Is there a possible basis for clinical engagement?

Imagine the managers at BMW going, “We’re going to get together a programme to get the engineers all fired up and enthusiastic about making BMWs. The engineers are not really engaged with the production processes at present.” You’d fall off your seat in amazement. Surely the criterion for being appointed an engineer at BMW is that you are competent and you love making high specification, well engineered cars. Surely their engineer’s skill is what BMW is selling to you? You wouldn’t want the engineer engaged to the process- you’d want him and his team to be the process.

In the NHS recently there have been a plethora of demands for “clinical engagement.” The call has gone out, “Send for the doctors” and “Bring them back.” Doctors apparently have some skills that managers need, and they have finally twigged that their reforms will never happen unless there is “buy in” from front line staff. Indeed the effect of changes will be less if front line staff are not signed up to them, or contest or seek to undermine them. Well this blog is good evidence that we are not signed up to the current NHS changes. We don’t like the status quo, but we equally don’t like the remedies suggested by government in last 19 years which have actually made the problems worse.

What is the product of the NHS? Healthcare. And who provides healthcare? Doctors, nurses, physios, midwives et al. So if the doctors (and probably the other staff groups) are not engaged with the NHS main product, who or what is?

When you, as a voter or as a patient, hears the NHS talk about “the lack of clinical engagement” you know there is a problem. How the fuck has the NHS ever got itself to a state of clinical disengagement? What is the NHS about if not about getting doctors, nurses et al to patients when the patient needs them? What else could or should the NHS be about?

Well, let Dr Rant guide you round the problem.

For some time now, the NHS has been run by idiot politicians, misleading advisers, health economists, management consultants, and a thousand and one others who all think they know better how to run the place than the bloody awkward old doctors, who resist change, are forces of conservatism, and are generally best avoided or excluded, or silenced. Yes the great NHS management in its wisdom thought it could do without doctors. They thought bureaucrats would do it better.

Or at least that they could keep doctors seeing patients, and get on with the necessary structural changes themselves.

So over the last 10-20 years the NHS managers have foisted one policy after another onto the NHS, and jumped on one management fad or another each week.

And now the results are disappointing, the doctors are thoroughly pissed off (as this and other blogs readily witness) the management have got in a new buzzword, “Clinical engagement.” Yes the NHS management is a total fuck up and the buggers now want doctors to come in and sort the mess out for them.

Well, Dr Rant has news for the NHS management. Doctors feel like a battered wife- we don’t know if you’ll be nice or nasty to us, and for how long you’ll stay nice. So you’re being nice at present as you desperately need something off us- but we know you really hate us, and want to tie us up in regulation, and procedures. We know you fear us for our independence and intelligence. We know that our criticisms of DH policy are valid, and indeed are getting a loud echo from many sources. We know that you know that NHS management is actually merely political apparatchiks imposing government policy by dictat, not consent. We know that most nights you’d happily take sullen acquiescence as enthusiastic support. We know that you do not have a clue how to do anything useful that will help any patient at all. And we know that even if we find a good manager our thinking they are good is kiss of death to their career. And that all managers move jobs too often and that there will be a new one around in a year or two. Plausible deniability I think Oliver North termed it.

How can we trust such crap and stupidity?

Now I think Diogenes the cynic gives us the best answer here, “Will you kindly get out of our light?” There is no golden mean with idiocy! A rod for the back of fools!

At present in the NHS we have two groups fighting each other over “Who best cares for patients?” For too long now the managers have claimed that they have no vested interests and that they best speak for patients. Whereas doctors are honest enough to admit we do have our pride and our vested interests, and professional standards (with risk of being struck off) whereas managers in NHS (all the way up to DH) don’t admit their own interests, and there is no GMC for managers, and incompetent managers simply get moved elsewhere.

The idea of clinical engagement is a good one. I’m just not sure there’s any current basis in sense or incentive for engaging with this government, its clapped out policies, and its lies, spin and deceits, or its local commisars and apparatchiks.

Personally Dr Rant thinks the Spaceship Programme might work rather well. The writing is on the wall for the whole of NHS management- “You have been tried. You have been found wanting. You will be removed.”