The malware WannaCry attacked IT systems worldwide in 2017. Microsoft wasn’t making any more money from their hugely successful Windows XP so to encourage sales of a new operating system they had stopped maintaining XP. Some NHS trusts were among the thousands of institutions and companies that suffered.
A new hospital opens with a fanfare and a celebrity. It is smart and up-to-date. Well, up to the date that the plans were approved. What does it look like a year later? Ten years later? How stained is the concrete on the outside and how scuffed the paintwork on the inside? How many of the lifts are out of order today? Are the shrubberies now sprouting discarded coffee cups? Is the IT system just limping along?
And 100 years later? My local hospital does procedures in the cellar of its decaying Victorian building. Keeping the ceilings up, the leaks stopped and stairways safe is an expensive and ultimately unwinnable battle.
Proper maintenance is a long-term investment. It costs. It’s boring. Perhaps the only sexy maintenance project ever was repainting the Forth Bridge.
"Ignore even modest wear and tear and any system spirals down to dilapidation. By the time people realise it’s seriously affecting their ability to do their job, breaking the vicious circle isn’t easy. But it can be done."
In health it’s an axiom that prevention is better than cure, but we are often poor at applying those principles to our environment. If molehills appear in your lawn, you whack the mole. A satisfying cosmetic fix, but sooner or later the mole pops up again. It doesn’t solve the underlying problem.
The demands on the NHS have increased relentlessly, but since 2010 funding has flatlined. The government has not maintained the system so this winter the seasonal pressures are even worse than usual. Ministers conjure some magical thinking on the Today programme, dump the responsibility on hapless NHS managers and produce a sop if the problem doesn’t go away. Whacking moles with a feather duster.
Ignore even modest wear and tear and any system spirals down to dilapidation. By the time people realise it’s seriously affecting their ability to do their job, breaking the vicious circle isn’t easy. But it can be done. Zero tolerance calculates that clamping down on window-breakers and litterbugs will discourage serious crimes. It may not fulfill that promise, but people love it and feel safer.
Facilities managers need the authority to foresee and uncover potential problems. They need adequate funding which can’t be raided to fund another need. No hospital should be relying on sticking plaster to cover deficiencies before the CQC comes round. Maintenance crews aren’t odd-job men; they need manifold skills. And they deserve recognition and our thanks.
It’s not just hospitals, motorways and the Houses of Parliament that suffer from lack of maintenance. “Never go to a doctor whose office plants have died” observed American humourist Erma Bombeck. She’s right; first appearances set the stage. Locums have little control over neglected poinsettias but they can check that their shoes aren’t scuffed and they can whack a few moles to improve the look of the room before they start consulting.
There are times when short-term thinking is inevitable. Given a terminal diagnosis, who buys new shoes? If a building is scheduled to be demolished, the budget for maintenance will have been cut. But then the demolition is postponed, so the sagging structure staggers on, difficult to work in and depressing for everyone who uses it.
We are living in an increasingly throw-away society. Grandmother said “A stitch in time saves nine”. But who darns their socks now? Clothing is so cheap that it’s rarely mended, and Christmas-themed jumpers are worn once and thrown out to end up in landfill. And why hang on to last year’s phone? Last decade’s washing machine? Cars? Modern technology has done away with young men in oily overalls who enjoyed spending their time trying to keep aged Austin 7s on the road.
Few new buildings now meet future needs, because the predictions that underlie their design are almost invariably wrong. And buildings designed to be maintenance-free are hard to repurpose – think of the Pyramids. If buildings are going to stand the test of time, they need to be flexible. There must be better ways than tacking on Portacabins. Simple buildings are usually more adaptable. They’ll need maintenance, but they can ‘learn’.
Homeostasis is a beautifully intricate maintenance system, an arrangement of chemical pathways which preserves our internal environment. It’s so reliable that we take it for granted. But when something goes wrong the outside maintenance team is called in. That’s us.
So there will still be work for Vishnu, the god of maintenance, and he’ll need to be ever more vigilant. E.M. Forster’s novella The Machine Stops was written as science fiction but it could easily become science fact. Undersea cables carry 97% of global communications and so underpin almost every aspect of our lives. How well maintained are they? They are vulnerable to sharks, those in the sea and those occupying seats of government, and if the network goes down, so will we.
Judith Harvey was a research scientist, ran the VSO programme in Papua New Guinea and taught in a Liverpool comprehensive school before going to medical school. She has been a partner, a salaried GP and a locum and an LMC chair. She started a charity which for nine years enabled medical students to go to Cuba for their electives.
Judith is a long-time supporter of NASGP and has been providing regular articles for The Sessional GP for over 12 years, her reflections ranging widely on practical, ethical and cultural aspects of health and medicine.
Judith has now published all her articles from the NASGP website as a new book Perspectives: A GP reflects on medical practice and, well, just about everything…