‘It’s a beautiful thing, the destruction of words.’ 1984
I still do work for the National Health Service (NHS), although not full time. Over the years, and especially the last few years, it has become an increasingly depressing, target driven, soulless place. When I re-read 1984 recently, virtually every page resonated with the type of management nonsense that rains down upon us each day. Particularly the way that language is distorted into meaningless ‘party’ slogans.
The more we are told that our healthcare trust is ‘meeting and exceeding’ targets, the more the word ‘doubleplusgood’ springs to mind, and I also know that we are, clearly, in big trouble. The greater the trumpet blast of triumphal news, the worse that things become. War is Peace, Failure is Success, Lies are Truth.
One thing that particularly sticks in my craw, are the pictures of happy staff members that adorn various PR brochures. The production of which seems immune from financial pressures of any kind. They are written in a distorted management language that uses thousands of words, whilst their meaning remains almost perfectly obscure.
A recent example of how dispiriting they are was encapsulated by a recent brochure I received through the post. It had a picture of two nurses on the front. They looked as if they had both won several millions pounds on the lottery. Their faces a picture of almost uncontrollable glee.
When I opened it, I found that this was a brochure informing all nurses, and doctors, that we would have to pay considerably more money into our pensions. In addition, we were going to receive a much lower pension, at a greater age, than we had been told we were getting in the past. Oh joy, oh joy.
I would have said the picture on the front cover was ironic, but NHS management do not do irony. We are continually exhorted, in a ‘Unite workers of the Soviet Union’ sort of a way, to be smiling and happy in our glorious tractor factory. A frowning worker is a worker who clearly does not love the party with sufficient fervour. A frowning workers needs re-education.
Ah yes, each year we produce more tractors to sell all around the world, with a song in our heart, and a spring in our step. Each five years we are set a new, joyous, production targets. Each year everything, we are told, gets better. The statistics tell us so. Each year, we can see with our own eyes, things are getting worse. I suppose people who do not work in the NHS may feel a certain echo of all of this in their work place.
Whilst mulling over this seemingly unstoppable drive from relying on professionals to be professionals; towards target driven, dehumanising, wearisome micro-management and meaningless jargon. I came across a post on Doctorsnet.uk. A website for UK registered doctors. It was written by a doctor A Boyle, and I thought it should be shared more widely. (I asked for, and got, his permission to do so).
What I wanted, and what I got?
I wanted to help old people
I got frailty assessments on incomplete information
I wanted to save lives from PEs*
I got VTE2 assessments
I wanted to diagnose the cause of acute confusional states
I got dementia screening on frightened old people at 3am
I wanted to spend my career constantly improving my knowledge
I got mandatory training
I wanted to perform cutting edge research
I got GCP3
I wanted to critically evaluate my performance
I got the audit department asking for a meaningless action plan
I wanted role models to inspire me
I got multi-source feedback forms
I wanted to teach the next generation
I got work based assessment emails
I wanted to be competent
I got competencies
I wanted to be good at difficult procedures
I got cannula care records and central access teams
I wanted to keep people alive, safe and comfortable
I got the four hour target, breach reports, and observation wards to fudge the targets
And Amen to that. And a happy Christmas to you all. Sorry if this seems a little off-beam from my normal musings, but I felt the need to get it off my chest.
*PEs = Pulmonary Emboli (clots in the lungs)
2: VTE = Venous Thromboembolism (assessment). VTs can break off and travel to the lungs.
3: GCP = Good Clinical Practice