26 April 2008

Trades and professions

When man developed agriculture some 10,000 years ago it was a major advance. Farmers were able to build up food surpluses and, since they didn't need these, they could trade them for things they did need. This meant that some people didn't have to be farmers. They could specialise in other things. And with time this led to trades and professions. The great advantage of this was that jobs could be done better by people who did that sort of work all the time. And when harvests were good people had time to sit and think. Some of them would become religious professionals who as well as praying and keeping the gods onside would do a lot of sitting and thinking. And from these sprung universities and scholarship. Such advances must have seemed rather without purpose in those days but nobody would now deny the great advances and benefits that resulted from time for sitting and thinking. Dr Grumble certainly thinks that this must have been one of the benefits of societies having a strong religion. All sorts of advances must have come from intelligent people congregating together to think, to teach and to learn. Time to think is frowned upon by modern managers. They seem to think that Dr Grumble should spend more and more time face to face with patients. That sort of approach can be damaging. It's this sort of thing that prevented doctors from getting sufficiently organised to prevent the disaster of MMC. Not allowing people enough time to think is dangerous.

So agriculture gave time to groups of people to be experts. Some prayed and thought and others became more practical experts of one sort or another. All had their important roles in society and were valued. Eventually those that sat and thought came up with writing and maths and science. In the end it was these people that produced the greatest benefits of all. But nobody was to know that.

Dr Grumble had the builder round not so long ago. He needed a couple of walls knocked down. Having a wall knocked down is quite cheap. It's building it again that costs. It's amazing how many people you need to build a new wall. There's the labourer who, under supervision, wielded the hammer and moved the rubble. Then came the bricklayer and then the plasterer and then the electrician. In between a very old pipe was accidentally broken so the plumber came too. "Why so many?" thought Dr Grumble. Each job looks simple. It would be so much more efficient if each person in the building trade could do all of these tasks. So why haven't builders organised themselves like that? There must be a reason.

Of course, health care is similar. Many years ago Dr Grumble was looking after one of his boss's private patients. She looked lonely in her single room and Dr Grumble commented accordingly. As it happened she had been counting the number of people that came into her room every day. It was over 60. Each had their own role.

A couple of weeks ago Dr Grumble was responsible for a few very ill patients. One of them, a young man in his thirties, was worrying Dr Grumble. It looked as if he might die from an undiagnosed infection that was iatrogenic. The number of people involved in his case was too great to count. Dr Grumble can immediately think of at least five consultants some at other hospitals. We didn't get these people involved for fun. Each had a role. Dr Grumble's job was to put it all that expertise together and take overall responsibility.

If you work in an organisation that's full of doctors the role of doctors is generally recognised and used to be valued. But when Dr Grumble worked more than ten years ago in a part of the civil service that was being privatised he was told that the doctors didn't do anything that others couldn't do. And he was also told he was paid too much. The former was utter nonsense. The latter could be argued over. Dr Grumble just left. With people like that in charge it was the only sensible thing to do. His job was advertised. They couldn't recruit. Nobody wanted a full time job with an organisation like that. And the salary was much more than they had ever paid Dr Grumble.

So where is all this heading? It's to tell you that the NHS managers are becoming equally mad. They have long been saying that we don't need in the NHS all these professional groups with their own areas of interest. And, yes, they are saying that the worst amongst these are doctors that do not do anything that others cannot. And if they do it's only because they or society has set up systems that prevent others from doing their work. What, after all, does a doctor have that others don't? That's easy. It's a list of skills and competencies. It follows that if you can gain all the skills you can hop on the skills escalator and become, say, a cardiologist. And if you don't believe Dr Grumble that this is what they really think, try the career options tool. Dr Grumble hopes this is a spoof web site created by a disaffected doctor. He fears it is genuine and that you, the taxpayer, have paid for it.

This post was first published under a different title on 28th May 2007 along with some pictures which are now lost. It seemed to be a rather heretical view at the time. But since then quite a lot has happened and the government that has been responsible for all of this is now looking very weak. Perhaps there is now a chance to reclaim our profession - not for ourselves but for our patients.


Elaine said...

Funnily enough, about 18 years ago, I was giving a talk to some Health Care Assistants undergoing training. Now at that time an HCA was a new animal to me as I hadd known only Nursing Auxiliaries.

The tutor of that group was listening in to my talk and came over to speak to me at the end.

Her view was that ALL skills could be taught in the same way, with Staff Nurse being level (x) and so on to doctors starting at level (y).

I was horrified at that prospect.

And now, I see I was right to be horrified.

Dr Grumble said...

About 30 years ago when I was just an SHO I was frustrated that the nurses would do do so little. Every step of the way it had been an enormous struggle to get them to do things normally done by doctors. To this day I am not sure I completely understand why. `But I spoke to a very senior nurse about the issue. My point essentially was that nurses shouldn't be wasting time washing patients and keeping them comfortable but they should be extending their role and doing some of the traditional doctors' tasks. I was told very sternly that if nurses ever gave up doing basic nursing care that we would be the end of nursing as we knew it. I was very young. She was about as old as I am now. I didn't understand. Now I do. She was right and I was very wrong.

I remember her name to this day. I will tell you what it was. It was Miss Morley. She had never married. She had devoted her life to nursing and, in particular, maintaining nursing standards. I don't know any nurses like that any more. I barely know the names of any senior nurses. The nurses too have failed to protect their profession - a profession very different from that of medicine but equally important, probably more important, to the patient.

I fear that the damage this government has done to our professions is beyond repair.