Don’t ask for permission, wait to be told off

In my last blog I wrote about a friend of mine, a former hospital chief executive (for whom I’ve never worked), who challenged my line of argument in a BBC interview, where I said that no politicians could be trusted.

He made another point that if he were my chief executive he wouldn’t want me blogging for Nursing Times or giving interviews to the BBC without his knowledge. On this point, I was less willing to give way. The BBC has never interviewed me as a spokesman for my NHS trust. I blog in my free time and if the blogs have attracted the attention of BBC researchers, then that’s a private matter.

A couple of weeks ago I was asked by the BBC if I would be able to comment in favour of Prime minister David Cameron’s major speech launching the government’s health policy. They seemed desperate as nobody within the NHS could be found. It is my view that the last thing the NHS requires is massive organisational change with all of the ensuing costs that this inevitably causes. Without a grain of cynicism or world weariness I predicted that the same patients with the same needs will still be requiring my services, irrespective of who is commissioning. I made this point to the BBC researcher and politely declined.

The fundamental question for me is whether or not the purchaser/provider split is the best way to be spending public money in straightened times – or indeed whether the NHS needs an internal market even in times of plenty. If my memory serves correctly, it was only devised after Margaret Thatcher was appalled during a hospital visit during her premiership when nobody could tell her the cost of a NHS hip operation. Of course she and her Conservative friends knew just what it cost from BUPA. Coupled with her suspicion of public services, she ordered a review that led to the invention of the internal market, an artificial marketplace pitting one part of the NHS against another – and increasingly against private providers.

I’m sure that many patients don’t mind who employs the nurses that provide their care. They’re just seeking prompt, excellent service. However I’m equally sure that the public wants to see as much of the money as is possible that is spent in the NHS towards clinical and prevention coalfaces. The overriding concern is for the costs of bureaucracy. Abolishing Primary care trusts and shifting commissioning to GPs perpetuates this massive administrative expenditure, spending even more in the process of implementing the change.

Now what is inflammatory or damaging to my employer in those last three paragraphs? Thinking about this as a nurse, might any of my arguments undermine my nurse-patient relationships?

This comes down to boundaries. Away from work it is my right to exercise my freedom of opinion when blogging for Nursing Times. I don’t expect to extend this to my consultations with patients, which is appropriate and professional. It would be flattering to think that my chief executive found a blog worthy of comment. However while working for the organisation that he manages, he should only be concerned about my performance as a nurse.

I have a guiding principle in life: don’t ask for permission, wait to be told off. Commenting on the film, ‘The Social Network’ in the Observer, John Naughton identified the free boundaries of the internet as the key to Facebook’s success. A precursor at Harvard was shut down within hours by university authorities. Facebook founder Mark Zuckerberg was disciplined for the precursor because it relied upon Harvard’s computer network. Operating outside the confines of Harvard, he required no permission to develop his social networking website.

I do not flatter myself to think that my blogs are in any way comparable to Zuckerberg’s work. They are personal reflections on what happens around me and my reactions as a nurse. I have no intention whatsoever of asking my managers for permission to blog for Nursing Times. And nor do I expect to be told off for this or for any other media interest that a blog may generate.

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