By Theodore Dalrymple
November 25, 2002
If anyone wants to know why British public services do not work properly, I should suggest that they look at the document containing the self-assessment rating scale of the 17 “learning outcomes” required for specialist practitioner registration by the UK Nursing and Midwifery Council. A nurse in training kindly drew my attention to this document, which she said she could not understand. Her incomprehension does her credit.
The linear “competency scale” goes from left to right, through the following points: (expert), absent, low (awareness), moderate (conceptual understanding) and high. The person in training is asked to circle which point on the scale best corresponds with his “current level and skill” for each of the 17 learning outcomes, among which are the following:
2. Set, implement and evaluate standards and criteria nursing interventions by planning, providing and evaluating specialist clinical nursing care across a range of care provisions to meet the health needs of individuals and groups requiring specialist nursing.
14. Identify specialist learning activities in a clinical setting that contribute to clinical teaching and assessment of learning in a multidisciplinary environment within scope of expertise and knowledge basis.
No doubt, when you clutch your chest as you suffer your next heart attack, it will be a great consolation to know that the nurse looking after you believes that she has a moderate (conceptual understanding) of the fifth compulsory learning outcome – that is to say: facilitate learning in relation to identified health for patients, clients and carers. What a relief to have done away with all that terrible lady with the lamp stuff!
Actually, a moderate conceptual understanding of these 17 learning outcomes is pretty good going: without undue modesty, I should put myself in the highest quartile of intellectual ability in this country, but should estimate my understanding of the said outcomes as being approximately absent.
The document is symptomatic of the deep moral and intellectual corruption that pervades the entire public service of this country, and now renders improvement of it virtually impossible. After all, the Nursing and Midwifery Council sets the tone of the nursing profession, and any person or group of people who could write a document such as the one I have quoted is beyond redemption. To entrust the nursing profession to the Nursing and Midwifery Council is thus rather like entrusting an aviary to bird-eating spiders.
We have trained vast numbers of people to write and presumably to think this rubbish. Indeed, the inexorable spread of this meaningless language is the sign of a quiet social revolution: we no longer live in a meritocracy, but in a mediocracy, for only people without talent, originality or integrity can master this language. But mastery of it is now the key to advancement, at least in the public services. The troubling thing is that the corruption has gone so far that it has become unconscious: those who produced the document from which I quote are so corrupt that they do not know they’re corrupt.
Interestingly, a consultant colleague recently tried to look up the website of the Plain English Campaign on a hospital computer. As quick as a flash, a message appeared on his screen: ACCESS DENIED: ADVOCACY GROUP. Our mediocrats may be lacking in talent and originality, but they have a sure instinct for survival: they know that plain English, and the use of words that have meaning, would be a grave threat to their position.