THEODORE DALRYMPLE
My one regret at having retired from the National Health Service is that I no longer receive official circulars. I used for a time to derive a small secondary income from publishing them; and such was their idiocy that very little commentary on my part was required. They spoke for themselves; it was money for old rope.
I am glad to say, however, that old friends keep me in touch with GogolioKafkaesque-Orwellian developments in Europe’s biggest employer (now that the Gulag is no more). One of them, a senior doctor, recently passed on to me an email written about him by someone rejoicing in the title of Lead Nurse Manager, sent to her superior, the Modern Matron (it is typical of the temper, and increasingly the biology, of the times that the Matron should be male), complaining that he had twice refused to remove his cufflinks, contrary to Department of Health policy and instructions with regard to these deathdealing sartorial accoutrements.
My friend had the email from the medical director, who had it from the Modern Matron, who had it from the Lead Nurse Manager, who had ordered two members of staff, a ward clerk and a junior nurse, to ask him to take off his cufflinks. The Medical Director informed him that the Modern Matron had told him that he, the Modern Matron, reported directly to the Department of Health, and asked the Medical Director to inform the miscreant doctor of this fact.
Six members of the hospital staff, therefore, had devoted time to this important matter: probably enough in aggregate to save a life or two, and certainly enough to relieve a little suffering. I am not sufficiently au fait with the procedures of the Department of Health to know how many of their staff would devote their consideration to this matter; but I am at least morally certain that they would not otherwise have been better employed, which is at least a consolation.
That same week, another doctor friend, on the brink, like most of the British medical profession, of early retirement, kindly sent me the brochure to a conference to which he had been invited, at a cost of only £399.50 to the British taxpayer, on ‘Lean Management in Primary Care’. ‘Lean thinking is a way of streamlining the patient journey,’ said the chairman of the Lean Enterprise Academy. (So, of course, was the T-4 euthanasia programme in Germany, where the patient journey was streamlined in buses marked ‘Community Transport’.) And one of the talks at the conference was to be given by a person whose position was Lead for NHS Productive Leader, a phrase so horrible that it tortures the mind merely to read or repeat it. The main subjects of this personage’s talk were ‘Releasing Time to Lead’ and ‘Focusing on Value: Experiences of a Productive Leader Site’. Another NHS functionary was quoted as follows: ‘Lean’s focus on delivering care is a refreshing antidote to benchmarks, targets and the traditional approach to performance management.’ It is unlikely, outside the confessional, that a franker confession of the moral, intellectual and financial nullity, not to say corruption, of professional management in the public service will ever be uttered. Perpetual bureaucratic failure is management consultancy’s opportunity, of course: without wilful incompetence, inefficiency and stupidity, where would the fees come from?
‘Lean is not a management fad,’ said the same functionary. And, as Magritte wrote on his painting of a pipe, this is not a pipe.
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