Society
The web of meaninglessness
Published 11 July 2005
Observations on the NHS
Having recently retired from the National Health Service, I thought I might soon miss the work, particularly contact with patients. But I was recently sent a circular from the NHS trust by which I was formerly employed that reminds me how little I miss the increasing managerialism of the service. It succeeds in combining fatuity with a hint of menace.
The circular, signed by the "Improving Working Lives Lead Nurse", concerned a series of meetings called 20/20 meetings. This was because they were to be held on the 20th of the month and were to last at least 20 minutes. (I can just imagine how proud the managers were of coming up with such a name, with its poetic connotation of perfect eyesight.)
The purpose of these meetings was "to engage staff in developing the core principles of our service". The meetings were to be "treated as a matter of priority" and were to occur more or less simultaneously throughout the trust; everybody was to be encouraged to attend, which in the event meant bullying them. Managers were to "reinforce the importance of the meeting" and "portray it in a positive light".
Each meeting was to begin with a manager reading a script out loud. This consisted of seven platitudes, badly or ambiguously expressed, the first of which was: "If in doubt, sort things out which are best for our patient in the first instance.' Another pearl above price was: "There is usually a better way of doing things."
One hundred and twenty doctors, among others, with approximately 3,600 years of education and training between them, were supposed to listen to these banali-ties and offer comments. The comments are what is known to management as "feedback". The purpose of asking for this is to entangle people in the web of meaninglessness.
A long interest in the political propaganda of dictatorships has convinced me that the purpose of such propaganda is not to describe, much less to persuade or change people, but to humiliate them. The more at variance with reality the slogans are, the better: nothing is more destructive of people's ability to resist than forced acquiescence to what they know is tripe.
On a small scale, this is the object of NHS management (and no doubt management in other services). The document implicitly acknowledges it: "Please try to avoid and discourage any cynicism." This suggests that they know perfectly well how most people would react to 20/20 meetings. You wouldn't have to be a professor to find the injunctions to "Try to look at the whole picture" or "Always be courteous and respectful" insulting.
This is doublethink. When managers say "avoid and discourage cynicism", what they mean is "promote and encourage cynicism". Careerists and opportunists as they are (though the blame ultimately lies with those who gave them their opportunity), they need to reduce everyone to below their own level. A cynical, demoralised workforce, without independence of action or thought, is easy to manipulate. And the ultimate goal? A world in which everyone just obeys orders.
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