An NHS Christmas Carol

By Craig Nikolic

Our tale begins with a bitter and unhappy NHS senior manager, wondering about another year where nothing seems to be better, and lots seem to be worse. It's just not Christmassy enough to lift the fog this year either.

And they see no need for anything they do to change.

What's that noise? Is it a ghost? No, it's their phone telling them they're still at OPEL 4 and everyone else is the same.

Another noise? This time it's not. The ghost is grey, formless, with an empty NHS lanyard hanging from its neck. Chained to it are boxes full of unfulfilled promises.

"Who are you?"

"Ask me who I was."

‘Who were you then?’

"I am you, and hundreds like you who've lost their soul to the pragmatism of keeping the NHS alive."

"You are fettered, tell me why?"

"I wear the chain I forged in life, with every compromise, silence of dissent, and unmet promise."

"You will be haunted by Three Spirits. Without their visits, you cannot hope to shun the path I tread. Expect the first tomorrow, when the bell tolls One."

Our manager tried to say "Humbug!" but stopped at the first syllable. Bed called; tomorrow's status reports can wait.

The First of The Three Spirits

The clock struck ONE. "The hour itself, and nothing else!"

Light flashed up in the room. It was a strange figure, like a child: yet not so like a child as someone older. It had a patient bracelet around its arm and an aura of failed care.

"Are you the Spirit whose coming was foretold to me?"

"I am the Ghost of NHS Past. Rise. and walk with me."

As the words were spoken, they passed into a university lecture theatre.

"This is my uni! That's me! I remember thinking that hair my was cool!"

Young manager: "Did you read about that NHS scandal in the news? I'm going to save the NHS."

Past: "I won't be like those senior people who look away, hide things, and fail patients repeatedly!"

(Fade)

A run-down hospital, our young manager recognises their first job after uni, "It was hard here, but our boss made it easy, and happy, old Fezziwig. He was just too nice for the NHS."

"A small matter," said the Ghost, "to make folks so full of gratitude."

"It isn’t that, Spirit. He has the power to render us happy or unhappy; to make our service light or burdensome; a pleasure or a toil. The happiness he gives, is quite as great as if it cost a fortune."

(Fade)

Our manager sees their first budget review as a junior manager.

"Spirit, show me no more. Conduct me home. Why do you delight to torture me."

(Our manager in the past) "Boss, how can you do this? You can't cut the budget and still want the same outcomes; it doesn't work like that."

Their past boss: "You need to learn to be pragmatic, take the least worst decision, you'll not last without that."

"He was right, you know, pragmatism is everything in austerity."

The Spirit looks at our manager with a tearful eye for promise lost. "I can do no more.", and fades into night.

The Second of The Three Spirits

(Fade back home)

Our manager's room had undergone a festive transformation. And not an NHS "transformation".

"Come in." exclaimed the Ghost. "Come in and know me better."

"I am the Ghost of NHS Present.", a Spirit who looked like every NHS era Health Secretary at once, Bevan to Streeting.

"You have never seen my like before." exclaimed the Spirit.

"I am afraid I have not. Have you had many siblings, Spirit?"

"More than thirty-five."

"Spirit, conduct me where you will. Last night was compulsion, and I saw who I once was. If you have aught to teach me, let me profit by it."

"Touch my robe."

(Fade)

We're now at a typical NHS hospital in December. Patients waiting in ED corridors, staff can't get anyone to take patients ready for discharge, and so many people off with respiratory illnesses.

But people still care, and provide that care with love.

(Scene is our manager's office a week ago, briefing junior managers)

"We're in severe deficit and it must be reduced or removed entirely. That means cuts, and I want you to give me 10% cuts to your staff budget by the end of the day. We'll tell them Christmas Eve to get the consultation done."

Junior, "On Christmas Eve? You could have let them have their holiday."

Manager to Spirit, "They had to be given notice to be out by end March for the new financial year. Make sure the redundancy costs accrue in this one."

The Spirit asked, "Have you no soul, no compassion for the impact?"

(Fade to a nurse's house)

"I know her! She's a staff nurse!"

Scene: Nurse looking at a table full of bills, rent increase next to a rent demand, a fuel bill increase notice, food bills beyond any honest comprehension.

But a festive scene with happy children playing near a Christmas tree.

Nurse: "I can't do this anymore on my salary, I need to take some bank shifts to cover them."

Friend: "Haven't they cut those, and the rate?"

Nurse: "They put out a briefing about how proud they were of cutting them. I don't know what to do," as she wipes a tear to hide from the children.

(Fade to a ward on Christmas Eve)

Staff overworked to breaking, with estates and equipment often worse. But they have Christmas joy among themselves, happy, spreading festive cheer to their colleagues and to their patients.

Our manager, "See, Spirit, they're happy! Why bring me here?"

Spirit turns a contemptuous gaze and says, "They're happy because they're kind, decent people who you and your like have abused and starved of any duty of care for years. You abuse their professionalism to keep them at work, playing the 'but think of the patients' card to guilt them."

The Spirit continues with frustration, "you play with fantasy finances, sign up to budgets you know are meaningless, nod along to briefings from your peers about how you have to improve efficiency to save the NHS, yet you give no care for these people", waving his hand towards the ward staff.

