Flash Parks

Some time ago there was a fashion, or a flashion perhaps, for flash mobbing.  Wikipedia’s current definition says: “A  is a large group of people who assemble suddenly in a public place, perform an unusual action for a brief period of time, then quickly disperse.”

The other day I took a trip from Settle to Carlisle, and when we got there, we found what I can only describe as a flash municipal park.

The plants were orderly and very very plentiful and

so healthy and cheap that the one I was with had to remind me just how difficult it would be to wrestle them on and off the train.  Otherwise I’d have flashed my cash and bought half the pavement.

The good, the bad and the ugly - part 3

Having been off work for a week, I’ve forgotten what it was like.  Here are a few of the folks I’m going back to.  But I’m not of course.  These are figments of my imagination, and all similarities to individuals living or deadly are entirely coincidental.

The graduate

One word. Plastics. The Graduate gets it. Instantly. He’s used to being the brightest person in the room, and is frustrated by what he sees as stupidity, arrogance and bullshit all around him. Everywhere. All the time. The fascinating thing about working with the Graduate is how someone so bright can be so stupid. The Graduate fails to contextualise his knowledge and he cannot read between lines or see shades of grey. He has no concept of experience, and dismisses other peoples’ caution as stupidity. He’s vastly impressed by himself, and is in denial about the fact that no-one else is. Female Graduates tend to be very pretty, and the brighter ones end up either as super-bitches or netball players.

The super-bitch

This woman has balls of steel. She delivers the goods and does not care who or what gets in the way. She’s Ms Perfection, so she’s physically attractive in photographs. In person, the combination of perfection and focus can be  off-putting. You’d rather not imagine her having sex: the thought is frankly frightening. On the other hand, if you do hear her talking to her beloved on the phone she often sounds like a completely different human being. Make that “like a human being”. She’s nowhere near as resentful of men as the Netball Player. Why bother? She’s overtaking them effortlessly anyway.

The dull boy

All work and no play makes Jack a dull boy. He’s probably a really nice bloke, and if he’s senior enough to send out updates to entire mailing lists then he’ll be all laddish and matey and finish up with a comment on the football. The thing is, he’s not a lad and you’re certainly not his mate. In his world, work’s for work, home’s for home, friends and colleagues never mix.  This ability to compartmentalise means that he’s may well run a discreet mistress for years, though whether he bores the pants off her or charms them off varies from dull boy to dull boy. At work, though, he shows no sense of humour. He doesn’t see why thanking people or upbraiding them in public is any different from doing so in private. He’s effective at what he does, but comes across as a teutonic version of Mr Spock.

Unsung National Treasures - 4 - The National Plant Collections

The National Plant Collections are what they say on the tin, collections established “to conserve, document, promote and make available Britain and Ireland’s rich biodiversity of garden plants”.   “Why bother?” you ask.  Well plants can disappear surprisingly quickly because gardeners, like the rest of us, follow the whims of fashion.  The range and variety of plants available to the casual gardener has been drastically reduced by the supermarkets and DIY stores, even though they have made their limited stock so widely accessible, because they have destroyed our independent nurseries as much as they have destroyed our independent grocers.  It’s not just historical plants: who’d have thought that a plant that was widely popular only 40 years ago could have disappeared?  However “the shasta daisy ‘Fiona Coghill’ was thought to be lost from cultivation. The Collection Holder, Lady Hagart-Alexander … discovered that Reg Maxwell … still held a plant. He had received it from Philip Woods, who was in charge of propagating ‘Fiona Coghill’ when it was first marketed in 1968. … the plant you can buy today is exactly the same as the popular plant in the late 1960s.”

This is not a matter of vague good intentions and a romantically English blend of aristos and plantsmen.  It is about botany, as much as it’s about anything and each National Collection is “as complete a representation of a genus or section of a genus as possible” and the National Collection Holders undertake to “document, develop and preserve a comprehensive collection of one group of plants in trust for the future”.

