Freedom 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.

Sir,
1964, 1974.
1984?
Yours

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, 1984.

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
Productivity
Money-saving
Improving methods of doing things
Staff moral
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 or well-intentioned
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 the initiatives
Abandoning or destroying successful systems without question or resistance
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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