NHS: Clinically Obese

(I wrote this after actually working for the lumbering behemoth that is the NHS. The decision making processes of Europe's largest employer are worryingly not too far off the example below)


Last week the NHS controversially refused itself lifesaving treatment on the grounds that the organisation is clinically obese. The much-debated obesity policy, that has up till now only affected members of the public, was originally intended to act as an incentive for those who have over-eaten to tighten their belts but has now taken on much more serious consequences.
Dr Alexander Simmons, spokesperson for the NHS, attempted to explain the organisation’s position;

“For several years the NHS has run a policy of refusing to help those who do not help themselves. Why on earth should a man who has existed on bean curd for the entirety of his life come second in the queue for heart bypass surgery to a man seemingly addicted to hydrogenated fats? Why should the sober Buddhist play second fiddle to the drunk Irishman in the queue for livers? And why should the Swiss cowgirl who has breathed nothing but mountain fresh air all her life not get treatment for lung cancer when she is trampled in the queue by a horde of wheezing and yellowed nicotine addicts. Its just simple common sense at the end of the day.”

I questioned him further as to why this policy has been extended to the NHS itself;

“Well the government has very much taken the view that the NHS has to help itself before it can be helped by itself. If we are to convert money into food and the NHS into the body of a man, it quite clearly becomes extremely transparently obvious that this man has eaten far too much and done little or no exercise. Consequently, this man has ballooned to quite astronomical proportions.”

I asked how the NHS should help itself;

“Well we must quite clearly and honestly and above all else definitely pledge to eat less and exercise more. Only once we have attained an economically sustainable body mass index (and one must remember that a well paid team of information analysts will come in to play here as we need to make extremely scientific measurements not just pinch the proverbial fat between proverbial forefinger and thumb!), only then will we be able to confidently say that it may well be the right time, approximately but relatively certainly, for the NHS to finally help itself… perhaps with a stomach stapling operation.”

I ask him what a stomach stapling operation may represent.

“Well I suppose, one could make some sort of loosely-linked comparison with job cuts or salary decreases. Perhaps, but only perhaps of course, there may be adjustments, small but large-scale, to pension funds, possibly. But if the NHS, now being described as the body of a man who has eaten too much and run too little, does enough exercise then the job cuts and salary decreases and the potentially possible, yet, if entertained seriously, certain adjustments, here or herewith, to pensions may not need to come about at all, or in some circumstances they may be lessened by a nominal or even substantial degree.”

I ask how the NHS will be expected to lose weight?

“Well obviously, well obvious to the trained eye at the very least or perhaps even that is an extremely obvious statement, obviously people may have to work harder. More efficiently, streamling productivity or somesuch idea so that the overall effect is one of a fat man straining to run a 100 metres in under twenty seconds.”

The spokesperson, turns a subtle shade of pink for a moment and then I ask him, if job cuts are still inevitable after all this exercise, who will be the first to go?

“Well, of course this is a contentious subject, contentious yet strangely palatable when viewed through the correct lens. Of course we value our nurses and our cleaning staff with high esteem but unfortunately it is they who must be the first to go, in some circumstances, though largely and predominantly in all circumstances (with some notable exceptions).”

Why? Why are managers and clerical staff not being considered?

“Another very good question, of course, well obviously to be sacked you need to be sacked by someone who is hierarchically, if not in physical stature, greater than you (of course this isn’t to say that they are a better person although we are unable to not reflect this in their paypacket and the size of their office seat but these are of course trivial items. Especially chairs!). Therefore it would only actually be possible to sack those at the bottom lest we loose a chink in our coil and the whole system comes tumbling down and all we are left with are hardworking, perhaps mythically so, nurses and cleaners. Who would never be able to be sacked under any circumstances as they would, of course, no longer be under the control of a manager. As for clerical staff, well I have only been aware that we employ clerical staff since last week, I thought all my letters were typed by a “PC” not a person but I guess we would be unable to let these people go as managers and doctors would have to either write legibly, or perhaps even in capital letters, or type their own work up, which is obviously quicker in the first place but would leave no room for long-winded phone conversations with understaff detailing exactly what font the letter should be typed in and would, of course loose all the fun of sending documents back and forth covered with an increasing amount of squiggly red pen. So they of course cannot be sacked, especially as they are the only people who know where we get the P45’s from.”

I question the man further about the relevance of bureaucratic work within the NHS.

“Well, it seems to me that at the bottom of all this if someone is sick they need to receive treatment. Bottom line… unless of course they are dead and then of course they’ve got nothing to do with us!”
He lifts his hands up in mock surrender and smiles bashfully while emitting a half-laugh half-spit which wets the lapel of his suit.

“At any rate people certainly come to the NHS to get well and that is an awful lot of people and if all those people were to get in the same queue at once obviously there would be bedlam. So really we need all these people to make sure that the queues or waiting lists, as you may refer to them, are organised fairly and properly. Imagine, persay, that you were at the fairground and you were queuing for a fast ride. There may well be, I am not sure as I have never personally been and therefore cannot vouch for the accuracy of this analogy, some sort of attendant keeping the queue in order. He may perhaps send drunk people and people who are too short for the agreed safety limits to the back of the queue or even out of the queue altogether, if he is particularly good at his job and a man of great resource he will add them to the queue of a ride that would be more suitable to their condition of inebriation or shortness. This man is very much a symbol, here, within this analogy that I am, of course, uncertain as to the actual accuracy of, a symbol of bureaucracy within the NHS. To paraphrase we could say, (I suppose, if I may parenthesis within a paraphrase), that the job, nay worthy occupation of the NHS bureaucrat, or Operational Manager as they are correctly called as bureaucrat is of course anachronous, that the job is really to move short and drunk people from one queue to the um… other.”

James Murray