So where do you go to see them, these catalogued collections of plants? These are the gardening equivalent of the British National Library or the cellars of the Victoria and Albert Museum, and you’d think that the National Plant Collections would be held at Kew or Wisley, but in fact they are held on allotments and back gardens, in large estates and municipal parks.  Almost half the collections are in private ownership, and others are held by councils, commercial growers and universities.  I don’t know about you, but I find the robust practicality of accepting the help offered by dedicated individuals over creating something flashy and unsuportable from scratch to be surprisingly  moving. It is confirmation that all you need to do to make a difference in this world is roll up your sleeves, pull on your wellies, and - well - make a difference.  This is what gardening geeks do for fun: think of it as our national gardening wiki.

If you fancy taking it on, then there is still much to be done, and the The National Council for the Conservation of Plants and Gardens publishes a list of missing genera.  Be warned, though, that holding a National Plant Collection is no sinecure, and Collection Holders have to document their plants and work with others to ensure that their collection can withstand whatever disasters might occur: “Oak trees need space and it may not be practical to hold a full back up collection, however, Lathyrus spend the winter as seed in the fridge. Collection Holders must propagate their plants so that if an oak tree is hit by lightning, or the fridge fails, the plants are not lost from the collection (and possibly horticulture) forever.”

The National Council for the Conservation of Plants and Gardens is a surprisingly new organisation, being founded as a registered charity in 1978 as an independent offspring of the Royal Horticultural Society.  This contrasts with the many batty British conservation and social campaign groups which were founded between the two world wars or during the outburst of change at the end of the 19th century.  This blend of amateurs and professionals combining their expertise into a national force to be reckoned with is, however, quietly and quintessentially English.

Ladies and gentlemen, I give you the allotments and cold-frames, the gardens and parks, the aristocrats and nurserymen, the plastic labels and extensive database that form the National Plant Collections.

A patients’ guide to Modernising Medical Careers - Volume II - in which we lobby parliament

It was cold on Tuesday, but at least it wasn’t raining.  The turnout for the Remedy Mass Lobby of parliament was pitifully small.  Rota swaps make it hard to get to London during the week and you can’t lobby MPs at the weekend, but the truth is that our doctors are punch drunk and have lost much of the will to fight.  So there weren’t many of us, though a lot of us had come a long way, and we did get questions asked in parliament as a result of our efforts.

Then the few of us who where there faced the problem of educating our MPs in the issue before we could ask them to help, and it is so complicated and unbelievable that there is no simple way to explain it.

The long and the short is that there is already inadequate cover on the wards - our wards, where your mother’s recovering from a fall, where my father-in-law has pneumonia, where your sister has breast-cancer, where your daughter’s having a baby - and this inadequate cover is a direct result of the restrictions placed on doctors’ choices by the government policy called “Modernising Medical Careers”.

There are thousands of unemployed doctors, and thousands of unfilled jobs - what’s the problem?

Ah.  This is government sleight of hand: they are encouraging you to confuse “jobs” with “careers”.  There is now a two-layer career structure for doctors in hospitals, with generalist posts providing ward-cover and specialist posts including training and career progression.  Doctors who want to be generalist and do the same thing year after year become GPs, work normal hours and don’t risk being sued for misunderstandings or mistakes.  You see, surgeons and specialist medics tend to be an ambitious lot, thank goodness, or we would have no Consultants and Registrars at all.  Doctors who are drawn to the more competitive paths of surgery or specialised medicine are - duh - more competitive, they are turned off by being told that they can never, ever, progress beyond where they are at the age of 28.  Do you want to be treated by a depressed and demotivated doctor?  No, neither do I.

