Lemmingaid

As you read this in sunny February 2016, Christmas will have passed us by and a New Year will have started. There are many issues round the world which cause anxiety to Wood, and proportionally are of more concern, from Syria, Iraq, global warming and international terrorism, taxes on sugar-rich drinks and – perhaps most troubling – taxes on alcoholic drinks. How closely linked these challenges are is open to perspective and knowledge of history, but Trees finds it tricky to ignore a fattening and more affluent population heading towards eight billion, a technological explosion, absence of a major disease or world war and wonders if, perhaps, we are fulfilling some deep-seated need in our brain to self-destruct and ruin the place?

So from this background Wood and Trees felt superfluous and self-indulgent to be considering the current state of the relationship between the public, the government and health workers. However, this is what they do best and the discussion carried on with all the energy, generalisations and poorly informed statistics that a coffee-room debate demands. With absolute ignorance to the assembled staff on a break wanting nothing more than peace and quiet, Wood and Trees undertook intellectual fencing with all the flamboyance and finesse of Prime Minister’s questions.

The situation was very clear to them both. The proposed contract changes were nothing short of a coordinated attack on the medical profession and coming hot on the tail of pension changes. Pay had been stuck for almost a decade with a pay cut of 25% not too far off, and now they are planning to bring in seven-day working, change working hour definitions and generally make Wood and Trees suffer. Sure things were not too bad now, but that doesn’t mean the turkey should feel guilty and vote for Christmas. And that smug duffer Fallen-Bough had escaped all of this and retired the other week keeping Wood and Trees working to maintain him and having them look after his chronic disorders of Western affluence. Other staff were getting irked by this exchange but trying to ignore it. There weren’t many non-medical staff who had seen pay rises in the coffee room that day and none of them had merit awards or the like. Agenda for Change had not seen too many smiling faces when it had brought its changes in but there are few things as vicious as a spoilt child when they have their sweets taken away, and Wood and Trees felt their sweets were being replaced with gravel. Best to leave them moaning …

Wood couldn’t understand why the Government had chosen such an aggressive approach and why Mr. Hunt felt compelled to continue on this collision course. Trees did remind him this wasn’t the first time, and Lansley’s Act had been quite a change. Neither was this the first profession to feel the heat and Wood agreed now his son the lawyer was a coffee shop owner. Trees felt it makes it too easy for the Government, directing your hatred at one individual, however unfortunate their name may be, as within six months they move on, and they have gotten away with it. Wood sagely noted the parallels with hospital management. Trees never talks about Lansley any more but his changes to commissioning and allocation of funding affect Wood every day. The emergency laparotomy which Trees had accepted to come to ICU later that day lost the trust several thousands of pounds, while Wood made that back when the elective orthopaedic work came through the business unit. Yep, Lansley and his colleagues had sure left them both with an incomprehensible and unworkable business model where your core business loses you money. Trees did not want the Government to wriggle out of this by blaming Hunt alone. Anyway, Wood was pleased they were listening and injecting several billion of additional funding into the NHS, until Trees reminded him of the commitment for many more billions in savings. After scribbling furiously on a patient safety leaflet, he looked up shocked and angered – “they are cutting billions” spluttered Wood. “But doing it with a smiling Hunt and a corporate NHS enamel lapel badge” reassured Trees.

But surely as democrats, the Government were simply acting on a mandate from the election? Trees pointed out the Queensbury rules of the coffee room where fighting, spitting and discussing religion and politics were clearly forbidden. They also observed the rule that all smoking must be done in the corner by the window and all exhalations blown sideways out the window. So they moved on to discussing the “patients” while observing Caldicott principles and ensuring dignity, privacy and candour. Of course most patients are removed from the planning stage when they get ill so Wood felt compelled to emphasise we have health care which is responsive to public whims rather than patients. Trees also felt he might be a (well informed on health care) member of the public. They both reflected, revalidation style, on how Specsavers had been a key wish for most people so they could exercise their choice in eye care and hearing aids and see improved care through choice while shopping for food they really don’t need. Delivering health care, free at the point of delivery, through shopping centre corporations who must turn a profit is indeed an impressive contortion and thankfully most politicians concerned hadn’t appreciated they were now staring at their royal rump, metaphorically speaking of course, having adopted the full pretzel position. Trees believes the public saw “their” health care as similar to Black Friday and “choice” being their right and this is what they got. Sure the choices are terrible pointed out Wood, but they do have a choice. Perhaps, they shouldn’t have been so easily distracted and wooed and instead looked after the NHS a little more wondered Trees? Now this is a question Jeremy Hunt would never dare to ask – when the ambulances are queuing up the street seven days a week will you learn to use the resources a little more responsibly? At a time when Black Friday bargains make billions of pounds of profit and over 50% of adults have mobile phone contracts, are we really seeing times of austerity? But don’t ask them to pay anything chortles Wood or they won’t be able to text a photo of a lizard falling over! Trees tutted … no one texts any more. Apparently.

But what of this strike asked Wood? Should we have it, did it work, have we lost public support, did it do anything?… Trees pointed to his NUM donkey jacket which he had dug out for the hostilities and had manned a picket only to be informed by the line manager of his business unit that he wasn’t on strike and it was the juniors – if he wouldn’t mind taking down the hammer and sickle flag, removing his Che Guevara beret and jogging on to the ICU where the ward round was waiting. It took a long time to extinguish the burning oil drum, especially being mindful of the fire lecture he had attended only last week in his mandatory training. Thankfully, he had done manual handling in the same session so was able to remove the tyre wall he had built across the main entrance and the equality and diversity training came in very handy when the police arrived and they understood it was “nothing personal”. This of course works both ways and the tazer was bracing yet oddly refreshing but no hard feelings, and yes, you can do a ward round 60 min after being zapped. Wood was very impressed by Trees striking stance but couldn’t help but point out that if he damages his donkey jacket he wouldn’t be able to get another one unless he went “on line” or something awful. “And it wouldn’t say NUM on it ether …” Trees said looking thoughtfully. Slowly the fate of other industries and professions which had seemed secure began to look like that of the NHS and the medical profession.”

“There'll always be a happy hour

For those with money, jobs and power;

They'll never realise the hurt

They do to men they treat like dirt.

“Shoosh! You can’t sing that!” Trees shouted.

“Too political?” asked Wood

“No! What about the women?” explained Trees. “Equality and diversity!”

“70% of them are medical students now, so you tell me. Whenever I want a sensible answer I ignore you and ask my wife.”

Wood and Trees went straight home and put their BMA donkey jacket, pension contributions and good will onto eBay. They returned the next day as shift workers and superficially trained service providers and felt a great weight off their shoulders. No politicians were harmed in the making of this story, but there are a few patients who wouldn’t be best pleased. Thankfully, they haven’t noticed and are delighted to be able to see their doctors in Nando’s at the weekend while shopping for … whatever it is we shop for.

The views expressed in this column are those of the authors and do not necessarily represent, and should not be attributed to the Journal of the Intensive Care Society, the Intensive Care Society, the Editors, or the Publisher, SAGE.