Staff: the major asset of a health service

What's the most important asset of a health service? Its hospitals, knowledge, equipment, plans? No, clearly its staff. The same is true of most businesses, but health services (certainly Britain's National Health Service) tend not to be good with their “human resource” policies. Just as patients are expected to be grateful, so staff must “soldier on.” This week's journal offers several insights into health service staff.

Aitken and others have produced data on how many operations surgical trainees in the NHS perform without supervision (p 702). The results are disturbing. Consultants supervised only a fifth of elective bowel resections performed by trainees and were present at less than two thirds of all the operations. The figures for emergency operations were worse. This is bad for patients as the outcome of operations clearly relates to the experience of surgeons. It's also bad for trainees obliged sometimes to operate beyond their competence. “The practice,” writes Charles Collins in an editorial (p 682), “is unsustainable, and doctors and managers must organise to enable more work to be done by consultants.”

Meanwhile, the NHS may be about to make 350 fully trained obstetricians and gynaecologists redundant because it can‘t find jobs for them (p 688). Medical manpower planning is “shambolic,” says Ian Bogle, chairman of the council of the BMA. It's the same sort of centralised planning that led the Red Army to have too many left boots, but the lag time is much longer: obstetricians and gynaecologists cannot quickly be turned into psycho geriatricians.

Experienced nurses are the staff in shortest supply in the NHS at the moment, and the government is frantically trying to tempt them back. An editorial explores the contribution of clinical nurse specialists, who now “lead services, admit and discharge patients, make autonomous clinical decisions, and organise programmes of care” (p 683). The authors, one a professor of general practice, observe that evidence of their effectiveness is limited and that randomised controlled trials are few. I can‘t help but note that randomised controlled trials of the effectiveness of professors of general practice—or, come to that, ministers of health or journal editors—are non-existent. By their evaluation, so shall you know them.

With excitement we begin today an ABC of labour care (well timed, you note, to follow our ABC of sex) (p 721) and introduce a new book from Samuel Shem, author of House of God (p 743). “Errol,” writes Shem, “addressed but one thing: drugs. If his patients wanted to talk diagnosis, he talked drugs. If they wanted to talk symptoms, he talked drugs. Stress? Drugs. Suffering? Drugs. Family problems? Drugs. Job? Drugs.” Ring a bell?