10/14 A specific example

Cross currents - Teignmouth 2014

In this post, I want to highlight a specific example of the negative language mentioned in the last post.

When I was a student, I was in awe of the complexity of the discipline I had undertaken. I looked at experienced practitioners and thought they were all brilliant – every one of them seemed stuffed full of the knowledge, skills and attitudes that I was aspiring to.

After I qualified and gained experience, I realised that I had been mistaken. We were not all stuffed full of all the knowledge, skills and attitudes that were open to us. Some were more skilled than others, some were very skilled at certain things and ignorant of others; while some were constantly studying, others had a more relaxed attitude.

A pattern was pointed out to me in numerical terms. It was stated that 2% of practitioners fully mastered every aspect of the profession, 8% became very adept in one part or another, 34% were students, studying hard to join the adept and the masters, and the remaining 54% practiced at a reasonable level but, for various reasons, did not wish to take their study a lot further other than the normal upgrading of current knowledge.

I’m not keen on putting numbers to this because numbers tend to imply an exact science and I am sure this is not one. However, I can illustrate the point. Take the annual London Marathon as an example. Every year some 36,000 people volunteer to run the 26 plus miles. This is a very positive group of people with a common aim.

However, if we look at the line-up at the start, we find a relatively small group of top class runners in the front row. Behind them is a bigger group of national class runners and the best of the club runners. Then come an even bigger group, the ‘students’ – the rest of the club runners and everyone who is keen to make a creditable time compared to all the good runners, i.e. they are in it for the race. Finally there is the majority – everyone else in the race for many different reasons. And there will be some stragglers who for one reason or another don’t make the course. There will be very few of the latter.

The success of the city marathons is that the language is a positive one and they involve a very wide range of people. However, it is important to their success that the best runners enter because they lift the whole field. The leaders create the space for those behind to run into.

Now, here is my concern. We are going through a period of regulation – in my example above, the stragglers – the ones who don’t match up to certain standards, are being removed from the race. If they are in a position to cause harm to others, this would seem to be a sensible aim.

However, the problem is not the regulation itself but the growth of regulatory bodies.

There are ‘stragglers’ in every walk of life and, for longer than I can remember, regulatory bodies have existed as a means of maintaining standards.  For various reasons in recent years, there  has grown the suspicion that people cannot be trusted to regulate themselves and would benefit from outside regulation – an independent committee to look into perceived problems. Not a bad idea on paper.

This was done but the newly-formed regulatory body took on a life of its own. It had the power to decide what aspects of the organisation to regulate and what form that regulation should take. Experts were consulted. Budgets were set. Software was introduced that allowed digitalisation and control. Policies, protocols and procedures were put in place. Managers were appointed. Inspectors were trained. Because there were other regulatory bodies, there was competition for more recognition, financial support and staff. PR became important to show that they were ‘fit for purpose’. Continued regulatory development meant continually changing inspection requirements and increasing imposition on those being regulated.

And suddenly here was an entirely new independent industry with a language of its own and with – ironically (although I doubt irony is their thing), the need for outside regulation to maintain its self-manufactured standards.

Unfortunately, in the caring professions at least, the language of the regulatory bodies is at odds with the language of the physician. A language that ideals with suspicion, fearfulness and dispute will inevitably be at cross-purposes with a language that is based on understanding, respect and trust. The result has been that that  the regulatory bodies have an initial benefit but then limit standards within the health professions.

Let me explain. Take the ‘marathon’ example above: rather than allowing the runners to run their own race, it is as if it has been made compulsory for everyone to run the race in four hours. An intense training regime has been imposed to do this. Yes, some people will raise their game but the ‘four-hour’ training schedule disrupts everyone else’s preparation. The best runners will lose their motivation and go elsewhere and the race loses its spark.

The problem is not the concept of regulation per se. The problem is that the very success of these outside bodies and the language they have created undermines the more constructive language involved in healing. Within the NHS, it is easy to see the language of the regulators competing with the language of business and finance, the language of the large corporation and the language of technology, all of which compete with the core language of the doctors and the nurses.

An “if you have done nothing wrong, you have nothing to fear” attitude is counter-productive, as is the encouragement of whistle-blowing as a form of confrontation instead of an opportunity for support. Suspicion invites more suspicion, dispute more dispute.

In my opinion, however exemplary the original aim, the language of the regulatory bodies contributes more towards ours becoming a more pinch-lipped, suspicious and fearful society than towards our becoming a more understanding, respecting and trusting one.


Although it can be read as a single post, the above is part of a series that illustrates one of the author’s current interests, taken from a locker full of interests, at a major waypoint in his life. The series sets out as a comment on retirement before focusing around language. He wonders whether he himself has the language to cope as he steps out into the wider world popularly known as ‘retirement’ – an irreversible step into a world that he has previously only glimpsed out of the corner of his eye, a world in which he thinks the word ‘retirement’ to be a misnomer. He has used the medium of the blog to paint the picture. The irony is that, whereas writing about it does allow him to reflect, sitting alone at a computer actually distances him from the face-to-face interaction he is describing.

Rough - Teignmouth 2014a