It flows down. I have been sent to find out how many beds you have available in your department. How many discharges. How many people can go and are going. How many people are waiting to move to A or B or C. I don’t necessarily want the details, I don’t want to hear excuses or things gone wrong or waiting for this or that, I want to hear when there will be a bed, I need to move from the trolley in A&E to the bed in AMU to the ward to the rehab to the home to home and I am adequately detached from the end or net result to be too concerned about whether Mr A or Mrs B or C don’t quite make it and have to come back three days later via blue-light ambulance as they were sent home too soon before everything was sorted-out, and hospitals are like pressure cookers – a point is reached beyond which nothing helps but blowing the whistle and you have to be careful that you don’t make people make decisions in haste that result in harm for what is the point of being able to save a life one day only to screw up the care two weeks later – the journey is one, it is all connected and whatever happens in one part has knock-on effects on another and I really do believe it is the mind-sets of those trying to lead or deliver results or achieve targets that once distorted become difficult if not impossible to unravel; untangle like the metabolic pathways of an addict brain, like the grooves worn in ice or grass flattened sheep paths, we run, we run down one alley and even though it is the wrong direction, it is at least somewhere to go, it is at least perceived as movement in one direction – despite the reality it might be taking you in reverse, you keep going, you keep going, deluding yourself into the belief that as you are busy, as you are occupied, you are doing and doing is good, for the alternative, not-doing is unacceptable and must be challenged – it is the action which cannot be spoken-of, it is the management plan, process, strategy, task and finish, executive board decision that makes everyone feel better as there is a sense of something being done even though that which is being done is closer to destruction than creation, even though those who get in the way risk becoming new victims of the analysis, becoming statistical anomalies of health or social care and everyone wants to do the right thing – this isn’t about bad people being malicious or wanting to stir-up the dirt or slow down the improvement, this is well-meaning people, well-intentioned, usually very bright and inspired individuals who a little like rabbits in headlights don’t quite know which way to turn when the car approaches at speed out of the darkness and you go left or right or stay where you are & the results will be the same, so why I guess, worry, why not let it flow over what you experience, let it drift over you, lie low, and wait for the seasons to change – this is self-preservation and so long as you are able to hold-on to your little clod of earth, to maintain adequate input, output and turnover, you don’t have to grow or change or look for a way out, you will get by and the growth or attrition or change takes place at such a rate that no one really notices, that no one is aware of any encroachment. We move right, we go left, we wait, to move forwards, no one is looking, no one cares, for everyone holds at their own private centre. Centre. Stay centred. Stay sane. & breathe.