Its Never Easy These Days Read online

  It's Never Easy These Days

  Gareth Hollbrooke

  Copyright © 2015 Gareth Hollbrooke

  The moral right of the author has been asserted.

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  British Library Cataloguing in Publication Data.

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  Dedicated to all healthcare workers everywhere –

  whatever their function; whatever their disposition

  Contents

  Cover

  INTRODUCTION

  ACKNOWLEDGMENTS

  MODERN TIMES

  IT’S A WONDERFUL LIFE

  O LUCKY MAN

  THE COLLECTOR

  THE USUAL SUSPECTS

  WHOSE LIFE IS IT ANYWAY?

  APOCALYPSE NOW

  EAST IS EAST

  CARRY ON MATRON

  THE YOUNG LIONS

  TO CATCH A THIEF

  MAD MAX

  THE HUNTING PARTY

  THE GODFATHER

  THE HURRICANE

  NETWORK

  FOR A FEW DOLLARS MORE

  COOL HAND LUKE

  CABARET

  THE EAGLE HAS LANDED

  CANDIDATE

  THE GOLD RUSH

  MAD MAX 2

  THE MATRIX

  I’M ALL RIGHT JACK

  GROUNDHOG DAY

  SECRETARIAT

  MEDICINE MAN

  CHAIRMAN OF THE BOARD

  (ALMOST) DEATH IN VENICE

  A PRIVATE FUNCTION

  THE SOCIAL NETWORK

  MAD MAX 3

  CAROUSEL

  BREWSTER’S MILLIONS

  ROSEMARY’S BABY

  TOP GUN

  THE NEGOTIATOR

  CITY OF ANGELS

  THE JONESES

  DAYS OF WINE AND ROSES

  BRITTANIA HOSPITAL

  MAD MAX 4

  A MAN (OR WOMAN) FOR ALL SEASONS

  INTRODUCTION

  – HEALTHCARE IN GENERAL AND THE NHS IN PARTICULAR

  My name is Gareth Hollbrooke and I have been a hospital manager. Many hospitals are named after saints and in some of my quirkier moments I have thought that every hospital should be named after St Jude – who is well known as the patron saint of lost causes. Hospital and healthcare management is arguably one of the most difficult management tasks that any manager would have to face. There are a variety of reasons for this; partly because of the articulate, powerful professions that have successfully represented their interests extremely effectively. A further factor is the relative lack of resources available to meet demand and ever increasing expectations from the public and consumers. Another very important aspect is public perception and the impact of the media that helps, certainly in the UK, to define and stereotype how our hospital and healthcare managers act and behave.

  One of the reasons for writing this book is to display to wider audiences that healthcare services are provided by an assorted team of staff. There are diverse ranges of professions, who are active team members in the delivery of healthcare. Besides medical and nursing staff, these professions and occupations range from physiotherapists, various types of clinical technicians to functions such as catering, cleaning, building maintenance and portering. All of the occupational groups involved make a contribution to the well being of patients. Another reason is to raise awareness, even further than it already is, about the effect and impact of external bodies such as politicians, the media and of course, patients and their families. The task of managers or administrators, many of whom are now clinical, is to try and coordinate the efforts of all the individuals and teams that work on patient care. The titles of the people have changed over the years from hospital secretary, to administrator, to manager and over the past twenty years or so to chief executive officer. For those of us who worked as managers in healthcare over the course of several years, we may sometimes feel that ‘ringmaster’ is appropriate!

  Let me talk more specifically about the National Health Service. ‘There is something almost religious about the NHS… we love it second only to the Queen’. The quote is not from a long-standing supporter of the National Health Service, or even indeed an employee within it. The speaker was a senior figure in the independent healthcare sector of the United Kingdom and the quote was taken from the late 1980s. I feel it goes some way to summing up the British public’s attitude towards the health service. It is certainly my belief that although attitudes are changing and indeed have changed considerably since I first started my career in the late 1970s, there is still an enormous fount of goodwill for the health service. I believe this will still continue even with the seemingly constant sniping campaigns of certain tabloid newspapers that rant about ‘our third world hospitals’ and the ubiquitous criticism and cameras of both healthcare related TV series’ and the ‘docu-soaps’. What may well change is the way in which services are delivered and the roles, which healthcare facilities will play in the future. For example, there is likely to be much more visiting of patients at home and attempting to emphasise that preventive elements of healthcare rather than the much more expensive, complicated and on occasion, the potentially more dangerous practice of placing patients into a hospital setting. An ironic comparison is that evidently in the last part of the twentieth century, the nuclear industry was a safer environment to work in than healthcare.

