A Period of Readjustment

The National Health Service was established in 1948 as a result of legislation passed two years earlier. It was founded on the humanitarian principles that healthcare should meet the needs of everyone, should be free at the point of delivery, and should be based on clinical need rather than the ability to pay. It is a perennially over-stretched service and the target of frequent criticism, which is often justified. Occasionally things go seriously wrong and there are scandals. However, without it, a large section of the population of the UK would have either intermittent access, or no access at all, to quality healthcare.

As of April 1^st, 2013, the NHS will cease to be an organisation whose sole purpose is to tend to the needs of the sick and disabled. Instead it will effectively become a brand name, under which a raft of private companies will cherry pick those parts of the service that make money and then run them for a profit. Naturally there are concerns about the conflicts that might arise between quality of care and the need to provide a return on shareholders' investments.

The short piece of fiction below is written in the style of the incident reports that I seemed to spend half my life writing when I was employed by the NHS. It is somewhat flippant, and yet no less absurd than the situations that those who work for NHS hospitals may find themselves in, over the coming months and years.

A Period of Readjustment

By Mark Sadler

Last Monday our hospital was paid an unannounced visit by a senior figure from the Department of Health. While I ushered the gentlemen into my office and made him coffee, my colleagues scrambled to alert the wards and departments that a dignitary was in the building, and that we should at least try to put on a united front, and give the impression that we all knew what we were doing.

Of particular concern was the possibility, however slim, that our distinguished guest might run into the disembodied spirit of Mr Wheeler, who had died the previous evening on the respiratory ward and had returned as a poltergeist. The member of the chaplaincy who normally deals with patient hauntings was away on annual leave. My secretary had spent the morning phoning around the usual temping agencies in an unsuccessful search for a qualified individual who would be able to deal with the problem. In the interim, a suggestion made to Mr Wheeler's spectre by a member of the nursing staff to “go towards the light” had resulted in him rapidly circling a strip lamp in one of the delivery suites on the maternity ward, like an over-excited moth.

As it turned out, our visitor expressed no desire to see the hospital and became openly hostile when I suggested a tour of the new Linda Mountjoy Diabetes Unit, which had been opened the previous month by Wagner – a former contestant on X Factor.

“Driving here was depressing enough...” he yawned boorishly. “...Tell me, do you actually live in the area or do you commute in?”

“Well, I live in Thorpe Bay. There's some quite nice houses there and the schools are improving. There's a lovely new swimm...”

“Do you know what: I was just making conversation. I don't actually give a shit.”

The gentleman went on to apprise me of the singular purpose of his visit, which was to deliver a special package direct from Number Ten Downing Street. This turned out to resemble a round hat box. When I opened it I was somewhat surprised to discover that it contained a top hat.

After I had signed for the package, the very important man from the Department of Health informed me that, as of 9 o'clock this morning, the government had unceremoniously cut all funding for our healthcare trust. As a substitute for this abrupt 100% loss of income, we had been provided with a high-quality, magical top hat. Whatever we were able to conjure from it we would be allowed to keep and use to run the hospital.

“I would ask it for sensible things such as a kidney dialysis machine, rather than a million pounds, in case it decides that you're a fucking piss-taking cunt and stops working for you,” he advised me.

My immediate response was to ask him how the top hat functioned and whether he could perhaps give me a demonstration. He reluctantly agreed to my request. After about ten minutes of rummaging around inside, interspersed by occasional light taps on the brim with a pencil, which he brandished theatrically like a wand, he managed to produce a very wet and surprised looking sardine from the silken void.

“Do you want this?” he enquired, dangling the wriggling fish above the upturned hat by its tail.

“No. Thank you very much for asking.”

“I'll fucking throw it back then.”

The fish disappeared into the hat with a faint splash. My visitor turned his attention to his coffee which he predictably described as “tasting like it had shot out of a C-diff patient's arse”. I assured him that this was not the case and offered to his address his concerns by sending a sample to the pathology lab where it could be tested for the presence of faecal matter. This seemed to calm him down. After the sample had been sent, he filled me in on some of blue-sky thinking that lay behind the government's Top Hat Initiative:

“The firm that won the bidding process provides transport for prisoner transfers and security at live music and sport events, so basically they don't know what the fuck they're doing. They had the hats knocked out in a factory in Jakarta. We think part of the problem is that the pixie inside, or whatever the fuck it is that does all the magic, either doesn't understand English or is ideologically opposed to western culture and the concept of socialised medicine. If you have a member of staff who can speak Indonesian it might be worth letting them have a go at it. Also if you sort of wave your hands above it like you're casting a spell, that sometimes works.

“There's one other thing: We're not entirely sure whether the hats are bringing objects into existence or teleporting them in from elsewhere. If it turns out to be the latter then, technically, every time you use it, you're committing theft. If you ever get anything that looks like it's come from another hospital, make sure that you peel off any incriminating labels and file down the serial numbers.”

After he left, my colleagues and I spent a fruitless afternoon attempting to conjure something from the hat. The following Tuesday was equally barren. On Wednesday one of the Heart and Chest consultants managed to coax a wheel of smoked Bavarian cheese from it. Later that day a couple of nurses emailed me and made it known that they were willing to accept this as part payment of their salaries.

On Friday I accidentally knocked the hat over. Somehow this jolt caused it to expel a quantity of uncut cocaine with a street value of around £5million, all over my desk and the floor of my office. We are currently engaged in high level discussions, exploring whether, given the circumstances, we might be able to legally sell it or, alternatively, whether the government would be willing to take it off our hands and then financially reimburse us for it.

The papers, of course, have been full of stories about the hats. Of all the hospitals involved in the program, Basildon has made the easiest transition, after they hired a stage magician and his assistant to oversee the magical procurement process. The hat at Queens hospital in Romford has gone berserk. The only thing that staff are able to pull out of it are bewildered patients from other hospitals, who have had to be returned to their point of origin by ambulance. One poor man has apparently made the round trip three times.

As is always the case with any new initiative, there is a period of readjustment before things settle down and get back to normal.