Liam Farrell - Don't turn our district nurses into bureaucrats

District nurses, don't you just love them; if I was in the trenches, I'd want them there beside me.

Even more, I'd happily give them a leg up over the top; greater love hath no man. I can't go over the top myself, you understand, I've got bursitis, and hay fever, the mustard gas would play hell with my sinuses, I'd just get in the way; war is for young people anyway, we old folks would be better off with the more responsible jobs, such as fearlessly guarding the food supplies a few miles behind the front line.

District nurses have always been magnificent and absolutely dependable colleagues. I'm not suffering an excess of nostalgia here; I know there was trend among the Tories a few years ago to yearn for the 50s-style hospital matron, but I'm not pining for Hattie Jacques. It's simply that I've admired and respected every district nurse I've ever worked with, and over the years their advice and support have been invaluable.

Knowledgeable, sensible, practical, never afraid to get their hands dirty and get stuck in, I could go on and on extolling their virtues. So it's been a shame to see this precious and irreplaceable resource being squandered, to see district nurses increasingly hamstrung by the same stultifying and ever more labyrinthine bureaucracy that constipates our own practice.

Everything has to be written down, everything has to be reported. I accept that some degree of accountability is desirable, but there comes a stage when it defeats its own purpose.

It takes so long to explain what we are doing that it significantly affects our ability to do the actual thing that needs to be done.

Middle management, that most proliferative breed in the NHS, just adore accountability. It's the Trojan horse which allows them to construct and justify their vast and ever-increasing bureaucracy.

They are like Lewis Carroll's White Knight: '"Come, tell me how you live!" I cried/And thumped him on the head.'

The raison d'etre of the bureaucrat, however, is nothing to do with patient care; it's looking out for themselves. And I don't need any detailed reports to tell me that they're doing a very good job at that.

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