Dr Matthew Doré (exploring Rome) Palliative Care consultant in Northern Ireland and Hon Secretary of the APM

Instead of meeting Hannibal’s forces head-on in a pitched battle, Quintus Fabius Maximus the Roman general opted for a strategy of delay. Fabius won the battle using a deliberate strategy of procrastinating, avoiding and promising to meet and not attending. He wore down the opposition until they just didn’t care.

This spawned the ‘Fabian society’ a socialist organisation in 1884 which has continued into the modern day and has had much influence on the labour government especially in the Blair years. Its coat of arms is a tortoise, symbolising the tactic of slow and deliberate wearing down.

I was having trouble outlining the tactics I have seen used within healthcare by management and leadership, but I wonder whether this is it?

When there is a crisis, discussion accumulates into recommending a report, and this report is invariably delayed, the report has to be discussed and presented, recommendations have been made, those recommendations need time to implement, and there are delays to implementation, but after a time (often years) in which they haven’t been implemented the report is called out of date. The cycle repeats.

The tactic of delay and procrastination is to not be responsible for any of the changes or to maintain the status quo. All these delay tactics are hidden in excuses of process and governance and so-called ‘noble’ endeavours.

Don’t get me wrong, there of course needs correct governance, but when the governance becomes the purpose rather than palliative care itself, this is the Fabian strategy.

This tactic I think is well recognised but hasn’t been labelled and called out. Well, my hope is by articulating it, it can be called out. The Fabian strategy.