ANNIVERSARIES AND PREDICTIONS

By Blair Smith
Contact the author by e-mail at christopher.johnstone@ntlworld.com

In one of those circular, self-referential styles beloved of philosophers, the Chinese sage Chang Tzu advised his protégés to "listen carefully to all advice, then do the opposite". One such wisdom pearl is the recommendation, made famous in calypso, to “marry a woman uglier than you”. This is either, as the song proceeds to counsel, to minimise the risk of imposed cuckoldry, or because, "who," as the famous Unkown Comic used to ask, "gives a shit?" in the event of such subsequent extra-marital affairs.

Of course I have followed the above advice. Which advice? Nobody who knows my wife could accuse her of being uglier than I. Indeed, they will probably tell you that she is the most beautiful wife in Scotland, or even history (with the possible exception of yours, but you are entitled to your opinion.) On the other hand, she is older than I am, and this has similar benefits to those proposed by the calypso (if not the Unkown Comic). We have faced together the tribulations encountered at each of her significant age milestones. Thirty was a crisis, and forty a positive disaster, in which it was apparent that she was the first woman ever forced to undergo the associated humiliation and decay. By the time I reached thirty however, it was all old hat, really. And, even though I haven't yet reached the large four-oh, I am confident that the recent successful negotiation of this temporal hurdle by the trouble and strife will render impotent the implied threat to my self-image when it eventually looms. Which will be, I should say, in a long time.

After all, hoolet has made it to 39 issues, and continues to thrive. Ten years of tittle, tattle, culture and jest. Anniversaries are a time for celebration, reflection and prediction. hoolet has, in its time, been fodder for the BMJ’s Minerva, the primary care digest of Health Ministers, and the only place where many colleagues ever actually read my name (isn't that right, Greg?). Although it has some way to go to beat the hundreds of volumes needlessly boasted by the Lancet, it has done better than the first journal to publish my research - a nameless journal in which my paper was cited as volume 1, issue 1, page 1, and subsequent issues of which I have never seen.

Other anniversaries are worth remembering too, as we contemplate entry to the fifth year of this millennium. For example, 300 years ago saw the worst storm ever experienced by London, and almost as bad as a typical weekend in Peterhead. Unlike Peterhead, however, London's storm was the inspiration for Defoe's Crusoe. Peterhead has also inspired several things, but they are usual punishable by custodial sentence. Twenty years ago saw the beginning of the year dreaded by all who had read Orwell, and which was, in this sense, something of an anticlimax. Looking back, the fear of 1984 seems a little silly. From here at the threshold of 2004 we can easily see that today's is nothing like Big Brother’s rÈgime. Blair’s Britain is much starker and more totalitarian, and the news more manufactured (but do I mean Tony’s or Eric’s?)

hoolet, like Orwell, has indulged in of a spot of prediction in its decade. This column alone has predicted the demise of fundholding, the introduction of NHS 24 against the face of evidence, salaried general practice, the opaque bureaucracy of clinical governance, and the need for critical incident analysis. The only inaccuracy was that the last was predicted as Analysis of Recent Significant Events (ARSE). Then again, perhaps none of these structural predictions required significant perspicacity. In a system with infinite iterations, it is only a matter of time before any particular iteration is current, and the NHS is such a system. I have also predicted the re-establishment of fundholding, as well as its demise, albeit that this will be in the distant future. I could equally predict a totally private healthcare system, a completely nurse-led service, or one based on witch doctors and superstition, and the predictions would also come to fruition in their time. At least once. Again.

When a football club performs poorly, the normal response is to sack and replace the manager (and while we’re at it, I now predict the sacking of Gerry Collins, currently helming Partick Thistle). In contrast, when the NHS performs poorly, the response is to effect a complete re-structuring. We are therefore in a constant state of re-structuring. For example, our Grampian primary care and acute trusts are about to merge under the umbrella of single NHS body in a radical planning move. The inspiration for this advance came from the remarkably similar administrative structure that existed (and was displaced) ten years ago, some two or three versions of the system ago.

Football teams such as Leeds United, Aberdeen and others are about to discover that, rather than frequent managerial changes in the face of adverse results, investment in individuals and the fostering of talent for the long-term future are all that will secure repeated success. I hope the NHS will learn the same lesson before hoolet’s next decade closes. Unfortunately I predict that it will not.

Other hoolet online articles by Blair Smith can be found at:
hoolet edition 49 - Ethics and Repression in the Bloo Toon
hoolet edition 48 - May The Best Team Win
hoolet edition 47 - Hunting Pink Elephants
hoolet edition 46 - Predictive Texting
hoolet edition 45 - Role Models
hoolet edition 44 - Time To Go Killorglin'
hoolet edition 43 - Salt and Shake
hoolet edition 42 - Stepping up the Pace of Life
hoolet edition 41 - Smoking out the Irish Question
hoolet edition 40 - Not Cricket
hoolet edition 39 - Anniversaries and Predictions
hoolet edition 38 - Is There Life on Mars?
hoolet edition 36 - Onwards and Upwards
hoolet edition 35 - Goal of the Season‘s Greetings
hoolet edition 34 - Chickens and Eggs
hoolet edition 33 - On Shifting Goalposts
hoolet edition 32 - Period Zero
hoolet edition 30 - Annual Appraisal
hoolet edition 29 - Working Towards Scotland's Healthier Children For Us All 2020 and A Framework for Maternity Services in Scotland
hoolet edition 28 - In Memoriam Admiral Byng. A cautionary Tale

hoolet is the magazine of RCGP Scotland. It is supported intellectually, financially and emotionally by RCGP Scotland.

This issue maintained by Robert Hallam.