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Opinion

Pinheaded weasels and bean counters

  • 7 Comments

Everywhere we look it seems huge institutions are in crisis, all seeking solutions to deep seated problems, awash with talk of ‘reform.’

Top of the list has to be the Catholic Church.

A new pope faces demands to tackle the scandals of child abuse, financial links to the Mafia and Mexican drug cartels and minor worries such as gay marriage and birth control.  

The police have to recover public confidence after the News International scandal and Hillsborough, along with a range of allegations about corruption and incompetence.

The press, of course, faces the consequences of industrial scale ‘phone hacking’ by Murdoch’s minions while the BBC – having produced a spectacular and memorable Olympics that reminded us of its finest qualities - humiliated itself over and over through its handling of the Jimmy Savile scandal.

Way down on its list of recent horrors would have been the sacking of London Radio DJ Danny Baker.

But his now infamous and damning on-air rant said more about the contradictions and problems within the BBC than any academic analysis ever could.

“It’s about kowtowing to the reams and reams of middle management,” Baker fumed, describing BBC management as lacking any integrity, interest in what they were managing or creativity, adding, “We dwell amid pinheaded weasels who know only timid, the generic and the abacus.”

I’ve been watching all this unfold over the past few weeks, returning in my mind to the implications of the Francis report and how we might begin to tackle the issues it raises and its recommendations.

Then Jeremy Hunt announced his nonsensical proposals that student nurses should have to spend a year as healthcare assistants, disregarding the logistical and financial problems of either creating new posts for them or getting rid of the tens of thousands of existing HCAs who would have to make way for them.

The fact there’s no evidence base to suggest this would make them better nurses doesn’t matter.

The signal is loud and clear: nurses are to blame for Mid Staffs.

The government will target us for ‘reform’ because a) the doctors would go ballistic were they scapegoated as we’re being [imagine student doctors being told they’d have to spend a year as hospital cleaners!] and b) senior managers are required to implement the other madcap ‘reforms’ in the shape of the new health and social care bill.

And therein lies the other problem facing anyone who ever thought there would be a rational approach to the Francis recommendations.

As with the Catholic Church, the police, the press and the BBC, the NHS has to rely on the same people who caused the mess in the first place to clear it up.

So David Nicholson remains in charge, the man whose denial of both knowledge of, or responsibility for, anything to do with Mid Staffs was truly sickening.

At trust level, managers continue to follow the same policies as those that brought ruin to Mid Staffs.

Nursing posts are being cut, the emphasis is on managerial concerns rather than clinical safety.

While indulging in ‘listening exercises’, managers are ignoring staff concerns and riding roughshod over their rights.

Patients are being put at the heart of the most fundamental principle governing the Coalition’s NHS at this moment – making savage cuts.

The same political structures are in place, underpinned by the same ideology.  

On the back of Francis, we’ve been promised a Masterchef winning meal by those who know they’ve served up a dog’s dinner.

Danny Baker’s verdict on BBC management could so easily have been composed to describe those running the NHS as the pinheaded weasels who know only timid, the generic and the abacus steer us towards further chaos and scandal.

 

Chris Hart is nurse consultant and principal lecturer at Kingston and St George, University of London.

Follow Chris on twitter: @Chris898Hart

  • 7 Comments

Readers' comments (7)

  • michael stone

    Chris, if you are checking back - I'm the Mike Stone, who has just sent an e-mail to you.

    'While indulging in ‘listening exercises’, managers are ignoring staff concerns and riding roughshod over their rights.'

    That is what my 'Culture Champions' idea, is intended to prevent.

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  • DH Agent - as if ! | 19-Apr-2013 4:13 pm

    and if I am not mistaken preventing them for adhering to their professional codes of conduct

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  • strange that when I pointed out that there were organisational problems from the Vatican down, just around the time of the election of the new Pope when it was so much in the news, I was accused by another commentator for some reason of being a bigot! Although I couldn't see the connection between this and my comment, the only conclusion I managed to reach was that perhaps in this space it was not politically correct to mention the Pope, the Vatican or allude to the RC Church in the same context as the NHS, but after all an organisation is an organisation whatever its purpose and is only as good as those managing it and working in it.

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  • michael stone

    Anonymous | 19-Apr-2013 5:30 pm

    'and if I am not mistaken preventing them for adhering to their professional codes of conduct'

    Did you intend to type 'from' (not 'for') ?

    My approach, would strengthen the ability of clinicians to apply professional ethics, if those ethics made sense - what it weakens, is 'moronically following a 'process' which doesn't work in this particular situation'.

