The Jaded Jedi

Journal and General Musings

Day 40 in the corona house: Don’t clap for me, I’m a cleaner.

17/04/2020

Earlier in this series of quarantine posts, I mentioned that I have a tendency to question accepted wisdom. Some see this as being naturally contrarian, others as being a desire to tilt at windmills.

I hope it’s not default contrarianism and I don’t intentionally tilt at windmills, though I accept it may appear as such to others. There are two fundamental ‘triggers’ for me. The first is a disbelief in holy cows. I can’t think of any body or organisation that is above question or challenge. Secondly, it’s all too easy to accept a universal truth that is so widely held that it must be true (mustn’t it?). After all there’s no need to actually think about or question something that people have always thought was true is there? Down that road leads lazy thinking, herd mentality and action without thought – just because it’s what everyone else is doing.

I prefer to remain open minded about what I’m told, to form my own opinion about what I believe and think. That doesn’t make me right, nor does it mean I won’t land in the same place as everyone else, but it does mean I’ll have thought about how I landed there.
If that all sounds just too weird to you and that degree of questioning seems abnormally and unnecessarily independent then I suggest moving to the next blog or post because it’s going to be a rocky road from this point.

Declaring a starting point

I did say that I don’t believe in sacred cows. However, this cow is so sacred at least in the UK that I have to start by declaring my starting position.

You’ll forgive the shorthand I hope, but for clarity, I believe in the National Health Service as a means of providing very good health care free at the point of use. I don’t support an insurance based system such as is found in the United States equally, I don’t have a problem with those who wish to insure themselves privately. I believe the service provides (on the whole) a good to very good level of medical care and is exceptional in some areas. I believe it is underfunded and staff are undervalued. I also believe it’s overly beurocratic, hasn’t adopted technology well in terms of the experience for many patients and its governance is broken resulting in post-code variations in the use or treatment of various conditions. As to privatisation, I wouldn’t want to see that, but it depends as always on what you mean by privatisation. I would be strongly against front line services or patient facing services being routinely delivered under a different model. I’m more relaxed about some of the ancilliary and administrative functions.

That done, I can now ask the impossible question. Am I the only person who find the scheduled clapping for the NHS a bit naff?

I took place in the first week without giving it too much pause for thought. Some of the events of the following week then started to give me some reservations though I did still join in on week two. Yesterday, I didn’t partake in the mass clapping as it had started to feel rather contrived and in my view risks being counter productive.

That doesn’t mean others shouldn’t partake, nor does it mean that I’m not supportive of or thankful to those working in the NHS. I recognise significant confusion and deficiencies over the provision of adequate personal protective equipment in sufficient numbers. Similar issues exist for maintaining their supply once initial supplied had been provided. I share the view that doctors and nurses should have appropriate equipment and supplies when dealing with patients who may present an immediate and significant risk to their safety and ultimately their life. However, the NHS isn’t alone in this regard. Some of this is language and I’ll return to that shortly, but some of my concern is also the fact the whole idea is feeding a different need to that publicised in the setup.

In the poster above I was struck by the words ‘during these unprecedented times, they need to know we are grateful’. I always twitch slightly with a setup assertion – or put another way, who are ‘they’ and who say’s they need to to know we are grateful. A friend of a friend put it even more directly with the question ‘when did the NHS get so needy?’

An early clap for the NHS poster

To answer his question, I don’t think it ever has been needy in this way. I don’t believe there has ever been any doubt that the public are grateful. I do also have a slight problem with the qualification that it’s important at this time – why is that there ?
In answering that question we hit the core difficulty I have. I can’t believe the poster means it’s important now but not before or once the crisis is over, although that’s what it says. My suggestion is that this has less to do with the needs of the NHS staff and more to do with the needs of the poster producer(s) and us the wider public. We are broadly powerless in the face of the virus, could it be that these communal rounds of applause are more to do with assuaging that concern than in providing needed reassurance to those in the NHS. If so, that’s fine but it does rather change the nature of the event.

Now to the language concerns I mentioned a little earlier. Looking at three posters all for the same events but sending very different and mixed messages.

The first poster refers to our NHS carers. As stated earlier I recognise the service and risks being taken by medical staff in our accident and emergency and hospital wards. They are doing a marvellous job, but a job they chose and presumably knew that this may involve some risk. Those working in infectious disease units know there is an increased risk of contracting an infectious disease. I don’t mean to imply the current risk profile comes with the territory, it is clearly disfunctional and poorly supplied, but we do risk overstating the nurses as angels line. They have chosen a vocation with risk just as a police officer, prison officer or soldier does.
So the first poster wishes to thank those in the NHS, this excludes the entirity of the social care providers, those providing the same services in nursing and care homes, home workers and local authority or private care givers, hospice and many charity workers, none of whom are NHS staff. That hardly seems fair given that these people with equal compassion and commitment are taking similar or exactly the same risks.

