Twelve months ago, the chief executive of Rotherham General Hospital threw open the doors to television cameras and Sir Gerry Robinson, whose challenge was to apply the rules of big business to the NHS and in doing so, to reduce waiting times by six months.

The result made for fascinating TV, but was not a particularly flattering portrayal of a hospital crippled by its own hierarchy. Sir Gerry, who had previously presided over the hostile takeovers of London Weekend Television and the Forte hotel group, was for once left speechless by the inability to make quick, common sense decisions, and accused Brian himself of neglecting the shopfloor, which makes him either a brave or foolish man to willingly put himself back in the spotlight for a follow-up programme.

"Those people who thought we were mad to do the first programme, probably think I've now completely lost the plot," Brian says.

"The programme wasn't a documentary, it was entertainment, but I think it did raise some really interesting issues about how hospitals are run and, for some people, what they saw came as quite a shock.

"Obviously the programme-makers were selective in the kind of footage they showed, but I think it was pretty fair and this is our chance to now show how far we've come.

"When I was approached to do the first programme I hadn't been in the post long, various members of the executive board weren't even in place and it was true I hadn't got out and about. However, the reason I wanted to do it was because I knew the hospital needed to change, but that we really needed a catalyst to get that process started."

Rotherham General was chosen precisely because it wasn't failing and had achieved the Department of Health's magical three-star rating, but even so the flaws in the system were apparent, and the problems were less about lack of staff than a waste of existing resources.

With waiting lists of more than 3,500, it didn't take Sir Gerry long to realise that the eight operating theatres, which were open for business only between the hours of 8.30am and 4.30pm, with an hour off for lunch, except on Friday afternoons, when the weekend started early, perhaps needed to be a little more flexible. What was even more frustrating was that every good suggestion was met by the kind of "can't do" attitude which has sent many businesses down the road to bankruptcy.

"Gerry was very frustrated about how long it took to make decisions and I can understand that, but the truth is no business he has worked with before deals with life and death," says Brian.

"The consultants are people who love their work, they are at the coalface of the NHS, they see patients on a daily basis. To outsiders they can seem obstructive, but, more often than not, they are looking after the best interests of those they care for.

"I'm not saying there haven't been divisions between management and consultants, there have, but often it's because of a lack of communication or a misunderstanding about which direction the other is coming from.

"The programme held a mirror up to the organisation and some people didn't like what they saw. Now if a consultant is on leave or sick, people are really determined not to let that slot go to waste. There is now a real sense of responsibility."

If Brian is refreshingly honest about both his and the hospital's failings, he is equally enthusiastic about the
changes which have been implemented following the visit by Sir Gerry.

Like many organisations, the hospital was seen to be guilty of ignoring the ideas of staff, whose knowledge was its greatest asset. When the cameras stopped filming, they introduced the Rewarding Ideas to improve Services for Everyone (RISE)initiative. It may not have the catchiest of titles, but Brian insists it is already paying dividends.

"A lot of the problems exposed by the programme we were already aware of, but there was a big difference in opinion about how we went forward," he says. "Gerry was right in the respect that staff on the shopfloor have a lot of good ideas but often find it difficult to put them into practice. RISE allows staff to take time out of their working environment so they can review how they do their jobs.

"We are rolling it out ward by ward and the results have been really interesting. The staff film each other doing various tasks and, watching it back, come up with ideas for how things can be done better. For example, it used to take one ward 45 minutes to distribute the
meals, by which time the food was cold and a lot of it was going to waste because those who needed help with feeding weren't getting it.

"Now meals, which are ordered two rather than 24 hours before, so patients get what they want, come on the trolley in patient order and those orders for patients who need help are flagged up. The serving of food now takes just eight minutes, which gives the staff the time to sit down with those who would otherwise struggle to feed themselves.

"It's the same with the drug round which previously took
an hour-and-a-half and now takes just 20 minutes. It became clear that as the nurse went to hand out the tablets they would become distracted by patients asking for various different things. Now, they wear a tunic which has 'Do not Disturb' printed on it – sometimes the simplest ideas are the best.

"We are not saying we have found a way to solve every problem on every ward, in the NHS there is no such thing as one size fits all. However, the important thing is that the staff feel they own the system and that it's flexible enough to change."

Sadly, no amount of new ideas of common sense initiative will change the fact that hospitals like Rotherham have to dance to the tune of Whitehall and that means an endless series of national strategies and targets which change in the blink of an eye.

With every new health minister keen to stamp their own mark on the NHS, the chief executive's post has becoming something of a revolving door.

"The NHS has seen 11 reorganisations in 33 years," says Brian, who after 34 months in the same job, compared to an average lifespan of just 22 months, is something of a veteran. "Each new government feels compelled to get rid of everything that has gone before, including quite often the chief executives.

"The problems is that there is little sense of continuity and the staff are understandably less than enthusiastic about implementing new strategies because they know only too well that just when it's up and running it will be replaced by a whole new set of ideas.

"The instability within the system makes it very difficult
to develop the level of trust needed to get staff on side and make change work. As I said to Gerry, when you don't even control the wages of your own staff you are at a big disadvantage in terms of building confidence.

"The more centralised the NHS becomes, the more people will lose out, but I feel quite proud about what we have achieved. I'm sure we would have got there without Gerry's help, but he gave us the push and started the domino effect."


Can Gerry Robinson Fix The NHS? One Year On, BBC2, tonight, 9pm.