Billy Boland: Playing the long game

billy_bolandI was struck by a pang of existential angst the other day when I was out for dinner with some consultant friends. They were chatting about their impending retirement and their hopes for life after the NHS. I got to jape that it was alright for them, some of us would still be working for the next 30 years. Prone to exaggeration, I quickly did the mental arithmetic. It couldn’t be that long could it? Given changes to life expectancy and pension, well, yes it could. Maybe more in the long run.

Gone are the days since I divided medical friends into groups by school year (and later, year of graduation, stage of training, first consultant job). I guess it’s a sign of where I am at that age doesn’t really feature now in my thinking about others. And perhaps this may also be why time gives the impression of becoming more easily distorted.

My anxiety was piqued by the enormity of what lay ahead, coupled with the degree of challenge we currently face. It is easy in the NHS at present to feel that we are in a constant state of crisis. Economic strife and the choking of the NHS budget seemed to herald the commencement of my consultant career and has never let up. Over the years these issues have only deepened, with apparently no clear end in sight. We know there is much inefficiency in the NHS, and that resolving this would be good for patients and staff. But the pace of change is so rapid and the complexity of decision making is so huge, there are bound to be many mistakes along the way and certain amount of frustration at the speed and quality of progress.

As a trainee, burn out was something I was taught about and warned against. New legislation like the European Working Time Directive was seen by many as necessary in order to ensure we had a work force that was rested and fit enough to deliver services. However, latterly its impact is often talked about with respect to its effect on training. Now concerns about hours at the coal face seem to have taken a back seat as people do what they can to keep the NHS afloat. Hard working colleagues now seem to be back to pushing the boundaries to get the work done. I regularly open my email to find messages about clinical and non-clinical matters alike, sent in the small hours when not at work. Why do they feel this is necessary? Why is it occupying their mind? And why can’t it wait till tomorrow?

On a good day, it can feel that there is all the time in the world to achieve career aims. With 30 years you could reinvent yourself umpteen times if you chose, and contribute in myriad different ways. Yet the urgency and demand is now.

When will the situation no longer be urgent? At what point does crisis become chronic? It is of course difficult to say, but without a tempered approach, the NHS’s main asset, its staff, could become worn out and wasted. Another resource not sufficiently preserved and too readily squandered.

To be in the long game, you need to play the long game. The current challenges are only a small part of what is left to come. Pace yourselves. This is just the beginning.

Billy Boland is a consultant psychiatrist and associate medical director for quality and safety at Hertfordshire Partnership University NHS Foundation Trust. You can follow him on Twitter @originalbboland

Competing interests: I declare that I have read and understood BMJ policy on declaration of interests and I have no relevant interests to declare.