The Doctor’s Surgery
The paradox disappears only if we make a radical break with the idea that language… always serves the same purpose: to convey thoughts…
No doubt some readers will have experienced occasional administrative or bureaucratic difficulty in their encounters with the NHS, for example in getting to see the same doctor twice.
There are probably few human organisations in which such difficulties are never encountered, and of course at our age we have the impression that everything is getting worse. The ageing brain, it almost seems, is hard-wired to perceive deterioration.
This does not mean that its perceptions are always wrong, however. One thing that has definitely deteriorated is the prose in the circulars that are internal to the NHS. Just as you think it can get no worse, you are surprised by the endlessness of human ingenuity. Here, for example, is a circular sent by email to a friend of mine, a very distinguished doctor, from an organisation called NHS Improvement:
‘As you will hopefully be aware, the Beta phase of the DPSIMS project to upgrade the NRLS and STEIS with a single new user-friendly and learningfocused digital service is well underway. During Beta, we build on our learning from Alpha, and work towards delivering a functional first version of the system… A message has gone out today in the NHS Improvement Provider Bulletin, asking Chief Execs, Chairs and Directors of Quality, Nursing and Medicine to lend their support to expressions of interest in becoming Private Beta pilot sites. There is more information about the ask [sic] and timelines, the selection process, and the benefits of participation here.
‘As our core group of day-to-day project contacts, we wanted to ensure you were also aware that this opportunity is now open, so that you can have conversations with the relevant people within provider organisations to decide if piloting is something they wish to support.
‘There will be challenges and uncertainty in the work – as you know, the agile development process is iterative and very responsive to user feedback, so while we can plan what we want to achieve, it will be your input that forges the path to get us where we need to be, and so some aspect like timescales, resources and effort required will only become clear once we get started… Expressions of interest will require senior-level backing, but we know that this group is where we will find our shop-floor champions.’
Thus doctors, in the minds of NHS bureaucrats, have now gone from frontline to shop-floor workers, and hospitals presumably from battlefields, in which victory is secured by doctors repelling as many of the enemy (patients) as possible, to factories in which productivity is measured by how many patients can be discharged from hospital without dying within 24 hours of leaving.
The above prose emerges from the murky self-referential world of the Care Quality Improvement Department, of the Department of Patient Safety, Policy and Partnerships, of the National Reporting and Learning System, of the Strategic Executive Information System, and the Development of the Patient Safety Incident Management System, among many others, all of which require their own heads, leads, and chairs, to say nothing of the PAS to the heads, leads and chairs (there is no point, after all, in being a head, lead or chair without a PA).
At a rough guess, I should say we have to employ about 50,000 extra doctors to cope with the work that the heads, leads and chairs of letter-salad organisations throw up. This also helps to explain why we cannot get to see the same doctor twice, as Heraclitus would no doubt have put it if he had known the contemporary NHS.