We are still all about the medical here. It is like being on Casualty, but in the boring, back office, where nobody shouts CRASH! CHARLIE! and runs around in crocs, throwing blood up the walls.

Now I’ve just read that back to myself, I’m quite pleased. I’d be terrible at blood. Let us not even think about what vomit does to me.

Mine, or other people’s.

One of the things that makes me cross about this situation is how many bureaucrats are worried about this. That might sound counter intuitive. After all, I should want them to be worried, right?

Yes, but I want them to be worried about the right things. What I want them to worry about is people with long term, chronic conditions being able to manage their lives with the help of GP’s they trust and who they can choose to see more than once in a blue moon. Not like the lady I spoke to today who has seen a different GP every week since she has been forced to move to one of the government friendly, large practices. What I want them to worry about is supporting GPs that are good at their job and not putting them in a position where they feel they have to resign.  What I want them to do, is to focus on helping from the bottom up, not the top down. What I want them to worry about is patient care.

Not self care.

What worries the bureaucrats, from all the evidence I’m seeing at the moment, is being shouted at by people like me. What worries the bureaucrats is what the media think of them. What the bureaucrats worry about is whether they will lose their bonuses, and their comfortable jobs. What worries some of them, is being found out.


It worries me that this is the mentality I’m discovering in the middle levels of the NHS. God knows what the upper echelons are like. I am not talking for one moment about those  who are on the front line services by the way. All my sympathies go to them. They are doing a hard job in trying circumstances, and much like us patients, they re being made the scapegoats of all this.

It worries me that for the management committees, and the groups and the bureaucrats it is all about what’s on the surface, not what’s underneath.  It’s all about platitudes, and patronising phrases that ooze with false sympathy and mean nothing. It’s all management speak and obfuscation.

Is that what we want from health care?

Guess what? Birth is grisly, living is a messy business, and dying is fucking horrendous. Health care is at the gritty end of things. That’s its job. That’s what it does. We don’t expect it to look lovely. We don’t expect  it to speak nicely, and wear expensive clothes. We expect it to work.

We expect it to get down into the guts of the matter and fix things. It needs to fix people. It needs to fix lives. It needs to help us give birth, it needs to ease living, and soothe the dying. It isn’t about forms and management committees and balance sheets, not where it really matters.

At the sharp end it is about making sure my baby is delivered healthy and well. It is about holding my hand while I’m dying and giving me the dignity I deserve because the life I have lived demands it. It is about making it all better. Even the terrible things can be handled so that they’re better. We all know that. It’s not magic. It’s just care, and patience  and being allowed to help people.

What absolutely frustrates me is that what I’m seeing with the middle men is the language of helping and the actions that make that a lie, that are the opposite of that. What I am seeing is them helping themselves, while we go without.

When the bureaucrats start worrying about the right things, I’ll start believing the things they say. When the evidence matches the words, I’ll start listening. When what they do matches the promises they make, I’ll start backing off.  Until then, I’m carrying on.

And I’m still worried.

I think I have every right to be.

5 responses to “Worry

  1. Hi Katy

    Am a huge and long term fan of your blog. And you’re right, the current changes afoot in pretty much every aspect of public life are worrying.

    But just to give a tiny bit of alternative perspective. I happen to be a civil servant – not, as it happens, in the NHS but in a department that gets similarly vilified in the press on pretty much a daily basis.

    Here is how those middle level bureaucrats might be feeling at the moment.

    As people, as citizens, as taxpayers, they have exactly the same concerns and frustrations as you.

    As employees they are shat on from every possible corner. They are shat on by the government who have been telling the civil service to do “more for less” for years, while reducing budgets and increasing targets.

    They are shat on by the media who shine the spotlight on every mistake, every mishandled case and yet never bother to mention all the good stuff that goes on day after day, all the hard work, all the hours.

    They are shat on by the public who demand answers and accountability and then get annoyed that an industry exists around managing and auditing everything. A lot of the bueracracy exists to try and provide audit trails so when “the people” start waving placards and throwing virtual eggs, everyone’s backs are covered, especially those of the frontline staff. The so called bureaucrats are tired and frustrated and yes, play the bullshit bingo because no one wants to hear the truth – that the money is not there to fund the types of services that everyone wants.

    As for bonuses – few and far between and generally limited to the highest echelons where salaries come out of a separate pot. The majority of civil servants have seen a reduction in take home pay over the last five years with pay freezes and now increases limited to 1%, plus changes in pension conditions. After 40 years service, you’re lucky to get a book token and a thank you note.

    Sorry for the essay but it is a pretty shitty time to be in the civil service at the moment and I suppose I just wanted to let you know that your frustrations are probably shared by the people you perceive as hiding behind a desk and firing out platitudes so don’t be too hard on them.

    Best wishes – I hope that this particular story has a happy outcome.

    • Hi,
      I totally appreciate what you say. I’m not saying that all bureaucrats do, and I get that for the most part it is a thankless task. I guess to be less disingenuous I am specifically referring to the CCG. Their salaries are available to find online. One of the people who is failing to give us answers at the moment is currently on a salary of £120K per annum plus pension schemes etc. That salary would almost pay for the extra GP we need to keep our surgery open to put that in perspective. I have been told by a different source that certain people who chair CCGs, not necessarily in my city, I was not given specifics, get £1000 every time they chair a meeting. I know that there is a cash crisis within the NHS, but it cannot be denied that there is wastage happening and money could be better spent. I am frustrated by the emails I am receiving that express sympathy but say that nothing can be done. Things can be done, but they are not necessarily pleasant or popular or in line with bigger agendas, but someone needs to keep asking the questions and pointing the finger.

      • I hope it has a happy outcome too. Don’t be sorry. You make a good point. I was trying not to be too specific, but fuck it. I am being specific!

  2. I know what you mean, Katyboo. Those at the sharp end are tired. Those at the top are (generally) overpaid and very out of touch. What we need are more doctors and nurses. What we don’t need are high paid execs, often imported from ‘industry’ to run the NHS as an ‘industry’, for less money.

    Why does everything have to be judged on monetary cost anyway? Surely better health across the population will work out cheaper as well as better for ordinary people? As for top execs trying to run the NHS as an ‘industry’ . . .

  3. Yes, absolutely right. I might have to steal a few quotes from that.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s