“Someone must have had it in for Joseph K., for without having done anything wrong, he ended up representing the Campaign to Save Mental Health Services in Norfolk & Suffolk at South Norfolk Clinical Commissioning Group’s (CCG) Public Meeting on 13th January. Or rather he should say its meeting in public, for as he was later to find out there is a difference. The meeting was held at the incongruously named Keystone Innovation Centre, Thetford.
“Joseph had never previously been to such a meeting, and he was surprised to find that the crisis in mental health services did not figure on the agenda, despite the fact that the Campaign had formally submitted three requests for this. Foolishly he had assumed that mental health was an important part of the NHS. Presumably because of his bemused air the Chair of the meeting reminded everybody that South Norfolk CCG’s policy was one of “Equity and Care for all Patients.” “It’s just that”, the Chief Officer explained, “we don’t accept agenda items from the public.”
“Joseph K.’s bemusement increased when he found that the meeting was not held in English, and that no interpreters were available for those present who only spoke plain English. Questions raced through his mind: Who could these people be? What were they talking about? Did they have any qualifications? What authority could they represent? K. lived in a country with a legal constitution, a democracy. How could these people operate without any concessions to this principle? Without meaning to he allowed himself to be decoyed into an exchange of views even though he could not understand what was being said and even though it had been made clear by the Chair that he could not speak until the meeting was over.
“Must I” he thought, “let myself be confused by the gabble of these wretched hirelings? They admit themselves that’s all they are. They’re talking of things, in any case, which they don’t understand. Plain stupidity is the only thing that can give them such assurance.”
“In fact, they were clearly very familiar and comfortable with their own language. No signs of confusion or doubt appeared on their faces. Phrases tripped confidently off their tongues – algorithms/commissioning/joint commissioning/co-commissioning/delegated commissioning/care pathways/footpaths/raising the profile/operation domino/refreshing the market/the fundless Better Care Fund – all these terms were used with apparent total understanding by those present, though not by the few members of the public in the room nor by Joseph K.
“What Joseph did gather was that the UNSATISFACTORY judgement of the CQC investigation into mental health service provided by Norfolk & Suffolk NHS Foundation Trust (NSFT) was not on the agenda because “it is not yet in the public domain”. Despite the language barrier he managed to convey the fact that the mental health crisis had been in the public domain for two years now, and that South Norfolk CCG, as the lead commissioning group for mental health, had not yet had it on their public meeting agendas. Joseph tried to explain that the CQC investigation would only enter the public domain if it was discussed with the public.
“He later realised how foolish this must have sounded as he became aware that CCG decisions were actually made by a rather sinister-sounding “leaders’ group”. Despite the language problem, it finally dawned on Joseph K. that all the important decisions had already been made in private by the “leaders” and that the meeting he attended was purely designed to give the public the impression that something was being done; the last thing the CCG could admit was that there was nothing they could do, for Norman Lamb had already patented that one. Stating that there is nothing you can do implies a moral imperative that something should be done. As Joseph K. left the building the snow began to fall and he resolved never again to submit himself to such an odious ceremonial of courtesy.”
WITH THANKS TO FRANZ KAFKA’S THE TRIAL AND JOSEPH HELLERS’ CATCH 22.