Saturday, June 7, 2014

Scylla and Charibdes

Homer had described it perfectly...no, not the yellow loveable being from the Simpsons but the original Homer, the Ancient Greek who penned the Iliad and the Odyssey. In the Odyssey, he describes two irresistible and dangerous monsters called Scylla and Charibdes who sat in the Strait of Messina, a narrow stretch of water the hero,Odysseus had to cross..and thereby was born the oft used idiom "between Scylla and Charibdes". English literature was one of my favourite classes to attend in school, perhaps made even more appealing by an amazing teacher...and I still recall Mr. Peters closing the book with aplomb while explaining that idiom and with his deep baritone explaining how in life we would always be faced with these two monsters. Today we have it in the NHS.

The NHS is not perfect. In fact, let me be perfectly honest, it never will be. Even if the whole country's GDP was diverted to the NHS, it still won't be. Why? Because we are in the business of looking after humans, their illnesses, their sufferings...by humans with their fallibility and foibles. Anyone who promises you an error free health system is either naive, ignorant or lying. So not surprisingly the NHS has them..in fact quite a bit of it. In between the amazing wonders done each day, errors occur and there is a drive to get it better..and there always has been..will errors still happen inspite of all the guidelines, the check lists, the hashtags? Yes, it will.

The problem begins when people hide them, deny them, cover them up...step forward Bristol, step forward James Titcombe, step forward Francis...and the perception is built that the staff just want to hide errors, be content with mistakes..an imperfect system stands exposed,warts and all. The public looks on in horror as the prom queen is shown to be someone who also takes cocaine as a pastime. The religion that is the NHS takes a beating and the perception of  a secretive culture is built.....and there you have Scylla.
For anyone who may even have an iota of tainting the sacred cow of the NHS, it's like Christmas. Every single campaign raised, every single whistleblower who are absolutely and absolutely doing the right thing by highlighting mistakes that the NHS should learn from becomes a lightning beacon for those who want to show the warts of the prom queen. How did that Abba song go again..."The King has lost his crown"...

And then we have the national campaigns such as "Hellomynameis", "6Cs", "NHSchangeday"... Each and every single one of them admirable concepts but my unease towards them has always been known..not because of the ethos of them but because how it can be misrepresented.When I first heard about the campaign which Kate Granger has championed so well, I must admit to being a bit surprised. Why? Because when I gave my medical final exams, or my PLAB or my MRCP, introducing yourself to a patient was a non-negotiable, mandatory thing to do. In fact, I was told clearly that if I didn't introduce myself to a patient, I would fail. I then was a house officer, then a senior house officer and at every step saw my Consultant introduce himself or herself by name...surely it was normal standard practice? But then,as I grew up, it dawned it actually wasn't...so more strength to the campaign...but the unease persisted as again anyone with an iota of an agenda could potentially use it. 
And lo and behold, we now have the Daily mail and the Telegraph showcasing "how awful the healthcare professionals are..they don't even introduce ourselves...thus thank heavens we now have a campaign"..or words to those effect. Criticise  those papers as much as you want but they do have a readership..and whatever retractions you get, however many re-tweets you get on twitter, sadly, reputations are easy to tarnish, much difficult to regain . Think of this one for a headline.."Nurses need courses on compassion as  it has been felt they haven't any". I refer to the 6C campaign...a great initiative aimed at changing the culture but one headline with potential to destroy a lot of faith..anyone working as an HCP will know that headline is sensational..what about the populace at large? And there you have your Charibdes...any openness or desire to change  seized upon with ruthless efficiency by those who have papers to sell or an agenda to push.

So the NHS is caught, isn't it? All the whistle-blowing etc has exposed foibles which have been needed to learn from...but seized upon as failings. And any attempt to correct them are seen as more examples of..yes..you got it..failings.The PR battle is being lost every day...each days end brings a sign that the battle maybe slipping away ever so slightly. Finances are tight, patient expectations are through the roof, evidence based medicine lies in tatters...There are plenty of folks with the desire but each day the ones who are more keen to get their head down, finish the job and just go home to their family rises. 

I will finish with one little story..in that school classroom as Mr Peters explained the ferocity of Scylla and Charibdes..their monstrosity and desire for destruction, I recall someone saying that it was impossible to survive them...to which Mr Peters with his baritone boomed.."Never forget Odysseus survived them both".How will the NHS fare? Time will tell..it's ticking to some form of conclusion...someday the history books will look at these times and marvel at this fascinating passage of time. 

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