The bureaucrats always win

Observations on doctors

The NHS spends £50m a year on the salaries of doctors suspended from duty and those hired temporarily to replace them. This may seem a small sum to people accustomed to bandying about the kind of figures routine in discussions of our public finances, but to those of us in the NHS who are trying, with limited success, to get our old dictaphones replaced, it seems like a very large sum indeed. For that kind of money, each consultant in the country could have 100 dictaphones (though I appreciate that suspended doctors and new dictaphones are funded from separate budgets).

Eight out of ten suspensions result in reinstatement of the doctors concerned. That is why quite a few doctors of my acquaintance hope for suspension: they will have a prolonged period of fully paid rest, followed by vindication and reinstatement. They might even want to repeat the experience of one doctor I know, whose suspension was the making of him financially: thanks to a bureaucratic error, he was not suspended but placed on prolonged leave, so that he was able to take a highly paid locum post (double his NHS salary) while receiving his full salary as well. Then, when he was thoroughly vindicated, he received a large lump sum in exchange for a promise not to sue. Not bad for him, but less good, perhaps, for the NHS. Needless to say, no one was held to account for this extremely expensive bungling.

Complaints against doctors in the NHS are usually investigated by bureaucrats with a thoroughness that is inversely proportional to their inherent seriousness. Most hospital trusts, for example, have a policy on bullying and harassment that defines bullying and harassment by reference solely to the feelings of the alleged victim, and has no requirement to show reasonable cause. This leads to a torrent of trivial but vindictive complaints, each of which is time-consumingly investigated by staff who may well do nothing else.

From the point of view of providing healthcare, this is obviously inefficient and counterproductive. But one should not forget that the ostensible ends of an organisation are not necessarily its real ends. Thus the waste of time and money on trifling complaints helps to establish total managerial control over the health service by, among other means, a policy of divide and rule.

Management decisions are routinely taken that will predictably end in the death of patients, but no one loses a wink of sleep over them. Old people, for example, are decanted from one place to another as if they were inanimate objects, though such movement is known often to be fatal to them. But just let a hypersensitive first-year student of something or other complain of feeling bullied, and all hell breaks loose.

There is no sanction against those who have been found to complain falsely or trivially, and thus waste everyone's time and effort. Why not? Because such complaining serves a useful managerial function and is therefore encouraged.