of speech in the NHS
posted: Sunday September 28, 2008
Although I’m getting on a bit and my mental
agility is not what it was, it seems only yesterday that I read
a letter to the editor of the Daily Telegraph. The year was 1974,
immediately after Harold Wilson regained power, just ten years after
he first became Prime Minister.
I have no intention of getting party-political
here, but this masterpiece of conciseness and innuendo perfectly
encapsulates the writer’s association of left-wing politics
with the totalitarian world described in George Orwell’s novel,
Orwell, whose real surname name, heaven help us,
was Blair, chillingly outlines the way in which the rulers of this
mythical (!) world employ constant surveillance and all-pervasive
propaganda to control its brainwashed citizens. History is erased
and rewritten, nothing is what it seems to be and truth has become
infinitely flexible and totally divorced from reality.
How closely Orwell’s frightening book mirrors
the world of our own dear NHS…
Within the NHS, propaganda, untruths, partial
truths, doublespeak and the cynical suppression of anyone dares
to who articulates problems or obvious solutions that run counter
to the party line, are all rife. I must make completely clear here
that I base these words on experience gained in an NHS IT department
and apply them only to administration and management. I simply do
not have sufficient experience of clinical staff to fairly comment
on clinical areas. That said, blogs authored by doctors, nurses
and paramedics of all varieties do suggest the fact that such behaviour
is also prevalent in clinical areas. I can only suggest you read
elsewhere if the clinical side is your only interest.
Where administration is concerned, I see no convincing
evidence to disprove the oft-quoted claim that NHS management mainly
serves its own interests. I get the distinct impression that the
following vital areas merit very little priority unless they happen
to coincide with the interests of the administrators themselves.
Service to patients
Overall operating efficiency
Improving methods of doing things
Retaining and leveraging the efforts of the best staff
In contrast, consider the following areas where
management can be relied upon to apply almost unlimited time, effort
and, if they think they can get away with it, funds.
Creating an ever more complex, interdependent
and self-interested management structure
Stifling open discussion and dissent, however productive, sensible
Routinely defending (often in the courts) inexcusable management,
regardless of cost, financial or human
Offering unquestioning support for any central initiative, however
misguided, because failure will always be blamed on those imposing
Abandoning or destroying successful systems without question or
Offering uncritical support for political correctness, regardless
of common sense
The way NHS management operates should not really
come as much of a surprise. Because management operates within the
same system that it so assiduously propagates, it is constrained
by its own suffocating culture. Genuine innovation is simply intolerable
in such an organisation.
The inevitable result is censorship. Dare to speak
out against the party line, either to question the status quo, or
to suggest innovation, and you are in deep doo-doo, because NHS
management simply cannot afford to be measured against anything
but its own dismal record.
Like the sinister Newspeak of Orwell’s 1984,
the NHS is developing it’s own NHSspeak, spinning failure
into success, reducing the ability to consider subtle shades of
opinion, and ruthlessly gagging anyone who stands up to tell it
how it is.
Room 101 might not be so far away.
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