I must talk about Pete Deveson, a GP in Epsom. The fella did make me sit up and listen at the BMJ Big Debate recently.
Pete talked about ‘learned helplessness’. Delivered with panache and fun, but with a striking message underneath, he talked about how many doctors had forgotten the art of speaking up when needed.
Many a time I have been warned about the ‘bigger picture’; our leaders can’t say things openly because the bigger picture is more important. But what does that actually mean? A bigger picture for the person or a bigger picture for healthcare?
Keith Willett recently spoke at a King’s Fund conference. He’s the Director for Acute Episodes of Care at NHS England. I followed on Twitter as he spoke about the challenges, spoke about workforce, spoke about working differently…and I waited for this clever intelligent leader to mention the recruitment crisis and low morale among juniors. But nothing came along.
What does that mean? Is the emergency care crisis solvable without improving morale or tackling the recruitment issue? Or is there a bigger issue at hand I am not aware of?
Sir Bruce Keogh recently spoke at an Agents of Change event – he spoke about leadership, challenges, issues to tackle…and I waited for one line about junior doctors, or indeed mortality issues with weekend admissions. I waited to no avail.
I hold Sir Bruce in high esteem, and I suppose it sucks even more when one of your heroes lets you down.
So what’s the message for budding leaders? Keep quiet on the contentious issues? Silence can be a tacit admission of support. Or is this all a form of learned helplessness?
Recently I wrote a blog loosely in favour of the CQC and on balance I feel it still has a role. Then it goes and commits the most spectacular own goal ever, hiking up the price of its registration fees in an environment where money is in short supply.
The CQC says it isn’t their fault, that the DH that they are passing on the costs of regulation. What stops an ‘independent body’ from publicly pushing back- learned helplessness or some nebulous big picture which escapes the perception of ordinary mortals?
I could raise a national campaign tomorrow showing gaps in diabetes services. It could be bigger than the ‘safe staffing’ debate, but what would it achieve if you haven’t tackled the basic question? The big picture.
We all live in our silos. And until we collectively ask what needs to be funded and what needs to stop, all the ‘small stuff’ is futile. It’s a circular debate in an echo chamber at best!
Ask yourself this: you want safe ward staffing – do you fancy stopping screening for diabetes to do that? You want access to insulin pumps – do you fancy stopping the funding of shinier CCUs?
That, ladies and gentlemen, in a nutshell, is what the bigger picture is about for the health of people. Beyond that, the bigger picture is one that concerns individuals and their ambitions.
In Sanskrit there is a saying “Maunam Sammati Lakshanam”. It means that silence is half-consent. Have a think on the Big Picture tonight, won’t you?