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The famous dystopian novel 1984 by George Orwell has long been considered one of the most influential pieces of literature of the 20th Century. Published in 1949, it has given terms such as ‘Big Brother’, ‘doublethink’, ‘thought-crime’, ‘Newspeak’ and ‘Room 101’ to the world. It has also led to the term ‘Orwellian’ being used to depict official deception, secret surveillance and the manipulation of the past by an arm of the state.

I’ve long been a little suspicious at the adoption of practices in medicine that mimic those of ‘The Party’ in the book, which is the governing elite that prosecutes individualism and independent thinking as ‘thought-crimes’. A defining feature of their discourse is the adoption of ‘newspeak’, a minimalist ersatz language that abbreviates two or more words by blending them into one sticklebrick one, for example the ‘Ministry of Truth’ becomes ‘MiniTrue’. Such neologisms are part of the everyday patois of our hospitals: MedEl, RadOnc, GenSurg grate on my ears like nails on a blackboard. For one, I’d rather spend the extra couple of tenths of a second listening to you say ‘general surgery’ than be irritated by stuff like ‘GenSurg’. Similarly, you cannot have a trial published in any sort of decent journal nowadays unless it has some snappy makey-uppy acronym that somebody thought sounded groovy, where in fact two letters might be taken from one word and the second letter of the next.

For one, I’d rather spend the extra couple of tenths of a second listening to you say ‘general surgery’ than irritated by stuff like ‘GenSurg’

I don’t know why, or if I’m the only one, but all this stuff irritates the hell out of me. Similarly, you can’t travel very far in a modern Western hospital without seeing some semi-jocular play on the concept or the words, ‘Big Brother is watching you’, screaming at you from a laminated sign made by some well-intentioned nurse specialist trumpeting the latest hand-washing audit, or expected date of discharge declarations, or prescribing spot-check, or whatever. Allied to the near-ubiquitous instruction to seemingly everyone to ‘chase’ everything, this all adds up to create a pervasive atmosphere of suspicion, harassment and negativity that in reality helps no patient. In fact, it probably disadvantages them by adding to the already considerable stress being endured by those tasked with treating the patients. This is a seemingly disregarded but still essential exercise that involves the professionals opening their hearts and exercising their minds to the limits of endurance for prolonged periods under extreme pressure.

Now that you know where I’m coming from, you might be able to imagine how I felt when the UK Care Quality Commission (CQC), a statutory body with powers and responsibility similar to those of HIQA, produced a guideline pamphlet for the issues relatives need to consider when using hidden cameras to monitor the care being delivered in hospitals and care homes. Now, a million-and-one words spring to mind when you hear of this, many of which are entirely unprintable, but foremost among them is: Why?

It is unclear what this is expected to achieve, or what anxieties it is expected to assuage. There’s no doubt that in the past, the use of hidden cameras has shone a harsh light on shoddy practices, most recently when used by the RTÉ Prime Time programme in the Aras Attracta care unit, or in several recent BBC Panorama exposés, but shouldn’t this sort of thing be a last resort for exceptional circumstances?

To give them their due, the guidelines do recommend using other means of resolving issues first, but the optics of producing an 11-page charter on how to conduct covert surveillance on a group of caring professionals in a public facility are simply awful and sit very uncomfortably.

This document, however well-intentioned, will almost certainly not stop the tiny minority of health professionals who behave in a delinquent, sociopathic manner; they will find a way around it, as they do.

However, it will give birth to a great many unnecessary conflicts between staff and relatives by placing the greatest levels of mistrust, suspicion and privacy invasion on an official footing. Students of Orwell will recognise the concept of ‘Perpetual War’ between staff and relatives. And in their belief that this will in fact protect patients and foster trust and understanding, those who devised the document are guilty of ‘Doublethink’, which Orwell defined as “the power of holding two contradictory beliefs in one’s mind simultaneously, and accepting both of them”.

The hidden camera footage I would really love to see is what deliberations lead to many of the decisions that are made at a managerial and political level about how and where resources are allocated.

We will be waiting for a long time for guidance on that one.

See our article ‘HIQA has no plans ‘at present’ for guidelines on secret filming’.

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