Change is hard but could be good

Right – so I moved out of Northern Ireland a few weeks ago. That was not an easy decision. Eventually the ‘pain’ of staying in that job exceeded the ‘pleasures’ of Northern Ireland. Calm down – in case your imagination based on some script begins to run wild.

Overview on NI experience

Northern Ireland is a beautiful ‘country’ – well it is a province in the UK, not a separate sovereign entity. But hey ho – people like to call it a country, so I’m not gonna get into an argy-bargy about that. The country is scenic, the air is fresher than down south, the people are kind, emotionally intelligent and they make extraordinary sacrifices to keep life going. Well, I’m probably generalising a bit because I was only able to travel within a 30 mile radius due to work-related matters. But I can’t imagine that my experience in that radius would be inaccurate for other parts of Northern Ireland. I’m happy to stand corrected.

So – I worked ‘up there’ for 8 months-ish. The health services (part of the NHS) had been left in a right mess. Apparently – as I was told – this was mainly due to political battles, leading to the absence of a real government. I’m not too interested to unpack that here. Things in NI were far worse in the health services than in E&W.

Mental health services were caught lagging in development by about 20 to 30 years behind E&W. It is not just me saying that. NI patients who had visited England – who had received mental health care there – returned to tell me that, directly. It is no one thing that has led to this. Some things I observed:

1. The law on mental health – the Mental Health Order – was very complicated.
2. The MHO made it nearly impossible to admit a patient suffering with personality disorder to a hospital (as was the situation in E&W until modifications to the Mental Health Act in 2007).
3. Personality disorder services were terribly under-developed. Those patients were victims of ‘polypharmacy’ (i.e. truckloads of medications) – even when it is nationally accepted that medications have only a very very limited role in treating the disorder. I recall those sorts of situations in England before 2010. Mind you, PD patients in England are still today victims of polypharmacy right under the noses of the GMC, RCPsych and the CQC.
4. Nurses seemed to have special powers over what doctors would prescribe.
5. Loads of patients inpatient and outpatients were either addicted to benzodiazepines and other similar medications.
6. Specialist psychotherapeutic services for patients are sparse in NI.
7. Shortages of mental health staff were far worse than in E&W.
8. Bed shortages were far worse than in E&W – which led to terminology such as ‘never leavers’ (if admitted). This is terminology such as ‘bed blockers’ in England. So beds are protected like nobody’s business, from patients who might need longer term inpatient stays to get properly sorted out. On one occasion – as an example – a complex and very needy patient I admitted was deemed fit for discharge in under 24 hours.
9. Community teams seemed to function like a law onto themselves (to put that in a tight nutshell).
10. Private psychiatry seems to be a booming business in and around Belfast.
11. Management structures are top-heavy and very bureaucratic. They seemed to live in worlds of their own – but they won’t know that. It was déjà vu for me, as I recalled how England was around 2000.
12. People in management circles appeared to be burnt out (in the proper Maslach concept) – which is not about ‘depression’. They knew what was wrong but they just could not bring themselves together to do anything corrective – and that was not about lack of money.
13. The RQIA (equivalent of the CQC) functioned in a similar way to the CQC in E&W – one got the feeling that it was about tick-boxes on clipboards.
14. Information Technology – was clunky and slow.
15. The unit and services I worked with became named ‘Shitzone‘ among some patients, I was to discover after I departed.

The combination of the above – which is not exhaustive – meant that I became increasingly frustrated in delivering standards of care required by the GMC. That frustration grew worse and worse.

What kept me there for so long was that I had very good hospital accommodation, a flat with: high speed free broadband, good bedroom, well heated, good kitchen, microwave, fridge/freezer, stove etc – all included in one fixed affordable rental.

But as I was saying the pain of frustration exceeded the comforts from the very nice saving grace of the flat. So – I had to leave; the job was ‘killing me’.

Next move

I terminated the NI contract and went job hunting. Well, I was lining up potential new jobs before I departed but none were definite. So a few weeks passed and another job materialised in England, somewhere west of the London by many miles. Early indications in the new job within 2 weeks:

1. Their IT was working for me on day ONE!! Laptop computer on day one – swapped for a better laptop at end of first week – it works a dream.
   1. People in this ‘SciFi’ world can make phone calls straight from their computers – their computers are linked to their desk numbers.
   2. MS Teams – not Zoom – is in common use and it works without a glitch!
2. Patient records access on Day 1.
3. Photo ID badge on Day 3 – and the badge has a chip that gives access to printers.
4. Hospital parking pass arranged within the first week, automatically.
5. One main secretary (Mrs X) to me and two others supporting – and they know what they are fawking doing! Mrs X  was as experienced as the one at the NI unit, but she actually knows the job and she said to me recently, “They are my patients.” I almost broke out a tear of joy. She really understands the job and the patients she serves. She cares for them and their relatives – they are not just ‘names’ or NHS numbers on a page.
6. Supervision arranged and happening with the Lead Psychiatrist and Head of Service on alternate weeks – these are astute supportive people.
   1. Lead psychiatrist – actually has a brain and a heart.
   2. Head of service – same.
7. Blinds in my office were broken. Request was sent of on day 2 and 10 working days later a guy came around and fixed it.
8. Back to IT: they have all the Microsoft Apps (Word, Excel etc) running through OneDrive on their sharepoint servers (securely) and even provide online training to staff on how to use it. I’ve shown Mrs X a few tricks with that and she loved it – so no emailing back and forth of letters I type (by personal choice, I typed nearly every letter in the NHS with my own hands over the last 3 years).
   1. I sorted out a true-template for letters with Mrs X. [a true-template has a .dotx file extension unlike the usual .docx extension.]
   2. So on Friday last, minutes after seeing each of two patients; letters were done and dispatched via OneDrive to Mrs X. She can now make minor amendments and send off.
   3. She likes Calibri font – independently of me suggesting it.
9. Appointment letters: I don’t have to read or sign every notice of appointment letter. The Secretaries do all that.
   1. On Monday last, I amended the appointment letter template with clear headings and inserted a map for carers to find alternative parking (as hospital parking is worse than at CAH). The new template was adopted pronto by secretaries without major pontification. And  Lead Psychiatrist  thanks me for doing that.
10. Staff in the community team, seem to know what they are doing. There are shortages of staff but they’re managing better.

To say the very least – the above experience is very different and good compared to that in NI.

Expectations

I’ve compared both jobs over the same 2-week period in my mind (not fully in this blog). The one in England now, appears more workable from initial impressions. Life is harder having to live out of a Travelodge, compared to the good accommodation I had in NI. But the nature of the job is more fulfilling so far (I say cautiously). It is a good start. The new job is tiring at times but I do not feel drained. It is amazing when you have people swimming with you instead of bumping into you from every other direction.

But none of above positive points, means that I’m predicting a good job for longer term, because I’ve seen many times before how jobs and people can change.

Lesson learned

Don’t stay too long in a job when you know it is cuhrap! Move on – regardless of other comfy things that keep you in place.