It’s been 5 years since your first GIRFT report was published. What would you say has gone well since then and where do you think the least progress has been made?
The first orthopaedic visit took place in 2013, a year after the report was published in 2012. Since that time we have completed the orthopaedic pilot and seen significant change in practice amongst clinicians in units across England. I have also had the opportunity to review clinical practice in orthopaedics in Wales, Scotland and Northern Ireland. With the publication of Lord Carter’s report in 2016 where GIRFT was mandated, we now have the opportunity to really drive change across many specialties that will improve care for patients. We are currently re-visiting every orthopaedic unit with up to date GIRFT data, and, there is no doubt that many trusts have already ‘moved the dial’ and changed practice in many facets. There are few trusts that haven’t responded to the data set, but this will now change given the mandate. I think progress has been very positive in the main with very little push back as I think clinicians see it as a way to improving their practice. I have also been encouraged by the relationships that are now developing between management and clinicians and I hope that we can re-energise that relationship as we drive for change.
The GIRFT scope is broadening significantly beyond orthopaedics, but where do the biggest opportunities for improvements still exist within the orthopaedic field?
The GIRFT programme has now been funded by the Secretary of State and DH to the tune of £60 million and is now extending to 35 specialties. In the orthopaedic field there are still opportunities regarding procurement and clinicians networking together to form MDT’s for complex procedures such as revision hip and revision knee replacement. Procurement costs for prostheses are falling and clinicians undertaking low volumes of complex procedures are now referring these on to colleagues, and I see this trend continuing.
You’ve been the National Director for Clinical Quality and Efficiency for two years now. How does that role work by way of influence and/or control?
I have now been the National Director for clinical quality and efficiency for 2 years. As the GIRFT programme expands to 35 specialties we will be able to drive the change that improves clinical care across all these specialties using data sets which will be regularly updated and will be available for all trusts to view and act upon. I have a mandate to drive the changes required from the speciality GIRFT reports and I find it a great privilege to do this as it will impact directly on patient care. The support of all the colleges, the special societies, the arms length bodies, NHS England and NHSE as well as the CQC and politicians has been fantastic and everybody is now behind the project.
You’ve famously been cited as suggesting that the NHS does not deserve more money until it gets its house in order. What reactions have you had from colleagues and other NHS stakeholders to that statement?
What I said was, “how can the NHS ask for more money until it gets its house in order,” the reactions have been very reasonable from colleagues. The press misquoted and said that I had said the NHS does not need more money, which was wrong. Most clinicians and people I talk to understand that we must make sure that we use every pound of taxpayers’ money effectively. I agree however that we have got an aging population who is growing older and we will need more money as we move forward but we also need to make sure that we spend every pound of taxpayers’ money on the NHS as effectively as we can.
What advice would you give to a trainee starting out in orthopaedics?
My advice to trainees starting out in orthopaedics is that it is still a great specialty and to enjoy it because we have some great operations that make a massive difference to patients’ lives such as hip and knee replacements. I think the world that they will work in will be very different to mine, and I think that the days of a consultant just acting independently without discussing cases with colleagues is over and will be much more of the way forward, working in teams. However, I think the orthopaedic future is very bright, we maintain patients’ independence, we help them to get back to independent living and out of pain and it is still an expanding specialty.
How are your renovations coming along at RNOH?
The renovations are coming along very well at the RNOH, as you know we have a new in-patient block which has been erected and we topped that out in June. I was present for that ceremony and I believe we will have patients in the building within the next 12 months.
We are also developing a new research hub with UCL on the Stanmore site, as well as a very innovative rehabilitation patient/parent accommodation unit which will break ground in the next 3-4 months. Overall the RNOH is now expanding as people realise that cold elective sites can produce best outcomes for patients with low complication rates.
If you had to choose an alternative job what would it be and why?
If I had to choose an alternative job it would definitely be farming. I was brought up in that environment and I love being outdoors working with animals and crops, watching them grow and developing in an environment that is environmentally friendly and organic. I am very lucky that I run a small farm which I find very relaxing and rewarding.
Which 3 people (alive or no longer with us) would you like to spend an evening with and why?
The 3 people I would like to spend an evening with would be Noel Chavasse, who was a young doctor in WW1 who was awarded 2 VC’s, but died from his wounds on the 5 August 1917 from injuries at Passchendaele. He was an extraordinarily gifted young man, was the Housman for Robert Jones, but also ran for GB in the Olympics of 1908. His citations for both VC’s demonstrate the extraordinary things he did for his men in the most appalling of circumstances and it highlights what medicine is all about, alleviating suffering for all as best as we can.
I would also like to spend an evening with Winston Churchill, just an amazing man, great orator and writer and a man who gave inspiration to a country in the darkest times.
The third would be Horatio Nelson, again a man of extraordinary courage who put himself in harm’s way to inspire others, wasn’t afraid to act on his own initiative and produced outcomes time and time again that were quite exceptional.
What might we be surprised to know about you?
As regards to what you might be surprised to know about me is that I have kept my feet firmly on the ground ever since I was a trainee registrar, and I would hope that I am as approachable today as I always was at that time – everything I am trying to accomplish now is all about improving the care of our patients in the NHS. I suppose, in part, it is because I do have a vested interest in that I will be a user of the NHS, but I also have 2 children studying medicine and I want them to make sure that they are as proud of working in the NHS as I have been.Back to news
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