Soundings: Fire down below
2002; BMJ; Volume: 324; Issue: 7334 Linguagem: Inglês
ISSN
0959-8138
Autores Tópico(s)Healthcare Systems and Challenges
ResumoSomeone somewhere must have been the first to compare reorganising the NHS with rearranging the deckchairs on the Titanic. The joke does not bear analysis—the health service is not about to capsize—but “rearranging the deckchairs” entered the language because it catches the real feeling in the engine room about activities on the bridge. The only people who go up and down the ladder between the two are doctors. A few of us spend part of the week in London on the medical equivalent of the promenade deck and part of it back home working in the galley. Or rather, this week, not working. I am writing in January and elective surgery in our hospital has been cancelled, as it was last year and the year before that and the year . . . Below deck, your reaction is fury. You are the person who saw the patients and shared their pain and anxiety. You are the person who will see them when they are finally admitted. Your fury is only increased by knowing that they will not blame you or anyone else for the failures of the NHS. Above deck, you are all urbanity. You nibble a custard cream, comment on the second draft of a discussion document, and check your diary for dates for the next meeting. If yesterday's anger intrudes into your conversation you feel foolish. Your colleagues smile and advise you not to let it get to you. After a while you think they are right. Your upper deck friends are talented and committed people. They may not feel raw rage when the service breaks down but they do want to improve things. The problem is that the higher people are in the NHS ship, the less is the fire in their belly. And on the bridge are the politicians, cold as ice and ignorant about everything except politics. It may be mythology but I like to think that the NHS was brought into being by combining Beveridge's cool brain and Bevan's hot blood. According to his biographer, Michael Foot, Aneurin Bevan was “a man of passion and compassion.” Those are exactly the qualities missing from the politicians who are steering the ship today. Those, and knowledge about life below deck.
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