Accounts from every decade of the NHS crackle like a broken record with the repeated themes of increasing demand, not enough resource, and changes designed to bridge that gap. Yet now it seems so much more critical, a real tipping point in UK social history.
We see news of junior doctors - having challenged the health secretary - being overridden and devalued. We hear of surgeries closing, increasing budget deficits and hideous chaos in hospital corridors.
Change is immensely stressful, evoking fears about survival – our individual survival, that of our workplace, and the very principles of the NHS. It is even more stressful when the only news surrounding us seems to be bad news, and the change is about making the best of a bad lot.
We can almost guarantee that everyone in the NHS will be experiencing fear, anxiety and stress at some level, whether consciously or not.
How does change affect us on the frontline?
Let’s dig below partisan politics to understand the deeper societal dynamics that lie beneath this perpetual urge for NHS change. And let’s consider how these deeper dynamics affect us, particularly those of us at the frontline.
In healthcare we offer care and support to the sick, needy and vulnerable. We face the fact that humans get ill and die, sometimes in grinding, lonely, undignified and painful ways.
Sometimes this means we work with people no-one else would like to even sit next to on a bus, let alone touch and examine. We look after people whose complex health and social needs challenge simplistic labeling like ‘worthy recipient of care’ or ‘scrounging dropout’.
We offer care to people who don’t speak our language or share our culture. We deal with the anguish of people that much of the rest of society would rather ignore, and those who struggle to even engage with the offer of care.
When we resort to simplistic thinking (which we are more prone to do under pressure), we too can feel judgmental and rejecting.
One way that people deal with this uncomfortable underbelly is to close our eyes to injustice, poverty, ill-health and struggles, hoping that they disappear. Or we can fall prey to the idea that if we simply reduce resources, we will squeeze the ‘unworthy’ into taking active personal responsibility.
This ignores the fact that society provides increasingly precarious options for those on the lowest rungs, and that wide socio-economic gaps yawn out at us from every street corner.
It also means that those of us working in health and social care share the impact of the squeeze, working in a more constrained and pressurized context.
Meeting need with diminishing resources
The current circumstances of the NHS represent not just an attack on the needy, but also an attempt to annihilate neediness itself. Political sleights of hand are used to disguise issues through a process of reorganising and renaming, so that no-one can spot what is being swept under the carpet.
What does it mean to work in a service where we are to meet needs with compassionate, safe, effective input, but where the sometimes gut-wrenching reality we confront is hidden from view and turned into a tick-box output? Where the real value, complexity and nuance of our work goes under-acknowledged as we are asked to meet more performance criteria, satisfy regulators and jump through the hurdles of the appraisal process?
What does it feel like to have a host of strong feelings as we connect with our patients and their predicaments, yet work within a system that takes no account of the emotional labour, treating our work as an assembly line?
As individuals working in the NHS, your experiences are part of the powerful dynamics that pervade society. Seeing the wider patterns we are immersed in can help us make sense of some of the challenges we face, and understand how easy it can be to get swept along by tides around us.
When working at the frontline of an organisation that systematically denies the emotional impact of the work, we ourselves carry the immense tension between feeling and unfeeling, and between the facing and denying of reality.
If you have any thoughts about this article, or any of the others in this series, please do email me at firstname.lastname@example.org. I’d love to hear your thoughts and feelings.
- Dr Jennifer Napier is a GP in London an honorary research fellow at Queen Mary, University of London where she has researched wellbeing and workforce issues. She is also the founder of Contextualyse, a consulting company focused on supporting organisations to create healthy workplaces