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If a patient has diabetes, for instance, a surgeon cannot operate until it is properly controlled.
例如，如果患者有糖尿病，外科醫生只有等病情得到適當控制后才能進行手術。
Yet an estimated 1 million adults in England who live with the condition have not been diagnosed.
然而，據估計，英格蘭有100萬名患有糖尿病的成年人尚未得到診斷。
The Calderdale and Huddersfield trust works with local GPs to identify and control cases of diabetes; across the NHS, such collaboration remains rare.
卡爾德代爾和哈德斯菲爾德信托基金與當地全科醫生合作，識別和控制糖尿病病例；在整個NHS中，這種合作仍然很少見。
Non-clinical reasons cause the last-minute cancellation of 80,000 NHS operations each year. One problem is a shortage of beds, particularly in winter.
非臨床原因導致每年最后一刻取消80000次NHS手術。一個問題是床位短缺，尤其是在冬季。
Huddersfield has got round this by ring-fencing beds for elective procedures, says Tom Strickland, the trust's director of operations. Equipment failures are another constant headache.
該信托基金的運營總監湯姆·斯特里克蘭(Tom Strickland)表示，哈德斯菲爾德通過為非急需施行的手術預留床位解決了這一問題。設備故障是另一個一直以來令人頭疼的問題。
In a corridor a man wearing scrubs and a badge reading "theatre co-ordinator" explains that there is a slight delay in Theatre 2, caused by a problem with the ventilation system.
在走廊里，一名穿著手術服、戴著“手術室協調員”徽章的男子解釋說，由于通風系統出現問題，2號手術室略有延誤。
On average, issues caused by the crumbling NHS estate disrupted services in 13 hospitals a day in the year to March 2023.
平均而言，截至2023年3月的一年中，NHS資產崩潰導致的問題每天會擾亂13家醫院的服務。
Clearing the NHS's overall maintenance backlog would cost ￡11.6 billion ($15.2 billion), about 6% of the NHS's annual budget.
清理NHS的整體維護積壓將花費116億英鎊（合152億美元），約占NHS年度預算的6%。
A lot of the time "you're sitting in tea rooms, not operating", says one former NHS surgeon who now works in the private sector.
一位目前在私營部門工作的前NHS外科醫生表示，很多時候“你都坐在茶室里，而不是在做手術”。
This is particularly wasteful since, with outpatient clinics, on-call duties and administrative tasks, most surgeons are actually in theatre for only one day a week.
這尤其浪費，因為由于有門診、值班和行政任務，大多數外科醫生實際上每周只在手術室工作一天。
More capital investment would help, but so would better management.
更多的資本投資會有所幫助，但更好的管理也會有所幫助。
There are 24% fewer managers per NHS employee than 15 years ago; doctors are often not predisposed to listen to those that remain.
與15年前相比，每個NHS員工的管理人員減少了24%；醫生往往不愿意聽取留下來的人的意見。
Huddersfield's answer is for a clinician to focus solely on theatre productivity.
哈德斯菲爾德的答案是讓臨床醫生只關注手術室的生產力。
Back in Theatre 2 the ventilation system has been fixed, and Mr Jones is unconscious. The lights darken.
回到2號手術室，通風系統已經修好了，瓊斯先生昏迷不醒。燈光變暗。
Someone runs through a final checklist on a touchscreen: "Antibiotics given? Hair removal? Is he diabetic?..." Once it is complete, the procedure can finally begin.
有人在觸摸屏上瀏覽最終檢查清單：“注射抗生素了嗎？脫毛了嗎？他是糖尿病患者嗎？”一旦完成，手術就可以開始了。
Next door, in Theatre 1, the surgical team is using a Cambridge-made robot; its upfront costs are a cool ￡1.2m, but urologists already do twice as many nephrectomies as before.
隔壁的1號手術室，手術團隊正在使用劍橋制造的機器人；它的前期成本高達120萬英鎊，但泌尿科醫生已經做了兩倍于以前的腎切除術。
After his surgery Mr Jones will be wheeled into the post-op recovery room.
瓊斯先生手術后將被推入術后恢復室。
During the covid-19 pandemic, all elective procedures were stopped so this bay could be converted to a spillover intensive-care unit.
在新冠疫情期間，所有非急需施行的手術都停止了，以便這個病房可以改建為溢出重癥監護病房。
In Huddersfield, as elsewhere, this was when the trust's productivity plummeted.
在哈德斯菲爾德，和其他地方一樣，這是信托基金生產力直線下降的時候。
A lot of the staff redeployed to covid wards ended up taking sick leave for issues such as burnout, says Saran Ahmed, the theatre's day-to-day manager.
該手術室的日常經理薩蘭·艾哈邁德(Saran Ahmed)說，許多被重新部署到新冠病房的工作人員最終因倦怠等問題而請病假。
To get through the resulting backlogs, Huddersfield now runs theatre lists on Saturdays, paying staff a fixed cost per case to incentivise them.
為了處理由此產生的積壓病例，哈德斯菲爾德現在每周六都會安排手術室名單，并向員工支付固定的每例費用以激勵他們。
But "it's a marginal gain, not a silver bullet", says Mr Strickland. It does not help that patients are staying longer in hospitals than they used to.
但“這只是微不足道的收益，而不是靈丹妙藥”，斯特里克蘭先生說。患者在醫院停留的時間比以前更長，這無濟于事。
That may be because less experienced managers are still learning the ropes of discharge planning. But it is also because of problems in social care.
這可能是因為經驗不足的管理人員仍在學習出院計劃的訣竅。但這也是因為社會護理方面存在問題。
In Huddersfield 120 beds are filled by people with no one to look after them when they leave.
在哈德斯菲爾德，120張病床被患者占滿，他們離開后無人照顧。
A shortage of district nurses and physiotherapists makes it more likely that patients like Mr Jones will be readmitted.
地區護士和理療師的短缺使得像瓊斯先生這樣的患者更有可能重新入院。
With investments in tech, a focus on efficiency and partnerships in community care, Huddersfield has done well since the pandemic.
憑借對技術的投資、對效率的關注以及在社區護理方面的合作，哈德斯菲爾德自疫情以來表現良好。
Between March 2021 and July 2024 it leapt from the bottom quartile of trusts for patients waiting more than a year for treatment into the top. But there is still room for improvement.
在2021年3月至2024年7月期間，它從等待一年以上治療的患者信托的最低四分之一躍升至最高四分之一。但仍有改進的空間。
Getting a patient through all the steps in a surgical pathway is "like a relay", says Mr Strickland.
斯特里克蘭先生說，讓患者完成手術過程中的所有步驟“就像接力賽一樣”。
"There are so many hand-offs…it's all about making sure they come together."
“有很多交接環節……關鍵是要確保它們能夠齊心協力。”
