Hilarious: Trying to use bureaucracy instead of incentives as a "hurry up"

You don't see many government employees hurrying!

Surgeons who dawdle over operations are to be identified in an official ranking system intended to monitor the performance of every consultant. Charts to be issued this week will assess surgeons working in the 10 most common specialisms, including general surgery, paediatric medicine, geriatric medicine and cardiology. The system of "performance indicators" will be announced this week by ministers, seeking to boost NHS productivity. A recent report from the King's Fund, an independent advisory body, said patients had not benefited from a 340 milion pound salary increase for consultants.

NHS trust managers will be able to use the data - which will not be made public - to tell slow surgeons to copy the methods of faster colleagues. Ministers point to the example of a specialist who more than doubled his output at a Norfolk hospital by using "production line" techniques learnt in France, which ensure he is never kept waiting for his next patient. John Petri, an orthopaedic specialist, radically increased the number of patients treated using a technique he calls "dual surgery". While he is operating on one patient, anaesthetists prepare the next, ensuring no time is wasted before the patient arrives in theatre. His technique cleared his waiting list at the James Paget trust in Great Yarmouth.

However, the plan has dismayed consultants, who warn that such pressure could foster "conveyor-belt" surgery. Similar rankings will be introduced this autumn to monitor spending on agency nurses, unnecessary emergency admissions and whether patients are being kept on wards unnecessarily. Andrew Burnham, a health minister, said: "This is not a big stick with which to beat consultants. It's a positive tool to help them make the best use of their time. If they do, then consultants, patients and taxpayers benefit." Burnham said consultants had "quite rightly" seen significant pay increases but must now demonstrate that the public was "getting value for that money".

The Department of Health says consultants are now paid 68% more in cash terms than they were in 1997, with those on the minimum salary scale earning an annual 70,823 from November 2006. A few of the most successful earn up to 165,000 in the NHS and many supplement their salaries with private work.

Ministers accept that most surgeons are "multi-taskers" who also care for inpatients, teach juniors and carry out research, making it difficult to judge their performance. Dr Jonathan Fielden, the deputy chairman of the British Medical Association's consultants' committee, said: "We don't see patients as cans of beans on a production line. If people are pressing us to push patients through in a factory-style manner, that would be opposed." He said most consultants wanted to improve their output and would work with managers if the data were used positively. "Unfortunately, with the financial pressures in the NHS, there has been a deterioration in relationships in some trusts." An analysis of surgeons' time sheets by the University of Birmingham, has revealed that some consultants were performing nearly six times as many operations as others.

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Queensland health sure know how to hire the good guys

Nobody seems to be steering the ship and they lurch from one crisis to another

The new head of Queensland's biggest hospital has lost the support of nursing staff after the bungled sacking of a senior nurse. Queensland Health director-general Uschi Schreiber met the Royal Brisbane and Women's Hospital's new clinical chief executive officer Thomas Ward and director of nursing Lesley Fleming yesterday.

The meeting was called after Dr Ward sacked Ms Fleming on Thursday and gave her five minutes to clear out her desk. She was reinstated several hours later and Dr Ward was forced to apologise and admit he did not have "a clear grasp of the industrial relations processes within Queensland Health". Dr Ward only started the job three weeks ago. After the meeting, Queensland Health said Dr Ward and Ms Fleming had "committed themselves to working together in a collaborative manner".

Queensland Nurses' Union state secretary Gay Hawksworth said RBWH nursing staff was still "very unhappy" with Dr Ward's actions. "Whilst they appreciate that the director of nursing is now back in the job, Dr Ward has shown his management style and they will be watching everything he does in the future," she said. Ms Hawksworth said Ms Fleming was not given a reason for her dismissal. "She had about a 30-second meeting with him and he handed her a letter and said 'your contract has been terminated, leave now'."

Shadow minister for health Bruce Flegg said Dr Ward's position was untenable. "Clearly, once you have this sort of tension operating at the most senior level, you have a dysfunctional situation," Dr Flegg said. He cast doubt on Dr Ward's credentials, saying he had not practised medicine for years and had not worked in Australia.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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