On Injustice, Exhaustion and Tough Love

Life’s lessons 10:  Hard choices for hard times
image

I used to think that, if people only knew about something going badly wrong, they would mobilise against it.

But I grew up under the lingering influence of World War 2. We were the brave little island that had held out against the evils of fascism and set up free universal secondary education and a National Health Service. We were the dragon-slayers.  We were the good guys.

Postwar childhood games, played out on overgrown bomb sites, always involved shooting down the bad guys to emerge victorious.

It took me a very long time to realise that knowledge alone doesn’t stop bad things happening. You need courage, spirit and commitment to confront monsters.

After reading Kara2008 (whobyf1re.wordpress.com) this morning I got to thinking about LB and all the others killed or damaged by health professionals in one way or another. I’d bet each one of us has experience of family, a friend or colleague affected. There is a stack of anecdotal evidence around. There is research evidence too. Think of the data circulated to hospital trusts about death rates. Think of the number of civil cases instituted against them.

We all know at every level that something is badly, systemically wrong and also that nobody, apart from a handful of lowly scapegoats, has been called to account.

As a teacher I had to call various culprits to account.  I remember one stubborn, little red-haired toughie, who had stolen some money from my purse. I usually kept it locked in my filing cabinet but I had been called out of my office suddenly and hadn’t stopped to turn the key.

I saw the set of her jowl and knew it was pointless to rage or accuse. The evidence was incontrovertible, but she would never back down. Then my anger and frustration lifted. I felt very sad for both of us. I asked her to imagine that she had done it. We would think about it as a purely hypothetical situation and consider the possible outcomes.

I can’t remember the detail, but at one point she protested that if she was able to walk away uncondemned, nobody would know anything bad about her.

“But that’s not true, is it?” I pointed out. “Somebody would know, wouldn’t they? Think about it!”

She thought.  “I would know,” she said at last.

And that was the thing that mattered most. Not the money. Not the punishment. Not her admitting anything. It was her looking honestly at herself and deciding what path she wanted to walk down. Did she want live a life based on feeling clever and pleased with herself for doing somebody else down and getting away with it? It was her choice to make. 

And, this morning, it seemed to me that, at an individual and systemic level, the NHS has reached a similar point.

For a range of reasons, individuals collaborate or collude with bad practice and organisations block or stifle concerns, protests and avoid the investigation of incidents.

Yet I can’t believe that the majority of workers in the system are happy about it. I can’t believe that the majority of managers are workplace psychopaths. I can’t even believe that the majority of elected representatives in the Commons are smugly complacent about it.

So why is it happening? 

I said at the start that you need strength, spirit and commitment to change bad things and it is clear that many within the system are too worn down to do it on their own. There are outstanding pockets of good practice, scattered examples of excellence, honourable individual practitioners, but as a whole the NHS is failing.

We have to help it envisage the way ahead, not just as a financial and organisational spreadsheet, but as a moral choice. Who really wants a shoddy, showy business, lacking integrity, getting away with minimum standards by the skin of its legal teeth?

We on the receiving end have already tried to highlight the need for an honest look at realities, rather than spin.

We’ve tried “consulting” nicely and so far it hasn’t worked.

I fear it is going to take a conviction for corporate manslaughter to strengthen the good guys, inside and outside the system.

In the sixty odd years from post war optimism and good intentions, it has come to this.

It should make us all very sad.

Then we should look at LB’s quilt and commit ourselves anew.
image

Alice Meets the NHS Meets Bladerunner

Life’s lesson 6 on Chaos theory

image

Grandpa was trapped in hospital, much as Alice got trapped down the rabbit hole. He needed a scan. They kept him in because the scan department was closed by the time we saw a doctor. (We had waited four and a half hours in A&E, this being the only route to get his day surgery checked out).

So there he was, in a hospital bed, fit as a flea, just waiting for a scan.  They put him on a drip, because when he arrived in the ward around ten at night he was dehydrated.  He was dehydrated because he’d been told not to drink when he first got to A&E, just in case he had to go to surgery. As soon as it was clear he wasn’t going to theatre, he started downing pints of water. It had been a very hot day. Made no difference, he was on a drip.

The consultant saw him at eight the next morning. He said he needed a scan. Grandpa phoned me at lunchtime. No scan so far. He phoned at three o’clock – no scan. By this time I realised there would be no scan that day. The department closed at five.

I set out for the hospital. Halfway there Grandpa rang. Could I bring his (extremely common) medication, because the pharmacy in this major London teaching hospital didn’t have it? Answer – no, I’m on the train!

When I reached the ward, I could hear a penetrating noise. Grandpa’s drip kept bleeping. It was driving everybody mad. A nurse had shown him how to switch it off, but every few minutes it still managed some piercing bleeps before he could reach it.

