You know how it is, when you wake up at 4 in the morning and your brain is under the control of some alien force, and you end up wondering about something that you haven't thought about in years? I remembered back to a beautiful summer's day in the mid 1990's.
It was hot. The NHS had just gone through another of its all too frequent reorganisations - this one merged DHA's, who planned and purchased hospital and community heath services, with FPCs, who managed GPs, dentists, local pharmacists and opticians. The reorganisation was going to sort out the problems in the NHS, once and for all, by bringing all the commissioning of services under one umbrella.
(Of course, each and every NHS reorganisation is going to sort out the problems in the NHS once and for all. The one that's happening now is going to sort out the problems once and for all. And the one after that. In less than 20 years in the NHS I saw RAWP (a huge transfer of resources out of London to the north of the country), the abolition of Area Health Authorities, the introduction of General Management, then resource management, clinical budgeting and performance indicators, then the internal market and GP fundholding, then the merger of DHAs and FPCs. On top of that were more organic changes caused by the realignment of DHAs with local authority boundaries, mergers and separations between hospitals, changing medical and surgical techniques, new hyper-expensive drugs, the ageing population, and the involvement of the Private sector in the provision of NHS care.
Every time there's a structural chance, you need a new management board. New policies and procedures. New signs, letterheads, uniforms, and logos. You've got to have a logo.
Every time there's a structural change, there's new ways of working, new people to get to know, new egos to learn how to work around. And of course, people to say goodbye to - people with a huge amount of knowledge and experience, just gone. Reorganisations are hugely inefficient, with everyone spending the months before in a state of heightened anxiety: and in the months afterwards in the same state - there's often a secondary cull, after some of the knowledge and contacts of old staff have been passed on to the new.
Repeated reorganisations sap everyone's life force. It's a wonder that the NHS works at all, with all the managers constantly diverted by the need to look good in the eyes of the new boss. I discussed this once with Janet Boulton FRCOG, a consultant in Newham, years ago. She said that working in the NHS was a bit like living in Italy, which at the time had a new government every year: "It's all constant change and bickering at the top. But the ordinary people just turn up for work and get on with their lives regardless". But I digress.)
This particular day, a sticky, sweltering day where the air was so humid I found myself thinking in a Louisiana drawl, there was a management board meeting scheduled. Because of the recent reorganisation, board meetings were alternating between the DHA premises (where there was a big board room ) and the FPC premises (where there wasn't). Today it was the turn of the FPC. 15 people turned up, in a room designed to hold 8. Some of us sat round a small table, some sat on filing cabinets or desk tops, some stood by the door. I got a table spot and waited for the iced tea and pralines, but had to make do with hot coffee and stale biscuits.
3 hours later we were still there. I was wet with sweat. I wasn't the only one. People were fanning themselves with the minutes of the previous meeting, wiping their faces on their shirtsleeves, and getting pinker and pinker by the minute. What they weren't doing was stopping talking. Everyone, old and new, were trying to prove themselves ahead of the expected 2nd cull. The pity was, there was so little of worth to say. There's a lovely story told of an American general coming out of a long NATO meeting who was asked by a junior why the meeting was taking so long. "Everything that needs to be said, has been said. But not everyone has said it yet." he replied.
Thinking back, remembering not so much the who said what, or who scored the most Brownie points, but just remembering the physical, visceral horror of the experience, I truly wonder why I and all the others put up with it. Why didn't we insist on going back to the DHA, where at least the room was big enough? Or going outside? Or just shutting up? There was a collective madness going on, which I was party to as much as anyone else.
Water buffalo at Broomfield Mill
And I wonder how much of this madness I still carry, this obsessive need to accomplish the things I've decided to do even when it's perfectly clear that I'm struggling upstream. I thought I'd learned to let go and chill, but here I am spending hours typing this on the hottest, sunniest day of the year so far when I could be sitting by a river watching the water buffalo. Silly woman.
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