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  • DH Agent - as if ! | 20-Apr-2013 11:19 am

    Anonymous | 19-Apr-2013 5:30 pm

    sorry, it should have read '...preventing them from...'

    those on the register are under a legal obligation to follow their codes of practice or risk being struck off

    obviously like all guidelines they are subject to intelligent and professional interpretation as of necessity they are fairly general and cannot cover all specific individual circumstances with which practitioners are faced daily. this is why they were permitted to qualify and register in the first place as they meet specific standards laid down by their regulatory bodies and are expected to be responsible enough to exercise their professional clinical judgement which relies of rational and intuitive thought, reflective practice and how to apply medical/scientific based evidence to particular situations with which they are confronted whilst also relying on the different or further experience of their colleagues.

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  • michael stone

    Anonymous | 20-Apr-2013 12:09 pm

    We agree in principle - but I have serious doubts about at least some Codes of Practice. There is also a fair bit of law to be correctly applied, and it is the way clinicians interpret law, that bothers me quite a lot. I will cut something out of some of my recent e-mails and post it later - it seems, at first sight, fairly 'barmy', but it is also pretty typical.

    It is the fact that attempts to write guidance explaining the law, usually will not apply to all situations, that is most problematic.

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  • michael stone

    Anonymous | 20-Apr-2013 12:09 pm

    Typed the following up in Word - I missed out, that reading the law in the context of a pre-existing clinical belief set, is also a distorting factor (perspective issues).

    I got this last Sunday, from a professor (a doctor) involved in care of the elderly, with whom I am currently exchanging a flurry of e-mails – in the e-mail, ‘the act’ means the Mental Capacity Act:

    ‘I haven’t studied in depth how clinicians in general use the act. I am pretty familiar with it because unusually for a doctor I do have a Masters in HealthCare Ethics and Law and regularly teach applied healthcare ethics to clinical professionals. I am sure there is a literature out there about clinicians' use and interpretation of the act and best interest tests etc.’

    Then I sent, among other things (we are both still playing catch-up with stuff we have exchanged), an analysis of the flaws within contemporary clinically-authored Advance Decision Templates, with my improved version which would actually fit the law, and on the Monday he sent this:

    ‘Having read this document, I do agree that the templates they (he meant my version) are suggesting would be useful. However I cannot completely agree with the argument that it is inconsistent to refuse an intervention in some circumstances and not others.’

    So I explained the problem with restricting a refusal on an Advance Decision – it isn’t that you should not be able to, it is to do with the way the Act was constructed, which makes it almost impossible to apply a clinical exemption to a refusal – and on Tuesday I got this:

    ‘I completely see this. Despite my having some training in ethics and law I had not thought about this issue to this degree of technicality as I have had many other things on my plate. Is your own background a legal one or have you done an Erin Brokovich and become really expert in this area of law. If I were going to say anything sensible I would be speaking to BMA/GMC but more particularly to an expert in medical law. I am a hospital doctor who spends his time largely in acute services. I deal with assessment of capacity daily, formal discussions of best interests 3-4 times a month, I often deal with patients who have (financial) LPA registered, but only maybe 4-6 times a year do I see advance decisions/living wills and only around 4-6 times a year do I see patients who have a registered deputy for welfare rather than financial decisions so I haven’t drilled down into the level of technicality that you have. As you can imagine, this is just one facet of a clinician's life. My colleague Dr X (I have redacted) is currently doing some work with the University of x (I have redacted) and in conjunction with our trust legal department on doctors' understanding of these issues.
    I will let you know what emerges’

    Ditto last autumn, when the senior paramedic (Regional Head of Clinical Practice) I discuss various EoL issues with, and who writes the EoL guidance for his AS, chipped in to a group e-mail discussion by sending me an e-mail, requesting my views on the answers to some EoL/MCA/VoD questions (preparation for an event he was going to attend), which started with:

    ‘I am not as good with this as yourself – my main points I feel are’

    Now, it isn’t to do with how ‘clever’ people are – it is simply that clinicians spend most of their time actually doing the job, they find it simplest to read their guidance and assume it is correct: much EoL guidance simply isn’t correct, if you actually read and think about the law itself. This does, however, leave clinicians potentially open to legal consequences, because if a court, and not an internal investigation, is looking at a case, the lawyers will be looking to the actual law.

    I’m not all that clever, and what I pointed out to the professor is pretty obvious, if you read the law and think a little bit – as he commented (and remember he said ‘I am pretty familiar with it because unusually for a doctor I do have a Masters in HealthCare Ethics and Law and regularly teach applied healthcare ethics to clinical professionals’ earlier) ‘Despite my having some training in ethics and law I had not thought about this issue to this degree of technicality … I haven’t drilled down into the level of technicality that you have’.

    It does not follow, simply because consultants are creating guidance, that the guidance is automatically correct – especially for guidance to clinicians, about the law. However, I accept that I am much more likely to send an e-mail to a professor, saying 'Your published guidance is wrong because ...', than most nurses or junior doctors are.



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