Money can build or re-open extra wards and operating theatres, but these need to be staffed, and new doctors, particularly specialists and surgeons are far harder to come by. Likewise, operating theatres can be kept running 24 hours a day - but there is both no certainty that the staff can be found to fill them, combined with the fear that delicate operations carried out in the wee small hours may not be completed with the same degree of skill as those during the day. Time to train It takes several years to turn a doctor into a fully-fledged surgeon capable of working independently. Nurses are also far more skilled today than they were even a decade ago, and subsequently harder to recruit, retain, and train. The government's strategy includes encouraging more GPs to carry out minor operations under local anaesthetic at their surgeries, theoretically lifting the load on hospitals.
Cottage hospitals are dangerous, and expensive to run.
Ministers also want to force some consultants to devote all of their time to the NHS rather than their private work, by rewriting their contracts with a financial incentive to drop their private sessions. However, this appears to conflict with the pledge that anyone whose operation is cancelled for non-medical reasons will have guaranteed surgery, if necessary at a private hospital. Cancelled operations are endemic in the modern NHS - even if these were substantially reduced by increased NHS capacity, many people would still need to go private, and it is uncertain how a private sector with a lessened supply of consultants would cope. More radical solutions exist - one, suggested by Professor Lilley, is to enhance the role of hospital technicians within the NHS, so that they were capable even of minor surgery such as cataract operations. A key question for the government will be when the clock starts running on a patient's waiting time.