@RealSteveHolmes – – 40 years of exploring ideas and now for 20 more

When we speak of being surrounded by information I believe we are tending to think of that in a fairly mechanistic way, possibly without expecting to understand any details, possibly as vague in our minds as we are about the mathematics that powers Google. It’s there; it’s everywhere; it is part of the fabric of our lives and our minds now. It supports us. It is rational. It is hard information, nothing vague and fluffy…

Next comes what we do with that information, another matter entirely, how much emphasis we place on which supposedly hard facts about life, which in truth are nothing of the sort because for everything that is known someone devised method of discovery and skewed the output. So that what we know to be true is actually just a form of more or less probable belief. The rest would be faith, as the religious would have it.

We are now familiar with the enterprise scenario in which thrusting people who don’t really belong in those angular clothes with those rapt expressions of passion are supposedly, in dynamic meetings, exercising their immense business and leadership skills to define, analyse, restructure, plan, implement and execute constant improvement towards a better bottom line. Whether this process can go on for ever is rarely discussed, but surely by now it is well enough advanced to wonder whether much more can be done through ruthlessly dragonish procedures, especially since everything has already been rationalised, synergised, outsourced, and Sygma-ed beyond recognition. No one sits around chewing the breeze any more, do they?

Now let me show you what rubbish this model is for the real world: please step into an acute care ward for respiratory patients. There are 18 of them in three bays and two private patients in rooms off. The nursing staff consists of at least one staff nurse and at least two other fully qualified nurses supported by at least three nursing assistants or auxiliaries. They are all working a 12 hour shift with lamentably short breaks. Also involved are one of two physios who serve this and other wards, a pharmacist ditto, the cleaning and catering team, occasional input from occupational therapy and various bods who come round doing tests, X-rays, assessments, whatever. Also on constant duty are at least two freshly qualified junior doctors working 3 day shifts as far as one can tell. And it’s visiting time so the ward is full of people, some of whom have dementia and are constantly acting up, some of whom are crying in pain and needing urgent help, some of whom need commodes and basic support and privacy, sooner rather than later. The nurses and their helpers are literally run off their feet, 12 hours a day.

The bays where the beds are were originally built for four beds but they have been adapted to cram in six, making access to powerpoints difficult at some stations and meaning that every single worker on duty is constantly cramped and harassed for space. This means that each nurse is now doing 50% more work than ten years ago with no extra pay or rights, in fact less in some cases. So you tell me how they’re yet going to save another £20 billion without cutting services…

Yet it all works and I’ll tell you how: the staff protest against the machine by speaking to the patients in their own local dialect; some of them absolutely refuse to compromise by speaking received English; they communicate with the sad old men as their wives and families would, altering their tone according to who is involved, rolling out their infinite kindness to the sickest and most demented, briskly encouraging those with hope, like me, prioritising their attention all day long, multitasking on several levels at once with rarely anything dropped.

They work by empathy; they manage all that information, all that technology, all that human drama; they managed it in an integrated way, not as separate channels like a manager might; they manage it like that because they are person centred. They do what works and they absolutely resist anything else. You cannot hurry them. You cannot panic them. You cannot distract them. You cannot disappoint them. Whatever comes up they cope with it, patiently, even if the same old man messes his sheets and needs changing ten times a day.

And even the ward sister, let’s call her Heather, gets stuck in when she can break from the damned stupid computer paperwork, finding time to comfort me when I am quietly crying because I fear that I will be a burden to Cora for the rest of my life. Heather is 69 years old and a law unto herself, as she deserves to be. And in any sensible world she would be Minster of Health. Heather doesn’t need any rat-faced little manager to tell her what to do and I doubt she’d listen if they tried.