield. His latest project - part of the BBC Headroom campaign - aims to demystify some of the issues surrounding mental health and distress.

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