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A few years back, in another country, in another part of that country (I hope some of you are seeing that first ever Star Wars opening) I told myself that I couldn’t grumble about NHS politics and processes if I hadn’t tried to do it. I put some research time aside for a few years and held the dizzying title of “Clinical Director” of the smallest Directorate of a very big NHS Trust.  I think I held the post for 30 months and we achieved some good things. Within much less than 30 months of giving that up I think most of those good things had been reversed and most of the poor things I thought I had failed to alter continued (and many still do from what I hear). One senior manager who resisted much I tried to do rose like Icarus but went when a long standing and frankly blatant nepotism he operated emerged,  or perhaps it suited someone sufficiently more secure than even him to,  at last,  melt his wax. The Chief Executive who oversaw things went when the overuse of staff postings of positive reports on services on NHS feedback systems emerged.  He did better than his substantive precursor who went,  ostensibly,  for abusing hospitality funds.  I think he heads up a private health care service now.

No, you are wrong,  after torturing me up the “relentless” climb to the Puerto de Ibañeta the bike isn’t called “Chief Executive.” nor “General Manager”, just “Toto” as that meant,  long after this had been true, I could slump off it and say “We’re not in France any more Toto”. In minutes the clouds lifted and Toto and I shot down into Roncevalles,  and  beyond, like a dodgy rocket.

Now when I was trying to be a competent Clinical Director,  which had some similarities with the climbing on an overgeared bike, I worked with a wonderful managerial team. The most senior had already left the NHS in frustration with some things but came back for a bit and,  with our two other great managers,  we did our best.  She,  she knows who she is,  gave me a lot of lifts around that distant galaxy to varyingly excellent or frankly repellent meetings and I learned that when she got a new car (second hand I’m sure actually), she would take some days to divine the car’s name. One rather swish mini was Ethan. (Predictive text made that “Ethanol” – not so!)

Anyway, one very small bit of this story is about the need for human systems,  whether they are food sales with WiFi give away, or health care,  to encourage some idiosyncrasies,  some real, unique personalities in all that work in them and use them. That’s no magic cure for anything, no recipe, perhaps that’s the point, it’s just a basic quality in rich human systems I think we’re eroding at our peril.

Enough. No-one I’ve alluded to in this post is or was basically malignant, but boy we have systems that don’t really bring out the best in people and perhaps encourage us to do very poor things. I’m very lucky to have been able to take some time to ponder things and oh boy,  did Toto and I do OK in tough climbs today!

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