It's easy to say when you don't have any consequences to bear. Easy to ask someone to "rock the boat", easy to ask people to "change". Let me be very clear at the very outset. To the many who have joined different campaigns, there is no doubting your willingness and intention to change. Yes, as I have said before, an ever increasing question is what it has ACTUALLY delivered as well as whether some of it is nothing more than tokenism. I have said before and I will say so again...it shows nothing but the stress of the system, the situation we are in that we have to pledge to smile at someone, be kind, answer a telephone or be polite. It's not necessarily something we should be proud of but if anything a bit worried that in a healthcare system, we need a pledge to keep patients safe. However if that works as something to reinforce the basics, so be it.
Time has also taught me that most of these individuals who I hear about seem genuinely interested, passionately care and want to make a difference. I respect that and appreciate your desire to help, humbled by your dedication too. The problem is the NHS needs not just those basics to happen but something much more fundamental. It needs changes in way we work, changes in how we deliver care in the modern century but a tripod of old school thinking, perverse tariffs and misplaced allegiance all combine to dissuade many a would-be a rebel or radical.
Let's take the case of the whistleblowers. If we believe what happened to them as documented, then what exactly has happened to those who were involved in shutting them up, destroyed their careers? The doesn't seem to have been anyone named, prosecuted or anything..so what's the message then? If we are saying the biggest radical of them was pinned to the cross for others to learn from and be dissuaded from raising the voice, where exactly does the slogan of "be a radical" fit in? Or is that we don't believe the whistleblowers and it was all just a personal vendetta we all just disagree with?
There's an oft used quote- rock the boat but don't sink it...I struggle to understand what that means. Go so far but no further? Be a radical but with limits? Ask the diabetes world, you will not come across a bigger rebel, radical, maverick than me, ask any organisation linked with diabetes- be it Diabetes UK, ABCD, YDEF...coin whatever term you want...and I bear the scars. The only thing that has helped me survive has been my colleagues, my family and the security zone of going back into that clinic, interacting with my patients and enjoying the day job. It's tough, it's hard, it's sometimes depressing and sometimes it doesn't feel worth it.Its easier to get your head down, do the day job- and go home. The salary stays pretty much the same, so why bother?
The million dollar question is..after seeing everything and reading the Francis report, ask yourself the question...would you whistle blow? If you are in in organisation like Wigan, as per what Umesh Prabhu says, you raise an issue, be a radical and you will be listened to. But let's face it...isn't that a rarity? I personally have been fortunate enough to work with different Executives locally and I have always had a willing ear, someone who has listened to needs of patients and helped....but does the story of the whistleblowers fill you with hope or dread?
I will tell you what will make you think twice. It's called life. It's called everyone around you. It's called your career. On the ground, unless you can change THAT,unless you radicalise that, all sorts of movements will always be objects of derision a for some. There will only be a handful few who would put their whole life at risk for sake of the patient...the change needs to be much higher up...the change needs to be in the openness of the system. If you work in a quango (for want of a better word), then exhortations to join the radicals will always be looked upon with one question....what's the consequence of leading people to change when that individuals suffering or consequences don't affect you? How many of the self professed radicals have come out and stood publicly with the whistleblowers? We all or at least Roy Lilley certainly does question the appropriateness of use of public money when CQC and Monitor is questioned. Quite rightly too. As should I be for the amount of taxpayers money spent in training me and now paying me.
So shall we also question the use of public money for all the various networks, organisations which seem to have sprouted over the last 4 -5 years? When money is tight and believe you me it is when I am battling for a few thousands to justify improved care..at what point do we question what these quangoes have achieved? Not in a derisory way but a genuine open discussion...is that even possible or as soon as you do that, you are a troublemaker, not a rebel? To paraphrase, one mans rebel is another mans troublemaker...all about your point of view, isn't it?
I am not a sceptic, if I was, all that has been achieved locally wouldn't have happened. I am a born optimist while time has taught me to be pragmatic. I will be the first person to ask a junior doctor to think radically but I would also be honest about the consequences, also be the first to be there for them if the evangelism of radicalism burns them. Those who advise must tred with caution, must appreciate the impact on lives, must appreciate why there is derision from some quarters.talk, as ever, is cheap.
Leadership is a fine art...the rats all thought the Pied Piper was a leader too. You want to change the NHS, you want radicals to take the fore? Show them that being a whistleblower doesn't need to end bad, show them the eventual outcome is good, stand by them and challenge the establishment. Or stand up and show us your own track record of being a rebel. A clever worded PR campaign can fool some, not all. I appreciate the value of PR, I am someone who has been to that school of arts...I also know credibility is built on results, not on empty words.
Prove me wrong.