Yes, this is a caring profession.  Yes, they have £30 grand’s worth of debt to repay and if they leave it may take them decades to do it.  And yes, many doctors have an emotional need to be needed.  But we can’t take the piss out of them forever.  They are clever, highly trained, used to working under pressure, and - get this - ambitious.  They’ve had to be ambitious to get this far.   They can go.  Many have already left.  Many more are leaving.  Those who have stayed as locums and staff-grade posts are keeping the NHS going, but are suffering enormously as a consequence.  The consultant psychiatrist who’d travelled to be at Westminster on Tuesday said she had never had to treat so many juniors for depression.   The government has turned our doctors into patients.

But why can’t they just apply for another training post?  

They aren’t allowed to.  This is so implausible that the government have got away with it.  No-one other than those directly affected believe it’s true, but tens of thousands of doctors are in the position where they have lost their one and only chance at a training post.

How can this be?

Imagine a railway station.  In the bad old days you’d mill around and catch a train that took you one stop down the line, and then you’d have to get off.  Then you’d catch the next train that was going in roughly the right direction and travel one stop down the line.  And so on.  Doctors took a series of 6 month training posts for several years, gaining experience, being trained, gradually becoming more specialised and progressing towards registrarship and then consultancy where they added accountability to their life and death responsibilities.  It was unsettling, geographically disruptive, nerve-wracking and all in all a very unpleasant way to spend your twenties and early thirties, but it did get you there in the end.

Now, instead of a flexible system, doctors have one chance and one chance only to catch the train.  This is so completely barking that no-one believes it’s true.  But if you wait at the station even a month too long, taking locum jobs or staff grade posts without training, you can no longer apply to get on the train.  You are forced onto the waiting busses, which just drive you round and round the car-park of locum shifts and ward cover and don’t go anywhere at all.  Or else you take a taxi to the airport and a job in Australia, New Zealand, or just walk out and get a rapid-grad job in a bank or law-firm.

Does this matter?

The fact that there is already inadequate cover on the wards really matters, and shifts all over the country are being run without the doctors needed for patients to stay safe and staff to keep sane.   No-one wants to locum - it’s perceived as failing in the profession, and this is a direct result of creating a two-tier profession.  As a result, hospitals are desperate for locums, and locums can and do name their hours and say “no night shifts, thank you”.

In terms of the medics themselves, then I think it matters that an entire generation of doctors has been prevented from progressing in their profession, though I know there are vindictive labour politicos who regard doctors as power-crazed middle-class hypocrites and MTAS and MMC as a job well done.

The separation of families certainly matters to those involved; on Tuesday I heard of a couple where he took a locum job in Glasgow to be nearer to her in Inverness, though a three and a half hour drive each way is not “near” when both partners work 12 hour shifts.  I also met Lindsay Cooke, whose daughter has emigrated to a job in New Zealand.  Nice work if you can get it, but emigration is always hard on those left behind.  Hell, the one I went to London with on Tuesday would be in South Africa by now if he’d not been offered a training post last year.

What next?

The government accepted that last year was a cock-up and commissioned an independent report on the situation from Sir John Tooke.  Tooke’s report makes dozens of clearly defined recommendations and it  is supported by 87% of the profession.  Tooke spreads blame widely among the government and also among the seniors who run the Royal Colleges and the medical schools, and asks such fundamental questions as what sort of doctors do we want and what sort of training will it take to get them?

The government is implementing only 25% of Tooke’s recommendations, it accepts a further 25% “in principle” - huh? - and is getting Lord Darzi to reconsider the rest.  Divide and conquer, anyone?

And the Mass Lobby?

Did I manage to explain any of this to my MP in a way she understood?  Probably not.  My neighbour runs her constituency office, and they are two members of staff down so even if I write to her asking her to support the BMA’s Early Day Motion, which I will, she will just forward the letter on to the DoH and that will be that.

I did discover that the Members’ Tea Room has the cheapest tea and coffee in London though.  £2.20 for a cup of tea and two cups of coffee - who needs an account with John Lewis if you can score caffeine as cheap as that?  Oh, and attempted acts of terrorism are worth commemorating with novelty foodstuffs if they took place in the 17th century.  I wonder what novelty foodstuffs will be used to commemorate the implosion of the NHS.