“Why is he on a drip?” I enquired, when she appeared to try and resolve the mystery bleeping.

“He’s dehydrated!” she said. He was drinking a cup of tea. I had read his notes.

“No, he’s not,” I pointed out. “Why’s he on it still?”

“I don’t know,” she said honestly.”I’ll check!”  She returned some minutes later, unplugged him and, much to everybody’s relief, removed the hypersensitive machine.

The next morning Grandpa saw three bright-eyed, bushy-tailed young medics. They poked his neck enthusiastically and said he needed a scan. By the time I arrived at 2 o’clock he was still waiting. I stood around the nurse’s station till somebody noticed me.

“When is he going for this scan?” I asked

“The doctor has to send in a request! Nothing to do with us!”

“Well, so far, three different doctors on three different days have said he needs to be scanned. Can you see from his notes if the request has been made?”

“No, I’ll need to talk to the doctor!”

“Then can you check with him please?” 

“I’ll give him a call. I’ll come and tell you.”

An hour later I started patrolling the corridor by the nurses’ station.

“He’s checking with Xray,” they said.  I continued my sentry duty.

In the end somebody got fed up and said “I’ll page him again. You speak to him yourself!”

Primed by Dr Kate Granger on Twitter, I introduced myself by name (staff nurse had just referred to me as ‘the wife’) and asked “Who am I speaking to?”

A polite young man told me who he was and also that the scan needed a specialist radiographer, who was shared by all five hospitals in the group. He was there that afternoon. He would check on Grandpa’s scan and get back to me.

An hour later Dr Bright-eyed&Bushy-tailed turned up, somewhat shamefaced. He looked just like my grandson. He was very sorry but Mr SpecialistRadiographer couldn’t fit Grandpa in.

“But what I can’t understand,” I explained, “Is why Grandpa’s in hospital in the first place.  If all he needs is a scan, why can’t he just stay at home and come in for his appointment?” Dr B&B looked thoughtful.

“Good point,” he said. “I’ll check!” And off he went to phone somebody senior.

Ten minutes later he came back.  “He can go home!” he said.”Come back to Xray tomorrow at 2 o’clock for a scan!”

That was the Alice in Wonderland experience.

So where does Bladerunner come into it?

image

Do you remember the opening scenes in the street market in the city of the future, where everyone milled around and communicated in a kind of pidgin English?  Well, that’s what it’s like in our hospital group.  Since everything’s been reorganised and rationalised we can’t use our local hospitals any more.  They’ve been relegated to basic routine stuff, and have to refer us on for anything more complicated.

So everybody from all the many communities in a sizable chunk of London has to travel to one of these huge hub hospitals, like a massive hub airport.  We hang around, lost and confused, waiting for our slot in theatre, or x ray, or outpatient clinic, or transport, or for medication from pharmacy 

The switchboard is so overloaded it is almost impossible to get through on the phone.  Emails go unanswered, because they all go to one address for every outpatients’ department in the five hospitals and the backlog is unmanageable.  The lift system can’t cope with the sheer number of staff and patients. (When Grandpa arrived for his day surgery, he had to walk up six flights of stairs. None of the lifts were working).

I loved the first scenes in Bladerunner.

I just never expected to live in them!

“God Bless Us, Every One!”

Life’s lesson 4 on What doesn’t change and what might

image

As a child I had to learn large chunks of the King James Bible off by heart. It was quite common in the Scotland of that day. As a result I still carry the echo of these around in my head.

One day I was on a train going to some conference or other on change in the public sector.  As I half-heartedly scanned the conference papers, all of a sudden one of those echoes slipped into my mind.

“The poor you have with you always.”

I had always felt this was a rather ungracious comment for the saviour of mankind, but all of a sudden it fell into place.  Not just the poor, but the learning disabled, the sick, the neglected, the old and the despised.  All the vulnerable populations in any society. Every generation and community has to choose how they treat their weakest members.

That’s something that doesn’t change.

Another echo I carry around in my head is of the literature I had to read at school.  A lot of it is just too long nowadays, but before digital technology and wall to wall entertainment, there was more time to fill.  Now I’ve gone back to the great Victorian writers in audiobooks.  They’re particularly clearsighted and scathing on the dark side of politics, business and charity.

That’s another thing that doesn’t change.

So why are we so surprised and hurt that we still have to fight the  injustices in our own society?

I suspect it’s that we swallowed our own post World War 2 publicity. We thought things were changing.  People were better off, healthcare was much improved and more accessible, secondary education was universal.  We all had more stuff.