The second poster is even less inclusive just focused on those within the NHS who work in hospitals – forget the GP’s, district nurses, health workers and visitors etc. The last is arguably even less inclusive focused on NHS front-line workers (admin, finance, porters, technicians are apparently not to be included).
I’m not being totally serious with these distinctions as I’m sure all three posters mean well – but my point still stand. Actions taken in haste may be taken in good faith but can still cause some to feel excluded and undervalued which I don’t think is helpful in the current circumstances.

Finally, did anyone think through the messaging before going to press – clap for the NHS ? As a wag of my acquaintance said ‘I think they’ve got enough on their plates haven’t they?’ Also, look at the splendid social distancing apparent in the second of the three posters above. Is that a poorly chosed picture, do the staff think it doesn’t apply to them or did the producer just not spot that it wasn’t reinforcing the social distancing theme?

For the last two weeks, on Thursdays at 8pm we have had a series of non socially-distanced gatherings that would in any other circumstance be broken up and potentially tickets issued to those taking part.

The three photographs above from three different areas of the country show the new weekly meeting outside hospitals of the local emergency services. If you blow up the photos you’ll see none are maintaining 2m distance, very few have masks on and all have and will be engaging with the public including the most vulnerable in their communities. These gathering lasted between 5 and 15 minutes on average, some longer. More than enough time for the further transmission of the virus.

It’s fairly reasonable to assume NHS staff have been in contact with active cases, similarly for paramedics and police officers. Let’s assume there are 2-3 infected people in these groups. The risk is the emergency services become the means by which this spreads further.

In many cases we see all three emergency services meeting up to mark the 8pm event. I wonder why?
If the purpose of the 8pm event is for the public to thank those on whom they depend that’s one thing, but it need not turn into a mutual appreciation event however well intentioned. This strikes me as being indicative of people seeing themselves as outside of the active bubble. Police are policing those in the bubble, paramedics assist those in the bubble etc. All need to understand they are in the same bubble and are not external to it. This behaviour is not helpful.

Today, I was listening to the Health and Social Care Sectretary giving evidence to a Parliamentary Select Committee. In that hearing, we heard a call for something similar to the clapping for NHS worksers but to include local authority workers, environmental health and trading standards officers. This event is achieving (or risks achieveing) exactly the opposite of its stated aims. It is building division, reinforcing a special and reserved space for the NHS based as much as anything on political dogma at the expense of those doing broadly similar work elsewhere.

I’m not usually a fan of reductio ad absurdum, but in this case it’s potentially helpful.

As I mentioned, I respect and will defend medical professionals and those who choose to nurse, but that doesn’t automatically confer angelic status. If it did, where would this chain of righteousness end?

Jane (for the purposes of debate) is a nurse and therefore automatically an angel for working at risk. Does Ian the Uber driver who ferried her from home to the hospital gain any angelic quality for enabling her to undertake her duties? Is the food delivery driver from a local farm shop angelic for keeping some of the medical staff in food and household goods? Is the Amazon driver who delivered the 3D printed mask angelic or a hero for making this delivery? If he is a hero, would he or she have been equally heroic if he or she had delivered something purely frivolous to Jane’s address. Is the local community pharmacist to be praised for dealing with two customers preventing them from otherwise ending up in Jane’s A and E unit.

The more we think of it, the more interdependant we are. To single one sector out is logically inconsistent and although it may assist with morale it comes with costs both in terms of inclusivity, mutual respect and further virus transmission. Of course everyone remains entirely free to join in if it helps them cope with the situation – but for me it’s started to feel more like those Chrsitmas party games that must be participated in or you’re not enjoying yourself (as defined by the host).
I thank all those making life more bearable, putting themselves at risk, undertaking their jobs in extremely challenging circumstances and working to keep people safe, well and enjoying a good quality of life. That applies to all those within the NHS and those outside of this important and amazing organisation from delivery drivers to retailers, care workers and those caring for others at home.

Today’s post takes its name from a mangled version of Don’t cry for me Argentina. For those who like to hear the tracks, it may be heard on the player below

Don’t cry for me Argentina – Julie Covington (from Evita)

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