buy one get one free

The new database was live, and the office was crammed with people – nurses, nursing co-ordinators, therapists of one sort or another, health care assistants, admin staff, pharmacists, and running around and over them all, a team of floor-walkers, problem solving, straightening things out, or trying to, like a team of super-motivated, superintendent, super-capable ants.

It felt good to get out.

* * *

Mr and Mrs Carter live in a cold little house at the bottom of a steep flight of concrete steps. Mrs Carter opens the door. A tall, grey, anxious woman in tracksuit bottoms and baggy black jumper, she greets me neutrally, as if I’m just the last in a long line of Things That Will Go On Happening.

She turns to walk unsteadily back into the bare sitting room, taking her seat by the heater that has just one bar on.
‘Cold today, isn’t it?’ I say, self-consciously setting up my laptop. ‘By the way. Apologies in advance. We’re using these things today. It’s all pretty new.’
‘Oh?’ she says.
‘God knows if I’ll get it right.’
‘Do your best,’ she says, folding her arms. ‘You can’t do more.’
‘No. That’s good advice. You can worry about these things too much.’
‘Yes,’ she says.

Mr Carter bursts through the door. He’s as tall and grey as his wife, but much more energised, with wavy white hair bursting from under his cap. He has one blue eye and one that’s completely filmed over, which intensifies his blustery bonhomie, somehow, and makes him look like some wild, superannuated robot just back from shopping.

‘Nearly fell over running for the bus,’ he says, dumping the bags, tearing off his cap and throwing it like a frisbee off into the corner. ‘That’ll be the next thing. There’ll be the two of us on your list. Buy one get one free.’

He glares and gapes at me, then strides over to the heater.
‘Let’s have this up,’ he says. ‘We’ll freeze otherwise.’
‘Thanks,’ I say, then tap enter to start the examination.
‘Fancy…’ says Mr Carter, nodding at the laptop, then throwing himself down onto the sofa next to me and pushing his fingers back through his hair. ‘The things you have these days.’
But I’m not sure if I’m on the right screen or not, and for a second I’m tempted to pick it up and throw it into the corner like Mr Carter’s cap.
‘Anyway,’ I say, turning to his wife. ‘Ignore all that. The most important thing is – how are you?’

hive mind

Maybe it would help if we dressed like bees.

A little history.

There’s a big reorganisation, a consolidation of three or four front-line community services that pretty well do the same thing. The reorganisation is aimed at reducing duplication, focusing resources, rationalising cover – and no-one can argue with that. Too many times we’re going out to patients and finding another agency already there, doing the same thing. Or, more worryingly, that a patient hasn’t got the help they need because of a glitch in the lines of communication. Although management knows that after consolidation the caseload will increase, the pros will outweigh the cons, the system will be tightened, efficiencies made, money saved, standards raised.

So far, so good. The pros are strong enough and sensible enough to sign up to.

But then the cons start to huddle-in as the consolidation plays out, and it’s more and more difficult to maintain enthusiasm.

There’s a lag in the provision of the IT needed to back the enlarged caseload. Extemporary changes are made to the existing systems, last-minute, white-knuckle affairs. Spreadsheets metastasise. There are queues for working computers, and the ones that work are noticeably slower.

And then there are the folders. In the middle of the office, three large cabinets of them, cluttered-up floor to ceiling with all those patients currently – and quite literally – on the books. A colour-coded, ragged-spined, wretchedly-administrative version of the Tower of Babel. A Wailing Wall of folders.

‘We should go full Victorian,’ says one of the lead nurses. ‘We should have ledgers up on high desks and write with quills. Have fireplaces burning coal.’ She sighs and folds her arms, waiting for the computer to stop updating. ‘Tall hats and moustaches.’

But beyond the IT deficit and the burgeoning folder problem, the most immediate and obvious result of The Great Consolidation is the overcrowding.

An office that was designed for the comfort of a dozen, an office that could, perhaps, at a pinch, handle twice that, now has to accommodate, at the busiest times of the day, upwards of forty. Plus guests. Plus cleaners.

The office runs from eight till eight. The busiest times are from half seven when the early shift arrives; midday when there’s a crossover, and then three o’clock when everyone heads back for handover. At those three times the office is like the floor of the stock exchange, or worse, a giant beehive, with the centre of it being the folder shelves, that great, comb-like structure containing all the honey – rich in patient intelligence, dripping with detail. And it’s these giant combs of information that the nursing staff principally serve, their arms filled with sheets of paper, correspondences, referrals, new folders (of course); doing their best not to crash into each other as they manoeuvre through the runways and cluttered spaces, turning round, feinting to one side or the other, hurrying this way and that, stopping, excusing-me-ing, laughing, gossiping, carrying on in the way that bee people do when they’re pushed for time and harassed and stressed and making the best of an impossible situation.

‘CAN WE HAVE A LITTLE QUIET IN HERE PLEASE?’ shouts the bee pharmacist, one pad clamped over the phone. ‘I CAN’T HEAR MYSELF THINK’

It would be satisfying and instructive at these busy times to lift the roof of the office clean away, and peer in for a moment, and watch with detached fascination the funny little comings and goings. Is that a dance they’re doing? Is that how they know where the patients are? Maybe after a time, you might be tempted to lean in with your puffer of gas, and smoke them all senseless – harmlessly, of course, just long enough to take out the racks of folders, and put them in a spinner, and extract the gorgeous, lovingly-collected intelligence.

‘Mmm! That’s amazing!’ you might say, admiring what you’d collected, dragging a finger through the observations, the progress notes, the summaries and the charts. ‘You could really make something out of that!’ And then gently replacing the shelving, and sliding the roof back into place, you might sit for awhile on the opposite roof, and breathe quietly, and listen to all the buzzing.

sig