The good, the bad and the ugly - part 2

Here are a few more corporate and business characters:

The Underminer

The Underminer seems to be the most helpful person in the room: they understand things quickly, they ask pertinent and clever questions, they contribute, smile and make the odd joke. However if you need them to do anything for you, at best they will do nothing and at worst they will sabotage you. To add insult to injury they won’t even bother to hide what they’re doing. They’ll criticise you for incorrect spelling but blithely fail to hand in their own homework, ever. Watch this failure to deliver: the underminer gets their greatest kick from humiliating you in public by letting you assume that the promises they made in private were true.

The proto-tycoons

Still at the stage of two porsches and a secretary, these young men live fast, drive fast, talk fast and pay slow. Your importance to them can be measured by the amount of attention they pay to you. If you are a minion in their world you won’t merit eye contact, if you can withhold something they need then you get their undivided attention. They are bright enough to stay within the law most of the time, but this is because they believe that only fools get caught, actually they think speeding fines, taxes and 30 day credit terms are for other people. Satisfyingly, a sub-set of them will spend their 60th birthday, and a dozen or so others, behind bars.

The working-class hero

It’s not a chip on his shoulder, it’s an entire timber-yard. In many ways he’s like the Netball Player, but he’s fighting the class war rather than the battle of the sexes. If you are more southern, more northern, older, younger or in any other way different, then you are - obviously - out to get him. He’s determined and will thirstily soak up new information and you will get loyalty for so long as you can teach him things. The moment he thinks he knows as much as you do, you’ll become “moody, unpredictable and impossible to work with”. Of course you will. On the other hand, if he sets himself a task, he’ll do it, no matter who or what lines up to prevent him. He’s a difficult but oddly likeable chap, life actually has dealt him some bum hands and he can be surprisingly supportive when women show vulnerability.

As before, these are of course entirely fictional.  I have a very active imagination.

The good, the bad and the ugly - part 1

I’ve been thinking about some of the people I’ve come across at work in the last couple of decades or so.  Here’s a wee taster:

The Explainer

Ask an Explainer the time and he’ll tell you. He’ll also explain the origins of Greenwich Mean Time, the legislative history of British Summer Time, the pros and cons of harmonising our time with Central European time and the origins and use of the 24 hour clock. Some Explainers will finally deliver a nugget of pure gold you’d never have found in any other way, others just talk till your eyes glaze over.  Explainers are kind-hearted souls and volunteer for tasks like being a first-aider.  Unfortunately they have kind-hearted larynxes too.

The Ducker and Diver

The Arthur Daley of the corporate world, the ducker and diver has an actual cupboard full off odd bits of hardware and software, bottles of wine, books and other bits and pieces. He also has a metaphorical cupboard full of favours owed. He’s great at fighting fires: if you have something that needs sorting out quickly, he’ll know who to ask, who to blackmail, who to bribe. Everything’s always changing in his world so planning’s pointless, but he’s the one destabilising it all. He’ll delegate activity but not control, which makes him hard to work for. However, he’s a useful employee because he’s good at getting things done even if “quick” and “dirty” are his middle names. Chances are you won’t even need to worry about internal audit coming along afterwards, he’ll know where they’ve buried their own bodies. He probably lent them the spade.

The Adrenaline Junkie

His mottoes are “JFDI” (just effing do it) and “don’t sweat the small stuff”. In his world, details cause delay. Work is an extreme sport, and he gets his kicks surfing the edge of chaos. He likes headlines and bullet points. He gets bored quickly and delegates as much as he can, though once he’s delegated something it stays delegated: he’d find picking it back up again - or even just checking on progress - to be frustratingly dull. More honest than the ducker and diver, he has the same restless energy, but for him work is a sport rather than a game.

