'The Whole System is Rigged' Part 1

This blog is based on my observations and experiences whilst working in the health sector for the last 16 years.

We live in a strange world, a world apparently hiding under a facade of humanity. Where it wants you to be human but creates a system which doesn't allow you to be one. 

Buried under red tape, paperwork and checklists; we are programmed to be robots not even androids. 

A system where, in order to help another human, you have to jump a few hoops. 

A system that tells you to help others but doesn't allow you to, by creating bureaucratic boundaries so high that its unimaginable to surmount it.

In my profession/work as a Psychiatrist, I have come across vulnerable people, homeless people but housing won’t help, hungry people but food bank would not provide, penniless patient but no petty cash to buy them a meal.

I have experienced situations where mothers with young children are allowed to live in dwelling with children without basic necessities.  When referred to Social services, it takes months just to make their way in and their excuse, we were not allowed in.

I have been in situations where I have to shout, plead, beg and assert people in the organisation to help my patients, sometimes I am successful and sometimes I am not. I have noticed that people have become so professional, so by the book, with a checklist, so compliance focused, that the human element is lost in translation. They forget that the system was created to help people and not crunch numbers. 

As a Doctor working in the Health Sector, whenever I read the annual report of an NHS Trust or peruse their website, the most prominent thing is their ‘Values,’ values that extend from humanity, respect, partnerships, collaboration, compassion but in reality, they seem to be mere fancy words with minimal applicability, and virtues followed are far from it.  Our systems in their existence thrive on dividing, power gathering, scapegoating, bullying, micromanaging and narcissism.

Why is NHS underperforming? More people are starting to ask this question. Is it the lack of resources? lack of structure? lack of workforce? or the wrong motivators or drives? Or is it Leadership? Leadership is one aspect where I have witnessed it lacks the most. In the NHS, it is a concept which is so misunderstood, and its application flawed.

Leadership entails  leading people with a vision, with respect, selflessness, humility, candour, compassion, transformation with patient-centricity; however our current systems lack these elements.   Instead, the workforce is pushed, invalidated, inadequately trained, improperly coached, dysfunctionally mentored creating a system which is at the brink of a collapse.

We are pushed ‘to do more', when this is raised as an issue, resilience training is offered and then again, we are pushed ‘to do more,’ rather forced to do more; burdened with massive workload, covering extra domains and forced to embark onto dangerous practices.  The workforce is not cared for, yet are expected to perform above and beyond.

Patient-centricity is a big issue. Our services are not patient-centric nor are our processes, it dwells on refusing rather than providing care. Health has become a corporate sector with an embedded callousness. People have become numbers, problems have become labels, and illness have become a stigma.

Systems are aligned at passing the buck. NHS partners like police will refuse to bring in a section patient who has gone AWOL from the hospital, saying it’s not their responsibility. Social services will refuse to intervene with young mothers with children, saying they don't have access. Housing refuse to give abode to rough sleepers saying they are addicts, addiction is an exclusion criterion on council's housing lists. Unwell patients are left without a framework because clinicians are not willing to take responsibility.

Some people working in the health sector thrive on challenges; but soon realise there is no solace as the whole process is fixed. Some succumb to it; some accept it as a norm. Those who pick a fight run out of gas soon.

In my first year as a consultant psychiatrist, working in a community team , I decided to connect  with my patients using music. 

I used to keep an acoustic guitar in my office, used as a prop to engage patients in talking about their interests, so many of them asked to play some tunes, a song writer got her niche back, a grieving friend asked me to play a tune for her and then played a tune for me.  A person with PTSD and Generalised anxiety got the  strength back and started performing in the gigs, a thing she used to enjoy. 

I knew I found a novel way to help patients recover and rehabilitate. 

I along with a support worker  thought of creating a ‘Music support group’ for patients , we drafted a proposal and presented it to the Lead, however the response we got  was something that totally took us by surprise, ‘so now you want to play guitar in your spare time at the expense of the Trust,’ and the proposal was binned.

We are in a system, where an outlier is considered insanity, where innovation is a fool's rush, where challenging the system is causing obstruction. In order to bring about a change, one has to be part of the system, however the resistance to change becomes steeper as one moves up the hierarchy.

How can we clean up the system when everything around is rigged?  Or can we?

It will be discussed in my next blog, stay tuned….