A good friend of mine, a hospital consultant in the NHS, recently underwent his annual staff development review. This involved a lengthy meeting that was halfway between a police interrogation and a psychotherapy session. These days, Big Brother is not only watching you: he is feeling your pain, and touching and feeling you. He wants you to do exactly as he says, but to be happy doing it.
In preparation for the meeting, my friend was sent a 19-page document to tell him how to get the most out of it. This suggested that he obtain a further six documents in preparation for the meeting, among them his hospital trust's "service plan", 24 pages long.
It goes without saying that no human brain can long survive the perusal of documents such as these. Here, for example, are two of the objectives laid down by the service plan:
"To complete the implementation of the new joint management structure and address a number of specific issues arising from the implementation programme.
"Following production of the Strategic Direction Document, to make progress towards the production of a fully costed Strategic Outline Case (and ultimately full Business Case) which reflects 'best practice' and addresses the requirements of the NHSE policy and guidelines."
The document designed to help my friend prepare for the meeting had an appendix entitled Learning Opportunities. This explained to him in detail the various means by which he might learn. It was pointed out, for instance, that "attending a course" involved going to "a short course of tutor lead [sic] group learning, covering one particular skill or group of skills and/or knowledge". "Reading", similarly, meant the use of "text books, professional journals, manuals, policies, procedures, guidance notes".
My friend underwent full-time education and training for upwards of 30 years to arrive at his present position, but the NHS management thinks he needs to be told that reading is a method of learning that involves the use of books. Is it any wonder that Hospital Doctor, a weekly publication sent to all hospital doctors in the NHS, should now be running a series on doctors who have abandoned the profession for occupations such as taxi driver?
Then came the questionnaire, for it is a truth universally acknowledged that no useful information can be had without one. Twelve pages long, there was sufficient space for my consultant friend to spend two hours answering it.
But how does a doctor answer a question such as: "In what way do you contribute to the quality of products?" What does a doctor produce (that is, other than answers to questionnaires)? And why, after many years' employment, should he once again be asked to list his qualifications?
To work as a doctor in the NHS is increasingly to inhabit a novel by Kafka. They must have been talking about you, because every day more centralised instructions arrive to circumscribe your freedom of movement and judgment. They present you with a list of demands, but pretend that it is all part of an exciting, new and better world, in which you must complete "a personal development plan" - all for your own good, of course, because They are only trying to help you. The fact is that until They came along, doctors had no idea what it was they were doing or were supposed to be doing.
What is the ultimate purpose of this constant humiliation and infantilisation of doctors? Why should highly intelligent men and women, with vast experience and knowledge, be addressed in the following condescending fashion? "Finally, take a photocopy of the complete documentation. You should keep one copy. Your manager, supervisor or team leader will place the original in your personal file."
There is no evidence that staff development reviews have helped a single patient to recover, nor is it very likely that they should. But it is hard to escape the conclusion that such insulting bureaucratic procedures have nothing to do with improving "the product", as managers so elegantly put it. Their purpose, rather, seems to be to destroy the morale and independence of doctors, who - despite the best efforts of the government and press - continue to enjoy the esteem of the public, at least by comparison with all other occupational and professional groups. They therefore constitute a potential political danger, and must be destroyed before they turn potential into actuality.