The Netball Player

If you’ve got a problem she’ll be very supportive, but she can be critical and extremely bitchy when she chooses. She has a clique of female colleagues who form a mutual admiration society, and everyone else is on the outside. She appears very professional and very on top of her game, but her underlying brittleness makes working with her an interesting spectator sport. She’s very certain about everything and can be astonishingly judgemental, which seems at odds with her sense of sisterhood until you remember that in her world all men are bastards. She may be lesbian, she may be straight, but she’s far too fond of certainty to be bisexual.

I do wonder how I’d summarise myself, if I worked with me. All resemblance to persons living or undead is of course coincidental. Allegedly.

An atheist’s guide to wrestling pigs

Richard Bandler, one of the co-founders of NLP, points out rather smugly that the word “generalisation” is just five syllables wrapped around the word “lies”. We all know that generalisations are false, but still we make them. What bugs me immensely about atheists who are anti-religion, rather than those who are just indifferent, is their tendency to see all christians as prejudiced zealots. Takes one to know one, of course. No projection there.

The thing is, there are as many kinds of Christians as there are kinds of people. Yes, some are bigoted, narrow-minded and spiteful, but not all. Not all, at all. There is a specific kind of Christian that I find compelling and attractive; the ones who are intelligent and questioning, funny, socially sensitive, tolerant of others and who quietly get on with making surprisingly substantial changes in the world. I’ve known rather a lot of them and I’d quite like to be one myself. In my dreams. They put me into a cognitive spin because I find the whole premise of Christianity so illogical that I simply don’t understand how anyone with two brain cells and a synapse can find it makes sense. How can anyone so bright be so dumb, I ask myself. They probably feel the same way about me.

When rabid anti-religionists start attacking Christians, I don’t recognise the form of Christianity they attack. I’ve known a few creationists, fundamentalists and people who have a personal relationship with their saviour and lord, and the internet constantly reminds me that they aren’t actually that unusual. I guess in the UK we are blessed with agnosticism and are spared the lunatic excesses of religious tv, evangelism and fundamentalism. I once visited the Bible Society head office in Swindon, though; it was like walking through a toothpaste advertisement made in Stepford.

They say you should never wrestle with a pig: you get muddy and the pig likes it. Put like that, it sounds kinda fun. And that’s the problem. The best responses to bigoted fundamentalists are ridicule and education, and the best responses to powerful bigoted fundamentalists (like the lunatics who’ve been running the asylum in the USA for the last years) are still ridicule and education. But in the US the Scepticism and Sceptical Humanism movements are getting sucked in to point-scoring and pig-wrestling, when it should in fact be poking fun at the pig. And then ambling off and doing something more interesting instead.

On the brink

On Friday, driving in to work, I saw the first green flurries of green coming out on the hawthorns, and I could finally welcome Spring.

Today I planted up twenty quid’s worth of perennials in my little slip of a bed 8 foot long and 3 foot wide at its widest.  Scabious, aquilegia, dianthus, saponaria, jacobs ladder, and a whole load of violas, since you ask.  This is all the garden I have, so it’s very important to me.

I love this moment, full of potential energy, when we’re poised and stationary at the top of the rollercoaster tipping delicately over into the accellerating, exhillerating plunge though the equinox, Easter, April and May to the riotous glory of midsummer.

Mind the gap

There’s a reasonably widespread idea that less and less can plausibly be explained by the existence of god because  science explains more and more about the world we live in. There’s even a term for a theology which uses god to explain things which science has not yet understood - it’s “The God of the Gaps”. So far, so widely accepted.

Recently I’ve been listening to Nigel Warburton’s excellent podcast series “Philosophy: the Classics”. (Website - book - iTunes). I very much like listening to Warburton’s quiet and articulate summaries of the canon; I know I’d never make it through his book, and certainly not through the originals, but I am slowly becoming more educated as I drive in to work.

