Tom Goodfellow

Schadenfreude is an exquisite dish but it can leave a bitter taste

It has been nearly a year since I hung up my ultrasound probe, switched off the PACS monitor for the last time, cleared my desk and wiped off all the incriminating data from my PC. I felt an oddly lonely figure as, after the farewell lunch, I exited the radiology department and the hospital for the last time as a Consultant Radiologist, clutching my farewell bag of goodies – gifts from my erstwhile colleagues who will, by now, have largely forgotten me.

No, I am not getting maudlin. Although obviously I miss the camaraderie of facing together the daily grind, I miss little else (other than some of the paediatric work which I loved doing). It was not until I fully retired that I realised just how completely knackered I was. Six years training (B.Sc., MB, BS) then over forty-one years working as a doctor including the chore of FRCS followed by FRCR – that was quite enough for anyone.

I had an enjoyable and a modestly successful career and was able to involve myself with a whole range of interesting and challenging projects over the years, and I would like to think that I left a small part of the behemoth that is the NHS slightly better than when I came in.

But let’s be honest – all of us who retire from the battle in some secret, shameful, locked away corner of our being, believe that we are irreplaceable and that the whole tottering edifice will come crashing down after we have left. Of course our rational brain does not want or wish that, and we know it is unlikely to be true, but schadenfreude is such an exquisite dish.

It was therefore with much interest that, following a CQC inspection of my ex-trust in March 2015, I awaited the final report which was published in August.

Overall the Trust did not do too badly; not much different to any other large acute Trust with a huge PFI debt and all the expected issues around acute admissions. Out of the five domains (safe, effective, caring, responsive, well-led) three were graded as “requiring improvement” and two were graded as “good”. Consequently the overall grading was “requires improvement”. Well there is always room for improvement in any large complex organisation, but nothing too disastrous.

However one single department in the whole Trust was labelled as “inadequate”. Yes you have guessed it – the radiology department, my erstwhile domain!

Now it is an indisputable fact that I retired over three months before the inspection, so clearly it was my departure that precipitated the debacle. If I had still been there then…

Would that were true, but the reality is different. In my opinion one statement in the CQC report summed up the situation. “We found that caring required improvement in the radiology department. It was clear that staff were under pressure and we observed that a calm approach was sometimes forgotten. We observed there could be more focus on the task than the patient and there was lack of consistency in how well people’s needs were recognised and responded to.”

The phrase, “the staff were under pressure…” was a significant understatement. The reality was that the inexorable rise in demand for diagnostic imaging over the last few years had simply not been matched by any increase in resources, either equipment or more crucially staff. To put it bluntly there were not enough people to do the work demanded and in many respects the department was “inadequate” almost every day.

I believe that more generally it is this type of frustration which is fuelling the current deep unrest among the junior doctors (how I hate that sobriquet – there is nothing “junior” about most of them). I personally don’t think that the BMA have handled the contract negotiations well, and the Secretary of State has been a complete prat. Yet if the proposed industrial action goes ahead it will merely put a huge additional strain on the consultant staff, and all the juniors who do not happen to be BMA members (who I believe are in the majority although I am willing to be corrected on this). And the service will still stagger on.

In my view the SoS is using the conflict with the juniors as a sounding board for the inevitable fight with the consultant body and the GPs as he attempts to force them to do routine work at the weekends, a concept with a nebulous evidence base.

As an aged retired wrinkly I am not going to preach to the junior doctors who are far more aware of the pressures of working in the NHS than I now am. Medicine can be great fun and very rewarding, but not if you are constantly fighting a rear-guard action to try to prop up a creaking, under-resourced, politically target-driven service where the predominant culture is name, blame and shame. If day after day you finish your shift exhausted and demoralised you are unlikely to be too patient with a Government that seems to be trying to extract more and more from you for less.

In my last few years of work I was very vociferous towards management concerning the inadequacies of the radiology department, but to little avail. The expectations kept rising while the ability to deliver stayed the same, so the CQC report came as no great surprise.

I now want to shout out, “I told you so, I told you so”, but I have come to realise that schadenfreude leaves a very bitter taste.

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