A foreword from Richard Steyn
As I have progressed through my medical training from medical student through general practice and subsequently as a surgeon, the emphasis has always been on structured history and examination followed by appropriate investigations and development of a management plan based on knowledge of the appropriate evidence base.
Conversely, throughout my career I have constantly been exposed to the assumption that waits and delays are inevitable and that it is a fact of life that we will effectively ration care using waiting lists. As a cardiothoracic surgical trainee, and during the initial period as a consultant, I shared the cultural belief that if only our funding was top-sliced off the budget and we were left to manage everything ourselves, we would be fine and could manage our waiting lists at a safe level.
Then I attended a workshop on demand and capacity and I was challenged to justify my beliefs. I had no evidence that waits and delays were inevitable. I had no evidence that ring-fencing resources for our own practice was beneficial. We were not applying any scientific method to our thinking around the organisational structure and management of our services and we were certainly not recommending plans developed with an understanding of the evidence base.
As I have investigated further I have been constantly surprised at what can be achieved by careful investigation, assessment and planning of the delivery of clinical services and how "impossible" waiting lists can be reduced or removed. I have been equally surprised how provision of additional resources to the wrong points in the pathways can actually make services worse.
Without a shadow of a doubt the best people to understand and help plan the service are the clinical and managerial teams providing that service and I commend to you to take an evidence-based approach. Achieve the best with the resources you do have, support business development plans with good evidence of need, and instead of being resigned to your work with the frustrations of waits and delays, redesign your work and look forward to coming to work every Monday!