  I can recall a conversation with one ex-hospital secretary who had learnt his skills over a period of many years, starting in the 1950s when the National Health Service was a youthful organisation. Many years ago, an old mentor of his had given him some advice at the time he started out as follows – “Much of the hospital administrator’s job, perhaps 75%, is applying commonsense. Remember that our primary brief is to support the clinical professionals deliver the service.” Since those early days in the NHS, along with many other organisational environments, life became much more richly patterned and complex. By the time that the 1980s and 1990s had arrived, with expectations that hung so heavily for effective healthcare delivery, it may have been more appropriate to restate the brief as ‘support and direct the professionals to deliver the service’. Of course, this is taking an old-fashioned and somewhat self-deprecating view of the power, influence and ethos of hospital managers. Certainly from at least the 1970s we viewed ourselves as professionals and often had the angst and battle scars to prove it. But one of the reasons that we were involved in our version of the ‘Great Game’ for so long is because we loved it. Some of us have moved on to different types of occupations but invariably we
often nostalgically hanker back to the good old days when we were running hospitals or parts of them.

  Healthcare in the UK is a pluralist system with input from both the public and private/independent health sectors. However, there is something rather special about the NHS – other parts of the health sector are only a small fraction of it. The health service dominates the health economy of the UK. Although I have worked in several parts of the healthcare sector: the NHS, the commercial hospital sector, the ‘not for profit’ independent hospital sector, a healthcare management consultancy and also at a hospital in the Middle East, it is the NHS where I found the most job satisfaction. Invariably it was also the most stimulating, but equally, the most frustrating, workplace. Therefore, a lot of content in this book is primarily about the National Health Service.

  It is with this background that I remember some of the very enjoyable, very interesting times that I had in the NHS. I had been asked on several occasions why I opted to leave an organisation for which I had so obvious an empathy and it has to be said, a great deal of emotional attachment. The NHS in many respects is a very unforgiving organisation and, due to the rapid changes experienced throughout the 1990s, it was not an easy environment in which to be comfortable. Too often, the machine collapses upon the individual. There are hundreds, if not thousands, of cases where burnout occurs – due to impositions that have been directed from the government or the civil services’ interpretation of what the government wants. If birds can act as metaphors, the NHS can be compared to magpies, where there are suspicions that some adult birds devour their young in a cannibalistic fashion. Although I have worked in non-hospital healthcare settings, my experience is predominantly in hospitals, which is why the hospital background permeates. The reality is that most members of the public seem to relate far more readily to hospitals than other providers of health services such as district nurses, the ambulance service or even GPs. So, in the late 1990s after twenty years of working in hospital and healthcare related organisations, I decided at that stage it was time to move on. However, I would like to share some of the memories I have in what has been for the most part, an unforgettable journey. There are a lot of interesting stories to tell, from this era that spans the twenty years between the late 70s to the late 90s, more than a few that are amusing and some which may even beggar belief. But they happened.

  ACKNOWLEDGMENTS

  This book has been fermenting as an idea for a few years and the team at Troubador are now making it a reality. All of the staff have been more than helpful, patient with my questions and always supportive. My special thanks for all those who were actively working with me - Alice Graham, Naomi Green, Rosie Grindrod, Jessica Hutchinson, Lauren Lewis, Jennifer Parker, Jane Rowland, Chelsea Taylor and of course Jeremy Thompson.

  Also my thanks to Pat and Pam for reading the manuscript and adding some valuable insights and to Chris for permission to use the “Catskills Movement”.

  Gareth Hollbrooke

  MODERN TIMES

  – “It’s Never Easy These Days”

  “It’s never easy these days, Garry boy, never bloody easy.” This was a phrase so often used by my first boss in the NHS, Victor Waters, that it was virtually a mantra. Victor had a habit of punctuating most sentences with at least one ‘bloody’ so after a while I found it unusual if one of his sentences did not contain that particular expletive. The time was the late 1970s and the NHS that Victor had joined in the 1950s had transformed into a much more complex, corporate beast. It was halfway into the eight-year-old lifespan of the area health authorities that seemed to strike a resonance in the consciousness of the population. Years after area health authorities had been dissolved and district health authorities were the bodies dealing at a local level with health issues, many members of the public still seemed to refer to the disbanded area health authorities. Victor, however, was even more entrenched in the past and related to the preceding era of Hospital Management Committees and a much more stable work environment.

