One of the best managers I’ve worked for used to allocate an hour per day for informal thinking and reflection – sometimes he did it alone while other times he chewed the fat with his colleagues in a completely unstructured way. During my professional career, I’ve seen and heard many people confuse activity with productivity. Further, a friend who works in a managerial capacity in the education sector told me that, at the onset of the lockdown, his boss immediately organised seven hours of Zoom calls for his team. That’s not seven hours in total – that’s seven hours every, single, day. He didn’t allow any time for pre-meeting preparation or post-meeting execution – let alone time to think and reflect. The boss, who is the CEO, clearly doesn’t trust his team to do the right thing. Unsurprisingly, his team doesn’t feel comfortable and they are exhausted from being in an artificial meeting environment almost all day, every day.
It will take a while to paint an accurate picture – but, perhaps in a year’s time, we’ll be able to look back and say who had a good or a bad lockdown. The phrase “(s)he had a good war” is little heard nowadays, however, it was commonplace when I was growing up. The example I remember best is Denis Healey, who was Chancellor of the Exchequer and a potential prime minister during the tumultuous mid-seventies. At the beginning of the Second World War, he was a lowly gunner and five years later left the army as a major with an MBE. He was decorated for his bravery for being in charge of the Allied beach landing at Anzio, Italy. And he spoke fluent Italian due to a number of local girlfriends… By most interpretations, he had a good war!
I’ve been keeping a diary since the pandemic first emerged. The most often-cited issue is the NHS. Has it had a good war? My view is that it’s a nuanced answer. With 1.4 million staff and an annual budget of £130 billion it really can’t be looked at as a single cohesive entity. It consumes about 10% of our national GDP. No other entity, public or private sector, comes remotely close.
Some elements of the NHS are in the “could do better” category. NHS logistics failed in the early stages of the pandemic, the provision of PPE was chaotic and it certainly didn’t communicate effectively. At the 2019 General Election, Comrade Corbyn tried to scare us into thinking that the NHS would be sold to US firms. Thankfully, the public wasn’t fooled by this nonsense – but, it does raise the issue of whether it’s an unwelcome idea. Who would you prefer to run the NHS supply chain: NHS bureaucrats with limited international capability and no plan for a pandemic or global logistics wizards with state-of-the-art technology at Amazon? Don’t get me started about NHSX – did they really think they are better at developing apps than Apple or Google? The heroic efforts of our hospital doctors and nurses can’t be allowed to bury these issues.
We are closest to GP services. A recent claim by Telegraph columnist Allison Pearson – that GP surgeries may not re-open until March 2021 – prompted a flurry of responses from doctors who claim to be working just “normally”. NHS England medical director for primary care, Dr Nikki Kanani, said: “General practice is open and has been throughout the pandemic. Whilst consultations may have been offered remotely or virtually to keep patients and staff safe, our practices have been open and offering care.” This is not my experience.
I’m 58 and consider myself fairly digitally savvy. I’m completely OK with telephone and video consultations. For me, in most circumstances, they’re better than face-to-face meetings. I also have a number of close relatives in their eighties with chronic long-term conditions. Most of these people have trouble operating a TV remote control – let alone a WhatsApp video-call on a smartphone. Very few of them actually own or have access to a smartphone! Many have some level of hearing loss, which an aid doesn’t appear to compensate for on the telephone.
Not all old people are technophobes, however it is a prevalent issue. I know old folks who still think the phone is really only for emergencies. A story on the BBC PM show recently highlighted that some old people still prefer to make calls in the afternoon because it’s cheaper than in the morning. (Note for younger readers: this used to be true in the 1980’s). One elderly chap said he only switches on his mobile phone when he wants to make a call.
GP surgeries closed their doors in mid-March and have only recently started a cautious re-opening programme. Before Covid-19 there were about 26 million GP appointments per month. If you’re elderly the only way you know how to communicate with a doctor is by meeting them in-person. When you meet a doctor, they will routinely assess your body language, your pallor and your general demeanour. How can they do this over the phone? Doctors are expert at listening to what you say and reading between the lines. Many of my elderly relatives will be more honest in the privacy of a doctor’s consultation room than in their own home. They are not accustomed to intimate, private conversations via telephone. The conversation is likely to be a lot more stilted and therefore less productive.
Speaking recently at a meeting of the Royal College of Physicians, Health Secretary Matt Hancock said: ‘From now on, all consultations should be tele-consultations unless there’s a compelling clinical reason not to’. My local GP website says: “You cannot book a face to face GP appointment. Following telephone consultation you may be asked by the GP to attend.” Only 10% of consultations now physically take place. This is a radical change – and hasn’t been properly justified, as far as I can tell. Plus, how much consultation on the issue has been conducted?
Medical professionals need to be protected – but, at what cost? My local authority has an infection rate (in the week to August 21) of 2.1 per 100,000 people. That equated to two people … The physical closure of GP surgeries may have been sensible at the peak of the pandemic, however things have moved on, surely? The medical establishment is very good at pumping out statistics about the number of virtual consultations it’s done. But, have they measured the effectiveness and patient satisfaction recently? It would be good to know. Perhaps it’s time they both thought and reflected.
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