I AM NOT GOING TO CRY

At least, I hope I’m not. But it is an inescapable fact that I am finding it much harder not to do so; that despite my best intentions the tears are frequently very close, even at work, which is a terrible admission. Tonight, there are tears in my eyes as I write this, even though I am safely at home and there is no apparent reason for them. So why this watery, emotional, display? I’m not even sure that I can explain, but I will try.

I became a doctor on January 9^th 1980, at the Royal College of Surgeons in London. I remember rushing down the stairs at Lincoln’s Inn shouting “I am a doctor” repeatedly at my anxiously waiting mother. It was probably the most important moment of my life. From being a lowly medical student, I had turned into that impressive being: a doctor. I was licensed, or I soon would be, to treat patients, to do good, above all, to do no harm.

The reason that I became a doctor at the Royal College of Surgeons in January, rather than at a University the following June, is that I come from Malta and there had been a little upheaval there. I might tell you about that another time. Suffice it to say, that I qualified six months ahead of the rest of my year. It was an amazing moment, emotional and impressive. There had never been before, nor would there ever be again, an exam of such life-changing significance.

What has that to do with the tears that are now streaming down my cheeks in an unstoppable fashion? That day I knew, with absolutely certainty, that I would spend the rest of my life working for the NHS, trying to improve the health of the population in whatever way seemed most appropriate. As it happened, I ended up in Public Health, but I could as easily have been a Paediatrician. I never thought the day would come, however, when the sub-speciality to which I belong (Health Services Public Health) would be essentially designed out of the system as of no importance and that we would be told that 30 years of experience were no longer of any use. It is not a good feeling. I would not wish it on anybody, except ………  But, no, that would be too cruel.

I Need A Job

Now who would ever have thought I would say that? Here I am, a Consultant in Public Health Medicine, medically qualified, trained in Paediatrics, trained in Public Health Medicine, yet I NEED A JOB.

I never believed I would be saying that.  When I became a doctor it was kind of accepted that you had a job for life – not necessarily which job, but there would be some employment. This was possibly a bad idea, but nevertheless I was fairly convinced when I qualified that I would be in gainful employment until I retired. Actually, I held this belief until the Health and Social Care Bill (as it then was) was published.

Now it is an Act. Whether I like it or not (and I don’t!) it is law. And my job is disappearing as a consequence. Not that Mr Lansley would accept that. Oh no! He says that Public Health is being strengthened. This only demonstrates how little he understands about what the discipline of Public Health really entails (and, possibly, contains).

Public Health has three strands or pillars. There is Health Protection – protecting the public from diseases like measles, HIV, Legionnaire’s, but also exposure to dangerous things like asbestos. Then there is Health Improvement, which is what most people understand by Public Health – the things in the environment and in our life styles that cause disease, like smoking and obesity. The third aspect of public health is what we call Health Services Public Health (HSPH). It is the most difficult to explain, but it is vital to the health of the nation and of the NHS. Basically, those of us who work in HSPH analyse what is needed for the health of the population and support commissioners in providing it. We look at how well hospitals are performing; we analyse the needs of our local populations; we advise on what should be commissioned. I could go on, but I won’t, because it is hardly thrilling to read. Yet it is vital, and difficult, and highly specialised, and critical to the NHS. AND IT IS DISAPPEARING.

Which is why I say – I need a job. The job that I have done for a number of years is disappearing: not because it is not needed, but because the powers that be do not recognise its importance. Already, many of my senior colleagues have left. We cannot afford this attrition rate. Yet nobody seems to care. When you try to reinvent it – remember us.

A BAD MORNING

Morning is not my favourite time. As anybody who knows me will tell you, I am not at my best before noon, and I am totally useless before ten. Unfortunately, the world does not work this way. When I first came to this part of the country, I negotiated an arrangement that would allow me to work from 10 till 6, rather than 9 to 5. Sadly, changes within the organisation have eroded this. People actually expect me to be bright and cheerful at nine in the morning! I cannot do this.