  “The worst bloody thing they ever bloody did,” was Victor’s summation of the new format. I suspected that Victor hankered back to a much more simple hospital structure to manage and quite probably a simpler society. After the 1974 reorganisation, Victor like many others, had become a displaced person. Previously he had been a hospital secretary at a small hospital, in a rural setting on the other side of the county. With restructuring, the post no longer existed and he was placed in charge of all stores for a group of five hospitals that totalled over 1200 beds. Victor’s style was never subtle. In fact he was secretly referred to by some middle management colleagues as ‘the China Shop syndrome’. Without question he could be loud, brusque and combative but he also had the ability to make things happen. Another nickname given by one of his staff members was ‘Farmer Bill’ which was perhaps more befitting. Although he never spoke to me about his background, several of his previous posts were in rural type areas, which may have indicated his origins. He could readily pass as a farmer with ruddy cheeks, a grizzled beard mottled between brown and grey coupled to a naturally abrasive style, which was never intended to offend. I had the impression that beneath his frequent bluster, Victor had the insight to select staff members who were in a far different vein from him and he could thereby ensure that the job did get completed in a way that the professional groups would relate to. There were two or three appointments that he made at that time, which included me, of a much younger generation that had a different approach but a firm public service commitment. When discussing with me the opportunity for a new role managing medical and surgical items and consumables, Victor advised me that this could prove a beneficial career move. For once I was familiar with the stock and its applications, he told me, “You will be able to talk to doctors and clinical staff in their own language.”

  Mr. Waters had been an army conscript during the era of national service and he often nostalgically referred to those times. We never openly discussed politics but I suspect his views were probably right of centre, as he seemed to yearn for a bygone age when concepts such as ‘character’ and ‘integrity’ were more prevalent. At one time when we were talking he mourned the passing of compulsory national service by stating, “It was the worst bloody thing this bloody country did, getting rid of national service.”

  Victor was my boss for a little over two years and although we never agreed on some issues I can only recall one really severe disagreement with him (and I was most certainly in the wrong in that instance). It was encouraging that he not only appointed me but very overtly supported me as my career at that stage had begun to develop and take shape. Interestingly enough, I had only applied for the post at my local hospital after seeing it advertised in the local newspaper. In a conversation the previous week, my father had indicated to me I should get myself ‘a proper job’. The words were not quite as exact, but it was the gist – the actual quote being along the lines of ‘I think you should be doing something more in line with your abilities’. In fact, I think this sage advice started with, ‘Listen lad…’ When a family patriarch from Yorkshire prefixes a sentence with ‘Listen lad’, it can be very readily and very accurately translated as ‘you had better listen son – and listen pretty damn good’. This had followed a series of rather undemanding jobs whose prime purpose was to fund extended trips to Europe and North America. My dad was concerned that besides having a gap year before they were even invented, the gap had actually escalated to over three years by now and the brakes needed applying.

  So Victor appointed me to a world which was both fascinating and frustrating – a world I have never regretted joining. When I applied for promotion in a different location within the area, he supported me and negotiated with my new manager on the timing of my departure. Victor never told me but I found out at a later time that part of his reference for me had read – ‘He is the sort of young man the health service cannot afford to lose’. Bless you Victor, wherever you are.

  IT’S A WONDERFUL LIFE


  – The Way We Were

  When I first joined the NHS I was a young man. Although I was committed to making a contribution for the good of the cause, at that age fun was something almost taken for granted. Hospitals and healthcare were far different from the delivery of the service today and certainly my first hospital was an enjoyable place to work.

  My first management role was running a medical and surgical store with a supporting staff of four people. In total it provided all the medical and surgical consumables for over 800 beds in three general hospitals, two large long-term care hospitals, a cottage hospital and nearly twenty clinics and health centres. The total population served by these facilities was over a quarter of a million people. By today’s computerised standards, the systems were from the ark – bin cards were used to control stock and if you didn’t quite believe the figures the cards contained, a swift peek at the stock on the shelf would provide the answer. A modern day auditor would have palpitations just thinking about the control systems in place then. The store held several hundred lines of stock – plasters, bandages, albumin sticks, various catheters, syringes and motley other items which I would not have been able to name but made my eyes water just looking at them and their possible application.