History matters

The PCT decided it was going to build a new Child Development Centre on our cottage hospital site in Erith. The outpatient consultants got wind of the plan. It required demolition of the existing 1960s department (which instantly raised questions about where outpatients might be seen during the rebuilding, as spare capacity in the DGH was non-existent).

However the proposal also demanded the demolition of the X-ray department. This is opened yearly under the London Open House scheme which allows public access to interesting buildings that are usually inaccessible; the department is housed in the only surviving underground hospital in the UK built in case of major attack from the air and was completed just before the outbreak of the Second World War.

Those planning its demolition were unaware of its significance. I assumed that it was a listed building, which would have knocked the whole plan on the head (car park spaces sufficient for the new proposal could not be provided without flattening it). I did some homework, and found it wasn’t. So I asked the Department of Culture, Media and Sport (once known as the Department of the Environment), by way of a detailed submission, which ran to a dozen or so pages, with pictures, to spot-list it.

It did. Curiously the CDC planners, once hell-bent on destruction, suddenly became enthused by this historic building they now had to care for and cherish.

But a sense of history is important – likewise joined-up thinking. Some while earlier a proposal to consolidate three Bromley hospitals picked a site on Green Belt land. The outline plan cost about £8m. Perhaps unsurprisingly (for it appeared that no-one had thought to run it past the DoE as it then was) that department turned it down.

When my rehab unit was being constructed there was a delay, as the builders struck water unexpectedly while digging out the foundations. Ah, I said, that’s because you are building over the old ice pond that belonged to the big house in whose grounds the hospital sat. They knew I had the estate plans in the archives, but nobody thought to consult them.

In all of these cases you might detect a sense of schadenfreude on my part. However each one underlines the fact that doctors are trained in analysis and if their analysis is better than anyone else’s then they will win. It is likely to be the case in many such instances (I confess the planning rules are well-known to me because my wife and I are serial NIMBYs who have objected to numerous planning applications near our various houses – not all of which we have won). But the principles are – know your facts, rely on your experience, look for every possible fault and consequence of any particular action and think not about what is necessarily best, but what is least bad.

There may be some managers reading this. I have met many good ones, though too many of those have become disillusioned by the constraints and bureaucracy and have left. But there is a rule for you, too. By all means pursue a firm agenda, be it related to service change, cost or political direction. But do not under any circumstances forget that if you do not carry your troops along with you, then you are lost. Too many plans and diktats are imposed without proper consultation and those who feel they should have been consulted will be those who will try to undermine you and even bring you down. Doctors, particularly consultants in the hospital setting, have longevity. Although there is increasing mobility many consultants will stay for 20-30 years. Managers, in comparison, are here today and gone tomorrow. You may resent the inertia of such a system but the only way to change things is to ensure that no-one will feel excluded from the decision-making (or worse, come up with an immutable reason for no change). So. Consult. Then, if you must, make the decision you were going to make anyway.

Now I am out of it all I can let you into a secret I was entrusted with by a friend. I was always impressed when, in meetings, he would preface a plan by saying “I have consulted with a number of people”. How thorough, I thought. Then one day he came out with a comment about something that would have involved him consulting me, but he hadn’t. After the meeting I asked who he had consulted. He winked. “Andrew” he said “zero is a number”.

As a corollary to this, sometimes you can achieve results by frightening people. Write a letter, and cc various influential folk (Chairmen, MPs and the like). There’s no need to send the copies.

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