Yesterday morning, I had set my alarm in order to allow me to be at a particular place at 0900. This meant leaving home at 0800, and therefore being awake at 0700. I set my iPhone for 0630, 0645, and 0700. When I crawled out of bed at 0715, I thought it felt very cold. I was right. The boiler had locked out and there was no hot water.

Now, I am very sorry, but there is a limit to what I am prepared to put up with, and turning up for work unwashed and smelly was beyond that. I re-set the boiler and waited the 20 minutes necessary to ensure an at least tepid bath. I abandoned the hair wash.

I thought I had been totally reasonable. Sadly, others didn’t. I was castigated for being late. By this time I was cross. Actually, VERY CROSS. Am I being unreasonable? Given that I took this job on the understanding that I would normally work 10 till 6, is it unreasonable of me to expect that to be honoured? Apparently, the answer is yes, because I had nothing in writing. I am sad that we have reached the stage where we are not prepared to honour agreements made on a handshake. It seems to me to have been the essence of English honour. Forgive me – I am only a colonial.

I’M BACK

I am amazed to find that there are still a few stalwart souls looking at my blog. You are wonderful and I thank you. The reality is that the passage of the Health and Social Care Bill depressed me more than I had expected and I could not face trying to write anything. Pathetic, but true.

Now, I’m back. I am still depressed about the Act, but I refuse to give up.  This is too important for us to roll up into little balls and whimper – which, I fear, is what I have been doing. So, please forgive my appalling behaviour and let us return to the fight.

Amazingly, it was being told by my superiors that I had been spending too much time away from the day job that did it. Don’t these people realise how important this is? Do they really think that their comfortable little lives will continue?

Well, yes, I think they do. I plan to do everything I can to disabuse them of this. I have learned that there are some things that are too important to be traded for job security and a comfortable life. If you hear that I have been exiled to Outer Mongolia (sorry Mongolia – just an expression) you will know why. In the mean time:

NEVER GIVE UP; NEVER SURRENDER

Courtesy of one of my favourite films: ‘Galaxy Quest’.

Mr Lansley Does Not Understand

Dear Ones, I am tired. That is is not something I would normally say. Normally, I would grin and soldier on. What brought me to this admission was a phone call this morning.

I awoke at 06.30,went to the bathroom then returned to bed. I dozed for a couple of hours, then sat up in bed and played Sudoku on my iPhone (OK, so I’m sad that way!). Later, at about 08.00, I realised I was still tired and lay down for a catnap.

When the phone rang, I was irritated: how could someone ring this early on a Saturday? But I was too polite to say so. I grabbed the phone and sat up in bed. The friend who was calling and I had a pleasant chat, but I was slightly bemused that he didn’t apologise for phoning so early. I reached across to my iPhone: it was 11.45!!!

I have come home with a mountain of work that needs to be finished this weekend. This is routine work that I just have not had time to get through during the working week. Yet the Government tells me that I am a wastrel, that I am over-paid and under-employed, that I am a burden on the tax-payer (a class to which I belong!).  All of us in the Health Service have been told that we are a burden on the tax-payer, that we do not earn our salaries, that we are parasites. This is particularly true of those of us who work in Primary Care Trusts. Yet I look at my colleagues and see only those who are doing their best, who want to ensure that we serve the public to the best of our ability.

Andrew Lansley says that he knows the NHS. Maybe he does. But he certainly doesn’t understand those of us who have given our lives to it. I have worked for years with people who have given their all in the cause of the public good; I have been impressed with a Finance Director who was prepared to consider Public Health issues before finance considerations; I have commiserated with patients for whom we could do nothing further.

Health is not a commodity to be bought and sold at a Supermarket. And health care demands a very different set of skills: it requires empathy, understanding, caring, absolute commitment. My job does not finish at the end of the working day: it comes home with me, and I continue to think about it and, often, to work on it. Please Mr Lansley, do not under-estimate the commitment of the NHS workforce – you would disadvantage the country,