The Soviet Union famously had near zero unemployment throughout its existence, which casual observers might have mistaken for thrusting economic superiority, compared with the much larger waxing and waning dole queues of the capitalist West. For multiple reasons, lowering unemployment to almost zero regardless of the economic health of the empire was state policy and the state was determined to achieve this no matter what.
I read an article about the inherently inefficient nature of the Soviet shopping experience, in which shoppers would queue to reach a desk where a worker would take their order and issue a slip, after which they would queue in another line in order to pay another worker the roubles needed, before finally queuing in a third line to collect their shopping. This experience took a long time, ensuring millions of lost hours of economic activity each day; a waste that eventually contributed toward economic stagnation and collapse.
I thought of this as I attempted to explain to the nice man from Roche why we still hadn’t spent the money his company had donated so we could publish a few open-access papers of real-world data from our department. For obvious reasons, the money had to be paid to the health board and could not have been given to me directly, Father Ted style, where it might be seen as ‘resting in my account’. So, it was paid into a specially created account where I was told we could access it when needed. Happily, the first paper was accepted and I forwarded the invoice from the publishing house to the man from the finance department so that he could pay it for me from that account. But oh no. Oh, no no no...
That’s not how it works, you see. The publisher needs to bill the hospital in exactly the correct manner, usually requiring 22 utterly pointless alterations in each invoice (never all communicated at once weirdly, but one at a time) and then after all that it needs to be put on a list of accredited service providers. This takes more time than you’d think as it needs multiple different people from the finance side with many being off sick or on holiday at any one period. Once the publisher is on the list then an order needs to be raised on a system called Oracle that then goes to several people to approve, during which time the publisher hassles all the authors continually wanting to know why the bill isn’t paid. Finally, it’s signed off and added to a ‘payment run’ (never paid instantly like in the real world) – that means within as little as a month or two it went through. As this process meant I wanted to die each time I submitted a single request, I thought it would be easier to do a block deal with the paper for six publications at once. Ha! ‘I’ve cracked it,’ I thought!
"Slowly but surely, he ground me down. But still I stood, despite increasing bleeding through my gauze"
No. That amount was too high and had to go through a different process. A special, extra set of forms then needed to be filled out which required signatures from the clinical lead, the manager and that manger’s manager, before being passed back to the finance people for further signatures. I thought this would be quick, so despite having just had a minor operation I returned to work the same day, still bandaged, to sort it out. Then, annoyingly, one error at a time as opposed to all at once, the form had to be done and redone until finally, the finance man achieved a victory and there was a delay as one of the people who needed to sign was away. An electronic signature wouldn’t do. The form needed to be scanned a certain way. The purpose of the payment wasn’t clear enough. There was a battle of wills between the parking-ticket style nature of the finance man and I trying to bat it back and forth. Slowly but surely, he ground me down. But still I stood, despite increasing bleeding through my gauze.
The form was completed and emailed back to the accursed finance man. Was that the end? Of course not! The order had to be raised again! Why? Because who the hell knows why! The chap who did the order though was away and this necessitated another delay. Finally, though it was raised again (pointlessly) and sent to the next stage, someone in the finance department needed to authorise it, and he didn’t. It ‘timed out’ for some reason after a mere week or 10 days. “Why does it time out?” I asked. “Why would such a stupid feature exist?”
Anyhow, the end result is that the order needed to be raised a third time, except the man who raised the orders had suffered a bereavement and was now away. Nobody else knew how to do this. My email etiquette was suffering badly by that point as the finance man was acting as if all this was totally normal and he just could not understand what my problem was – this made me want to find out where his office was and insert his laptop deep within him. At the time of writing, this is still unresolved.
I believe in the NHS and I know that it serves the people better than a private system ever could. A US-style insurance system would see these bureaucratic Byzantine difficulties foisted on the poor patient instead of a long-suffering Welsh ophthalmologist slowly digesting his stomach lining from the stress of it. But this sort of nonsense must be stopped. I don’t know if it exists to put people off from bothering the finance department – whether it is in fact NHS-wide and used in some Soviet way to cut the unemployment rate or whether it is just simply a case of systemic incompetence with no ulterior motive – who knows? The Roche man said that in a trust in England, the clinician had in fact failed to get their funding out of their finance department completely and had given up, so it could be worse, I guess. But for now, I am filled with a righteous anger and want nothing less than some sort of coup against finance where I would gladly draw up a list of those I would want sent to a gulag.
