… and all the reasons why that’ll never happen!

Despite my 30 odd years in the NHS I’m, very deliberately, not management. I’d be a terrible manager because, I cannot lie, it looks like a fiendishly difficult job.  We, the workers, are routinely failing to be perfect. We are consistently human with our pesky quirks and foibles. Our home life issues have a habit of following us to work. Trying to hold it all together for everyone causes anxiety, stress and fatigue, which invariably leads to sickness. The manager knows this, she’s also a stressed human with health issues. Nevertheless she needs us to comply with a gazillion rules, regulations and guidelines, covering anything from uniform policies to timekeeping, from annual leave limitations to sick and emergency leave situations.  These are problems that need to be solved using thin air, imagination, and quite a lot of unpaid overtime. But never money. There isn’t any. I genuinely admire and respect my boss, I think she does a phenomenal job. She is a shining beacon of exemplary management who leads by example, does more than her fair share of unpaid overtime thus inspiring loyalty from us, her motley crew of menopausal midwives. But I do not, under any circumstances, ever, want her job.

If, hypothetically, someone offered me quadruple my salary to take on boss-woman responsibilities, I might consider it. On my own terms.

Firstly, no more pointless meetings; no meetings about meetings. Meetings about problems without cash to solve said problems just lead to recriminations and bitterness, more meetings, a lot of wishful thinking, and ultimately, nothing. Money doesn’t just buy decent equipment (although that helps), it buys time, time to think carefully and act wisely. It buys us the answers. Which are expensive. We know what the answers are, everyone does, and no amount of fresh air, optimism and goodwill can make it cheaper. We know this because we’ve really tried. But complaints keep coming from patients and the CQC and everywhere in between. My boss has to respond to these complaints. Explain what was learned and why they won’t happen again. Without mentioning the C word (cash, if you were wondering). Why would I want that job?

Let me give you a few examples of how I’d deal with complaints if I were the boss under present circumstances:

To those who write in because they somehow expected royal service but got treated fairly, like everyone else, I’d choose at random from one of the following stockphrases:

– I didn’t know there was a free ‘entitled git’ upgrade. Unfortunately it was released at the same time as the ‘stressed and overworked’ midwife/nurse downgrade.

– Or your complaint was sent to Internet heaven where it will linger for eternity.

– Or we respect your right to complain about dumb stuff. We hope it made you feel better. Problem solved.

– We think this complaint has originated from a Russian bot, trying to destroy the NHS by ruining morale. Please tell your bosses that it’s working.

– Your complaint is number gazillion in the queue, we doubt we’ll ever get to it.

– The client isn’t always right (although you are welcome to have an opinion; we will always listen). You are cordially invited to go to medical/midwifery school before telling us how to do our jobs.

And if someone does actually have a valid complaint undoubtedly related to staff and/or cash shortages, I’d invite them to urgently share it with their MP whose job it is to make actual laws. I presume that includes NHS funding. Delegation is the name of the game. Now the MPs have to deal with it.

They’d soon be overwhelmed. I’d love to watch them squirm as they discover the uncomfortable and sometimes devastating reality caused by chronic staff shortages. If your MP truly believes that these problems won’t affect them because they have health insurance, read on, I have plenty to say about that. Here’s what they should demand on our behalf:

Unlimited budget to hire more staff. Could we please stop pretending we are fully staffed.  We are never fully staffed except if we count those that are off sick (don’t even ask), those on maternity leave (the NHS is run and staffed by women, and childbearing age is fast increasing), or those managers who are supposed to get their hands dirty when the sh!t hits the fans, but never do. We often have a decent number of newly qualified midwives (who work very hard but aren’t 100% independent) who also shouldn’t be counted in the numbers just yet. We’d really like to keep these women who have just sacrificed three years of their lives (and have gone into mega-debt)  just to qualify. Rather than them using their hard won degree to do something, anything else. We need to incentivise them to stay. They say that money talks. I bet it’s pretty convincing! So, we hire all the newbies (on generous terms) and we ease them in gently, maybe part time, definitely set days so they can actually plan their lives. Now we have so many staff, we can offer part time set days to more seasoned (also better renumerated) staff as well. It’s called job share, and for us interchangeable shop floor midwives, it’s perfectly plausible.  That way I guarantee we cut sickness to virtually nothing. I’m also willing to bet that the number of complaints drops dramatically.

Working unsociable hours should be properly rewarded. Working nights and weekends really takes its toll and should be worth triple time. I’m gonna need a bit of a budget for that. Christmas is quadruple.

We scrap yearly mandatory training days which merely serve to remind a room full of overwhelmed staff of what they didn’t know without taking the time to remedy the knowledge gap. Midwives work in a variety of clinical settings, so we don’t need every single update. When you give us a bunch of new information mixed in with old information, some of which isn’t relevant, some of it being pure magical thinking, we just shut down. When we are told we’ll work it out on our own time ‘because we care’, it is implied that either we have access to a time machine or we are not expected to sleep. As a well paid manager with unlimited funds, I’m sure I’d find a better way.

Instead of dumb and pointless manual handling sessions which are basically a way to victim blame your staff when they hurt themselves while trying to do a poorly paid job with none of the equipment they were taught to expect (by the manual handling experts who have never been to your ward, or worked in a clinical setting), there should be mandatory protected time for gym workouts. In state of the art, well maintained, fully staffed, 24/7, free, sports centres. Oh, and free healthy meals. Again, no more sick leave. Your workers now magically work right through to 67  years, passing on all their hard won expertise to the next generation. Brain drain is a thing of the past. It pays for itself. Eventually!

Look, I don’t know how we’d fund my expensive solutions especially if no-one is brave enough to raise taxes. I do have one idea though. Anyone who has sooo much spare cash that they can afford really decent health insurance: thanks, we’ll take that cash! The NHS is the best health insurance known to mankind,  you absolute nincompoop! After all, would we even have a private sector without the NHS? I mean,  who trains the student doctors, nurses and midwives so they can go on to care for you in the private sector? It’s the NHS staff. We teach them every single practical skill. It takes time and dedication and reams of paperwork, and we do it for free. Who picks up the pieces when your cheap  overseas surgery goes (literally) tits up? Or when your Brazilian butt lift goes south? Who looks after you when your health insurance premium is no longer affordable because you were audacious enough to get sick? Who looks after you when you discover that your seemingly reasonably priced insurance doesn’t cover any hospital admissions? Do we ever want to be forced to crowdfund our hospital care because we sleep-walked into a 2 tier health system? I’m guessing not. I’m looking at you, America, your system sounds absolutely terrifying.

So, yeah, I might not be ready for that promotion. Not yet…

But that doesn’t mean we shouldn’t all bypass PALS (Patient Advisory Liason Service, aka complaints) and complain in droves directly to our MPs. My amazing manager would be unbelievably grateful.