"There are some upon this earth of yours who lay claim to know us, and who do their deeds of passion, pride, ill-will, hatred, envy, bigotry, and selfishness in our name, who are as strange to us and all our kith and kin, as if they had never lived."

Our manager avoids the Spirit's gaze.

Our manager asked, "Forgive me if I am not justified in what I ask", looking intently at the Spirit’s robe, "but I see something strange, and not belonging to yourself, protruding from your skirts. Is it a foot or a claw?"

The Spirit opened his robe. They were a boy and a girl.

"Spirit, are they yours?"

"They are Man’s," said the Spirit, looking down upon them.

"This boy is Ignorance. This girl is Want. Beware them both, and all of their degree, but most of all beware this boy, for on his brow I see that written which is Doom, unless the writing be erased."

"Deny it." cried the Spirit, stretching out its hand towards the hospital. "Slander those who tell it ye. Admit it for your factious purposes, and make it worse. And abide the end."

"Have they no refuge or resource?" asked our manager.

"Can't you just transform them?", spat back the Spirit.

(Fade to fog and nothing else)

The Last of The Spirits

The clock struck the hour, our manager remembered the prediction of the first spirit, and lifting up his eyes, beheld a solemn Phantom, draped and hooded, coming, like a mist along the ground, towards him.

The Phantom slowly, gravely, silently approached.

It was shrouded in a deep black garment, which concealed its head, its face, its form, and left nothing of it visible save one outstretched hand with the same patient ID bracelet as the Spirit of Christmas Past.

"I am in the presence of the Ghost of the NHS Yet To Come.’ said our manager.

The Spirit answered not, but pointed onward with its hand.

"Ghost of the Future, I fear you more than any spectre I have seen. But as I know your purpose is to do me good, I am prepared to bear you company, and do it with a thankful heart. Will you not speak to me?"

"Lead on." said our manager. "Lead on. The night is waning fast, and it is precious time to me, I know. Lead on, Spirit."

(Fade to an anonymous grey state office building)

The Spirit stopped beside one little knot of people with NHS lanyards, all with senior roles on the ID cards.

"No," said one, ”I don’t know much about it, either way. I only know they're gone. Shuffled sideways to another Trust and everyone given an NDA."

"Are we getting a sideways shuffled replacement? Or is it someone good this time? I know they won't promote anyone from within."

(Fade to a dark future, a new government in place, a bitter, angry one, new to power)

"Spirit, I know that one on the stage about to speak! Learnt all they knew from me"

Future Executive: "We'll be transitioning to a new world of insurance-funded care, billing, and diverting unviable patients."

"Spirit, we were promised it would never happen! They swore to us!"

The Spirit points at a sign that says "You must remain politically neutral at all times."

"I understand you," our manager returned, "and I would do it, if I could. But I have not the power, Spirit. I have not the power."

"No more Spirit, no more. I can do no more, if I did more, I would be replaced, and my replacement would not have patients in mind at all. It would be worse. I do what I can. I DO WHAT I CAN!"

The Spirit inclines its head and simply points to a foggy iron wrought gate.

A churchyard.

The Spirit stood among the graves, and pointed to them one at a time, with them spreading into the distance.

"Before I draw nearer", said our manager, "answer me one question. Are these the shadows of the things that WILL be, or are they shadows of things that MAY be, only?’

Still The Ghost pointed to grave after grave.

"People's courses will foreshadow certain ends, to which, if persevered in, they must lead," said our manager. "But if the courses be departed from, the ends will change. Say it is thus with what you show me."

The Spirit was immovable as ever.

Our manager crept towards the graves, trembling; following the finger, read upon the stone of the first neglected grave the name, "Prevention of Future Deaths Report".

The next, "Inquest finds patient neglect".

The third, "Referral rejected".

The fourth, "Service closed for CIP efficiency"

The finger pointed to the graves and back again.

"No, Spirit. Oh no, no."

The finger still was there.

"Spirit." they cried, tight clutching at its robe, "hear me. I am not who I was. I will not be the person I must have been but for this intercourse. Why show me this, if I am past all hope?"

"Good Spirit," they pursued, as down upon the ground they fell before it:

"Your nature intercedes for me, and pities me. Assure me that I yet may change these shadows you have shown me, by an altered life."

"I will honour the NHS in my heart, and try to keep it all the year. I will live in the Past, the Present, and the Future.

"The Spirits of all Three shall strive within me. I will not shut out the lessons that they teach.

"Oh, tell me I may sponge away the writing on these stones."

Holding up their hands in a last prayer to have their fate reversed, they saw an alteration in The Spirit. It shrank and dwindled down into a bedpost.

Yes! and the bed was their own, the room was their own. Best and happiest of all, the time before them was their own, to make amends in!

The End of It

Narrator comment: We won't finish the story. How your story ends is entirely up to you.

You won't have the privilege of three Spirits to show you how you'll end your career. Only you can do that.

A Merry Christmas to us all, my dears.

________________________________________________________

P.S. this isn't aimed at anyone in particular, but it does strike me as very much needed.

I am, by nature, a pragmatist, and I want to make things work, but if you do it by sacrificing patient care, or the people who work for you, why are you even in the NHS? I don't understand you.