Tuesday, 1 March 2016

This Crazy World

In popular film culture, the character that spends their entire time being mean to people ALWAYS gets their comeuppance. Think Darth Vadar, Hans Gruber (Die Hard), Gordon Gecko (Wall St), Ivan Drago (Rocky IV) Alex DeLarge (A Clockwork Orange). Crickey, even Tony DeVito got found out for being too bad in a world of bad men in Goodfellas.

Not all of life is represented in popular movies, but there is a sense of natural justice, even benign schadenfreude when these bad guys get taken down. Who didn't enjoy it when Biff finally got punched in the face in Back to the Future? There is almost a narrative imperative that their misdemeanours come home to roost - it just wouldn't be right for them to get away with it. How did you feel when Kevin Spacey posted Gwyneth Paltrow's head to Brad Pitt in Seven? It was dramatic, but it wasn't right.

This fantasy of movie justice has played over in my mind over the last week, as I have witnessed numerous counts of meanness in the popular press. From the imposition of the junior doctor contract, to the shameful hectoring at PMQs (http://www.bbc.co.uk/programmes/b071xc9z) and onwards to swapping of personal insults instead of open debate about the EU referendum. It is in this crazy, mean world that Donald Trump looks like he will get the Republican nomination. Who was the last person to be elected on the mandate to build a bloody great wall, on a ticket of isolationism? Where's the narrative justice?

Was it ever thus, or are we stuck in a rut, unable to remember the benefits of being polite to each other? Is it arrogance, certainty or chutzpah that leads our political leaders to focus discussion around personal inadequacy rather than principle, ideology or ethics? You've got to be pretty confident about yourself when you make a point predicated on the failings of your opposition.

There is the sense that it will get worse before it gets better. Who knows how the refugee situation will play out. Yet in the world of faux-ideology, those leading the charge will try to persuade you that they are on an ideological mission: the 7 day NHS, the recession-proof economy, the elimination of poverty, and the enhancement of social mobility.

I have no doubt that there is ideology involved, and that I can live with. What I find increasingly difficult to stomach is the sense that we are seeing the implementation of an ideology that many people did not know they were voting for.

Is this culture of austerity, ruthless budgetary restraint, European entrenchment what we wanted? Do we feel it is OK to wring as much 'productivity' from hard-working staff as long as it isn't us who is being wrung?

I can't help the feeling that I might be up next. As the terms of the new proposed consultant contract become public, I start to imagine a different future. I don't yet know all the details, but my initial feeling is that it asks a lot of doctors to accept a less bright future, and to start to wonder whether they might be better off working somewhere else, or putting discretionary efforts they currently put into their own services into something else, which allows them to bring home a little extra cash.

Of course, this may be one of the ideological drivers behind the contract: by undermining the motivation of those who work in the NHS to continue working in the NHS, alternative forms of healthcare provision become unavoidable. Increasingly it is difficult to ignore the emerging narrative that the general direction of travel is to take the comprehensive out of the comprehensive health care provided by the NHS.

As someone who has spent the last two and a half years working to provide comprehensive, integrated care to elderly patients at home, this is something of a blow. And I don't know yet whether I am supposed to rage against it, or simply get on with making the best of a bad situation.

I might be prepared to go along with it if I felt that the plan had been implemented on the back of good communication, respectful collaboration and expertise, but I can't see any of those things anywhere I look. I keep hoping for my narrative justice, but suspect this isn't Back to the Future - it's Seven, and I'm just going to have to find my peace with it, or find something else to get my teeth into.

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