Appraisal? They just want you to tell lies

Observations on NHS bureaucracy

As part of Britain's inexorable drive to utter mediocrity, conformism and time-serving, consultants in the National Health Service now have to fill in an annual appraisal form 13 pages long. They will then discuss this with their appraiser: that is to say, a colleague from their own hospital. This discussion will lead to the filling of another ten-page form, including a Personal Development Plan, in which the consultant will have to manufacture "development needs" and invent both the means by which he will "address them" and the effect that having addressed them will have on his practice.

Needless to say, these various forms are deeply insulting to consultants, the great majority of whom are conscientious, hard-working, devoted to their patients, and who have always changed their practice as new methods and treatments have become available.

There have always been consultants who do not fit my description: but the idea that they will be weeded out by such forms is laughable, and could only seriously be entertained by a British civil servant or politician.

The process of appraisal, states a document by the government's chief medical officer, the Marshal Petain of the medical profession, "will be a positive and supportive development process, a constructive dialogue . . ." Needless to say, no one will appraise the appraisal: calculate the hours wasted upon it (the forms take several hours to fill in) and thus the number of patients not treated because of it; demonstrate the actual effects it has upon patient care; or investigate the effect upon medical morale.

The reason for this is that appraisal has nothing to do with improvement, but everything to do with control. Ever since Margaret Thatcher, governments have hated and feared the professions, because of their independence and the possibility that their integrity will show politicians up in a bad light.

Thatcher acted upon the characteristically dim-witted Shavian bon mot that the professions were conspiracies against the laity, and all subsequent governments have found it convenient to follow in her footsteps.

One of the sections of the form con- cerns probity. Needless to say, the most crooked members of our profession will find this the easiest part to fill in. But for the majority, the object of this section is to demonstrate beyond peradventure that they have no probity left, because if they had they would have refused to engage in the whole farcical process, in which they have no belief.

A consultant is being asked a question along the lines of whether he has stopped beating his wife yet - to be answered with a simple yes or no. For in his Personal Development Plan, he will most certainly tell lies: he will not mention that, thanks to such "positive and supportive" processes as the filling in of annual appraisal forms, and increasing bureaucratic circumscription of his work, his most urgent need is to achieve financial independence or another means of earning his living so that he can cease to be an NHS consultant (now the ambition of the great majority). He will not mention that he proposes to devote less time to his work, because of its increasingly thankless nature. He will say things that he knows not to be true.

In the section where he is asked to describe his management activities, he will not mention his increasing irritation and bewilderment at being - despite an unprecedented increase in the number of managers - expected to engage in ever more management tasks, as if the object of management in the NHS (unlike that in the private sector) is to get him to do as little clinical work as possible.

In other words, he is to be made complicit in the lying and spin-doctoring that pervades the British public service and renders it so peculiarly incompetent. His probity having been destroyed, his will to resist is broken. This is Gleichschaltung without the Nazi razzmatazz.

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