What strikes me though, is just how many of the questions which philosophers used to ask have now been answered by neuroscience. We know that Aristotle’s ideas on vision and matter were wrong, and we also know much more about the questions which the 18th Century philosophers such as Descartes, Hume, Locke and Kant were asking about how we know what we know. These questions are being answered by neuroscientists though, not by philosophers. I am of course not the first to notice this, even though it was a conclusion I came to on my own. The 18th century philosophers were, if you like, the philosophers of the gaps.

The gap which is usefully plugged by philosophy is narrowing as neuroscientists and cognitive scientists do their job. For example, we will soon know whether or not a moral sense is innate and why it might be that some people appear not to have one. This will hardly put the philosophers out of a job - in fact we need ruthless critical thinking more than ever. To take a concrete example related to this issue of why some people have no moral sense: it was another podcast which told me that in the UK and Europe we have a far smaller percentage of our population in prison than is the case in the US, but that if you add those who are caught up in mental health institutions into the mix, then the percentages even out. In other words, in the US they imprison the mentally ill, while in the Europe we hospitalise criminals. These sorts of topics obviously give rise to questions which can be answered empirically: what is the best way to prevent offenders re-offending for example, not to mention the practical ones of how best to monitor people at large? However, they also prompt difficult questions we need to think very clearly about, and this is where philosophers and other critical thinkers can help. Do we want to punish or rehabilitate is the least of it. We can also prepare ourselves for what we do when we discover where the boundaries are between free will and biological determinism.

The gap for philosophers may be narrowing, I’ve no idea whether it is deepening. However, as technology makes us become more powerful and as science gives us answers which we may not want to accept, we certainly need the clearest possible thinking to stop us falling into the ethical and practical abyss between the two.

Remedy Mass Lobby of Parliament - 18th March

I’ve never had any particular need to be glad that I don’t live on the west side of Leicester before now. The M69 is a pleasant enough minor motorway, and there isn’t really much else one can say about the place. Isn’t it where Adrian Mole grew up?

On the 18th I will be one of a worryingly small number of people lobbying Parliament about medical education and the plight of the missing generation of junior doctors who are too old to benefit from whatever reforms the government introduces as a result of the recent Tooke review, and too young to have made it safely to registrarship already. A year after the original MTAS debacle, I still could not have managed coherency if the MP I were lobbying was Patricia Hewitt.

By lobbying, I force my MP to inform herself on the details of the issues.  The problem of course is that one can only find MPs in their lairs in Westminster during the week, and most doctors will be working then. It is entirely happenstance that we can attend at all - it was the one week during this rotation that the one I’m going with could get for his holiday. I loathe London and all its works and I would far rather be on a cheap beach or a Scottish city, but I am privileged to live in a democracy and it’s important that those of us who live in democracies avail ourselves of the privileges while we still have them. It is important that my MP knows that, when she discussed this with her constituents, at least one of them asked her to vote for implementing Tooke in full.

As I type this I find myself getting more enthusiastic about the whole thing. When I followed Remedy’s directions and wrote to my MP to ask for a meeting I discovered on They Work For You that she voted against the war in Iraq, though she also voted against in inquiry into it. I find that I am looking forward to discovering her views on MMC and MTAS. Does she agree with the government’s proposal to implement about half of Tooke’s report? It’s an opportunity for me to decide whether or not to vote for her in the future. It’s an opportunity for me to become more informed, and for me to contribute and participate. Democracy - use it or lose it

I’m not just interested about my MP - I find myself wondering what’s going on at my local general hospital, (the one I’m going to London with works elsewhere), and I’m beginning to feel the first stirrings of willingness to pick up the fight again. I am, however, very glad that I’m not going to see Patricia Hewitt. If she’d been my MP there was a real risk that I would have lost it completely. Dribbling rage is never pretty.

For up to date comment on Modernising Medical Careers read the Witch Doctor - or even better: subscribe to her blog

To sign-up for the mass lobby of parliament go to the Remedy site - they will provide you with briefings and do all they can to support you.

Remember - it’s our NHS and they are our MPs.