Puberty, the NHS and Laloux

Puberty isn’t something I have written about before – it is, I guess, a subject that I know little about beyond my own personal experiences, which were quite some time ago.

Yet, the whole process, the difficult period of change, like any, is something that I feel we, those who are either working-in or in receipt of care of support from the NHS are experiencing.

Some of it is pleasant, some painful, other aspects confusing and frightening – we are changing, some of which is necessary, some not.

Just as with puberty, there is the good and the bad, there is a morass of complicating factors – related to peaks and troughs of hormones – and, what is this process, or perhaps better, what is its purpose?

Puberty is the transition from child to adult – passing through adolescence and youth;

Our NHS was born in 1948, the starting point here is to explain that the NHS or massive organisations like our health service do not age at the same rate as humans, they are like cats and dogs, although in reverse, one NHS year is more like six human years, which would make it about thirteen now, just ripe for the change – spots and all.

And what is the point of the change? Well, during these incremental and at times seismic moves within the NHS, there have been equally radical changes in society. I wasn’t alive in the 1950’s, but I know that we hadn’t even, as a human race, landed on the moon, inequality was on a different scale to today – gender, race or religion – and the music was not what we have now (see Desmond Carrington).

The numbers of older people, and those living with chronic, multi-morbid conditions have exploded, family structures have reorganised, broken-down and reformed in myriad different ways; our planet is sagging beneath the weight of pollution and over-utilisation;

Yet, safely tucked away, or at least, trying to pretend that none of this is real is our health service; sure, there have been developments – MRI, PET, SPECT, robot surgery, electronic outpatient check-in, yet, much, I think, probably most of the system is still stuck in the 50’s – wards, beds, pyjamas, medicine rounds, visiting times, the hierarchical structure of clinicians and managers; clinical examination, diagnostic synthesis, waiting times, out-patients, uniforms.

So, change is needed, a change in how our hospitals and healthcare is structured, run, organised, delivered and understood by those working in the service and those in receipt of its care (oftentimes the same people).

I suppose what I haven’t mentioned or even alluded-to is the way in which this change is happening – the forces that are influencing all of this. The elephant in the room being the government and its sledgehammer, curmudgeonly, exploitative and ugly techniques of change, many of which, we know, relate to self-interest, other aspects to a fundamentalist approach and others, I just don’t know – I don’t know why they do much of what they do.

Here we have it, a system that needs to be changed, a system that is changing and a process that is threatening to kill that system – you might think of puberty with anabolic steroids or platform boots – wobbly, unsafe and unsightly.

What is our response to all this change, beyond, despair (and despair within the health service is real – it is something I encounter most days when talking with people)?

I think, and I have little evidence to substantiate this, although possibly more than exists to support the at-scale destruction/immolation of the NHS that seems to be happening, is that we take a deep breath and look at what we are doing, where we are heading and how we are doing-it;

We say, yes, things need to change, those imposing the changes don’t seem to have grasped its reality, how to implement it or what a future-state might look like, so, therefore, we move to the original model of puberty.

We acknowledge that our experiences will be messy, painful, embarrassing, ineffective, even, at times, doomed to failure, but that we take the approach that those who understand the change best are those whose lives are caught-up in the process; the patients, the carers, the doctors, therapists and nurses, the porters, healthcare assistants, technicians, phlebotomists, radiographers and all the rest of the multitude that make-up planet-NHS.

We talk with them and listen to them and not just in a lip-service, consultation or road-show phone-in, but in a real, meaningful way, by allowing those people to take the helm, to lead the change, to provide the solutions in a safe arena, free from the threat of redundancy, reorganisation or annihilation.

And back to the model, the struggling 13 or the contemplative 70-year-old; both have more in common that separates them – both bleed if cut, both have significant pasts and futures, both have a stake in the world around them; yet, how often is the 13-year-old asked their opinion of society, of school and education, how often do we subject them to Victorian warehouse schooling? How often do we adopt an approach to 70 year olds that is more in keeping with the 1920’s than the 21^st century?

The model needs to turn itself upside down, with governance, with rules and meaningful direction and allow nature – evolution, Mr Laloux, to provide us with support, succour to move into our next phase of being.