Why do we work this way, and ignore the obvious.

"You have to understand how stressed out we all area and how that makes us behave... I have so much to do, I take my work home, and I try and do some of it when I can. Sometimes my husband says I should stop, so I put the laptop away. Then, I might get up in the middle of the night, to do the emails - he won't know.

We're in crisis, and I have worked 70 hours a week before, but only get paid for 45. I have to do this, because I am the only one who can help them. I really cannot go on like this, I am on the verge of having to quit."

For me it was one of those moments that I instantly recognise as having caused a shift in me. I generally welcome them, but in this case it causes me to realise how bad we sometimes are at designing and organising. We can be very good at pretending we have not noticed, and turn a blind eye.

It is all too easy to get used to the problems around us - climate change, famine, and some public sector staff working far too hard. But, what if this is problem is one of our own making. Can we not solve it?

If a manager from Special Educational Needs, in a County Council had been repeatedly hit with a stick, then the Police would be called, and the perpetrator would be detailed. The public would be shocked at the abuse. But what happens when the abuse is invisible, it is mental, and it affects peoples well-being and lives? Why do we ignore those? I really mean it, Why do we ignore that abuse?

Hey, we don't even call it abuse, we call it the necessary effect of austerity.

Come to think of it, I dont think that manager had much to do with austerity...

Who is there to identify and prevent such abuse, our MPS, councillors, senior public sector managers, they all know this is happening. Maybe they should do something about it.

Then we have the organisations that are there to assess and improve our public bodies. The CQC, you seem to be doing lots of activity, and writing lots of reports. Have you missed this one? Do you actually look at the abuse pushed onto those staff of the services you analyse? No? Why not? If one member of the public was treated even half as poor, would you not want to hear about it? Then there would be a public outcry.

CQC, If you found equipment that was worn and hardly able to operate properly in one of your inspections, that would end up in your report. Please look at your role systemically, and look at outcomes, effect and cause. And when you look at cause, dont leave out the most important part of the health service delivery service - the people who deliver it. Then act on abuse when you find it.

Another way of looking at this situation; imagine we had been called in to improve a house, and we were deciding on the colour of the wallpaper, and what furniture goes where. We don't notice the owner hopping up and down, trying to get us to notice the fire in the kitchen

In situations like this, spending heaps of resources on innovation, or discovering what we can do differently, is wasted effort. First, just focus on that fundamental elephant in the room and get that sorted.