A couple of posts in other blogs today shed some light on ways in which the NHS, like other government monopolies, is failing. But not nearly enough light is shed, and not in the right places to let anyone see how to fix the problem.
Following the death of “Baby P“ there has been widespread criticism of Haringey’s social services department. In the Centre for Policy Studies blog, Kathy Gyngell looks deeper, lambasting the systems that create the culture of bureaucracy that creates the problem, and asking: Labour’s dehumanising computerised people management ‘assembly lines’ – time to rethink our response to public services?
All these people management systems are based on three principles – economies of scale, standardisation and centralisation. In terms of outcomes, even more unacceptable than the billions wasted in IT failure, is the human cost…
This is because in all of them there is an inevitable and irresolvable tension between front end referral, (at which they are mostly very successful) and the back end log jam of irresolution or ongoing need for care.
It’s no surprise that irresolution and ongoing need for care are such prominent features of NHS mental health care, too.
Lola is one of the logs in the NHS mental health jam, but she has a plan to break free. In A Plan, no bones about it, she tells of the nightmare of conflicting diagnosis, miscommunication, and inept attempts to make her fit the system, and of her cunning plan to wrest her life back from them:
…cunning like a desperate man dying of dehydration, in the desert. That is, If water was professional support, and the desert was the NHS mental health services. Sometimes being mentally ill in the mental health system, feels like being a wheelchair user trying to negotiate a hospital with nothing but staircases. Eventually you have to go in armed with a sledgehammer and smash your way through to your destination.
Reading it, I get the strong feeling that if anyone can, Lola can. Risk analysis, support in place in advance, a cool appraisal what she is up against, deeply-understood goals — she’s calculating and determined. Good luck, Lola!
Where we need more light is where the thinking behind these failing systems originates. Everyone knows that these centrally-planned systems always fail. Everyone has known that for a long, long time. So what kind of addiction or cognitive distortion is it that makes us, as a society, crave these systems?
Ironically it’s the psychotherapists who, although trapped in these systems just as much as their patients, have the knowledge of human nature to look into the dark places of the NHS and discover the real answers.