We overlooked the dark side.  The increasing power of the state, the surveillance and intervention of officialdom in aspects of life that had previously been a matter of personal choice.

No wonder so many of us feel guilty and unhappy about aspects of our work. We’re the Bob Cratchits of today, sitting shivering at the modern equivalent of the clerk’s desk , at the mercy of a corporate Scrooge. And our Scrooge isn’t going to be visited by the three ghosts of Christmas. Our Scrooge is hanging on to his money and looking to make more.  Tiny Tim is going to his grave.

But I sense we’ve reached a tipping point. Too many articulate, educated, stroppy people are now affected. Government, local and national, might get away with fobbing off the poor with crappy services. Hampered by lack of education and resources, they’re too disadvantaged to put up much of an organised fight.

It’s organisation and persistence and ingenuity that is dangerous to the corporate Scrooge. It’s the sustained guerilla campaign that undermines, as it increasingly gathers support from a disgruntled, disparaged citizenry. 

That might just tip the point in the right direction.

That might just make a change.

On Being A Bad Person

Lesson 2/2. Making the best of a bad job

image

From when I was very young I knew I was a bad person.  Not seriously wicked, but definitely willing to resort to low cunning.

When I started school, I used to travel on a tram, by myself. (These were more trusting times, when little children frequently went to school on their own).  For this I was given my tram fare.  I worked out that it was possible to walk home, cutting through various back street short cuts, thus saving enough money to buy a weekly copy of The Beano, a corrupting publication my parents had vetoed.

I even selected a back street newsagent on the route, one that my mother would never visit, so that my deception would go undiscovered.

Later on I made good use of an undated doctor’s note to be excused games.  This enabled me to escape the sports field for two winters and avoid being frozen to the bone by the merciless wind straight off the North Sea.

Thus I recognised early in life that I would never make it as a good person.  I could never emulate my contemporaries who worked diligently and consistently to achieve their success. I needed guile and good luck to get there.

I couldn’t understand people who wept because they didn’t make an A grade.  I was just grateful to scrape by!

But over time I discovered that being a bad person has its rewards.  It makes you less ready to judge others. I might have plenty of opinions and be only too willing to air them, but I could never be secure enough to feel superior about the weaknesses of others.

Being a less than perfect person also gives you a healthy appreciation of luck, good and bad. Over the years this can help avoid fruitless heart-searching. You did what you could at the time, but you were dealt a bad hand.  Sometimes luck goes against you.

This doesn’t stop you feeling sorry or guilty when you mess up, but it does make it easier to accept that sometimes things just go wrong.

And when they do, you make the best of a bad job.

Lesson 107 The Disappeared

Lesson 107 on Being seen and heard

image

One night, quite out of the blue, my daughter, by this time grown up, had a seizure when she was out. Her friends, who were much more sensible and competent than I would have been, got help and managed to contact me, but they didn’t know what hospital they were being taken to. They said they would let me know as soon as they could. It was before mobile phones.

As I lay awake, waiting and frightened, I had a sudden memory of the mothers of The Disappeared – the many, many women of South America whose adult children had been seized in the past by the political regime. The mothers whose lives had been spent never knowing where their children were or what had happened to them. Every year they gathered with photos of their sons and daughters to stand in silent testimony to show the world that these children had existed and been loved and mattered. They mattered.

In fighting for Justice for LB we are witnesses, but persistently noisy ones, to another kind of disappearance.

Because Connor and Nico were meant to disappear. An implacable authority, with plenty of resources to cover its tracks, tried to bury them too, but in mounds of spin and jargon and callous disincentives to their families to keep them alive and seen.

We fight for them, because they mattered.

We fight a system that increasingly seeks to disappear its most vulnerable members. The elderly, as well as the dudes and dudettes, are locked away, without respectful care and human consideration, denied treatments they need to keep them healthy, ultimate condemned to die.

However much this is dressed up in glowing vision statements and shiny aims and empty “consultations” and mutual back slappings for meeting “targets”, that is what is happening.

Yesterday I blogged about living in two cultures, but in only one do I feel valued. In the other I feel increasingly invisible, without worth and disregarded as an older person.

In the first one evening, I caught the last local bus home. It leaves quite early around 10.30 and its terminus is Magaluf. It was a bendy bus full of noisy teenagers, as you would expect, off for a good night out. But as we made our way apprehensively up the boisterous,crowded aisle, two lads immediately gestured to us to come and take their seats. They spoke to us cheerily, treating us simply as fellow human beings, not as old nuisances who should have been penned up in their homes out of sight and mind.

Today we think of Connor and Nico, of their lives, their families and their all too preventable deaths. But they stand for all the others with names known only to those who loved and cared for them.

All the others, young and old, our present system seeks to disappear.