The Devil is always in the detail

One of the stories I read last week was of Kevin Spacey being accused of sexually assaulting 3 men. The alleged offences occurred whilst he was artistic director at the Old Vic theatre in London in the early 2000s. The truth will come out in time, I’m sure. The story caught my attention. Whilst I enjoyed many of the films he has starred in, I have never given a thought to whom Kevin Spacey might be in real life. I have only ever thought about him as the particular character he portrayed in his many films. Two of his films stick in my memory. The first was American Beauty, a disturbing psychological and satirical look at small town American communities, beautifully captured by Sam Mendes. The other film is an earlier one, The Usual Suspects. The film has a superb twist at the end and the famous line ’the greatest trick the devil ever pulled was convincing the world he didn’t exist’ – you need to have seen the film to understand the context. The meaning behind this idea is something for another time.  

In any event, Spacey has but a walk-on part in this blog. He is a means to an end. It was whilst reading about his troubles that my mind turned to the line about the devil from the film, which in turn, and perhaps strangely, resulted in me saying out aloud, the devil is always in the detail. Now as J and many of my colleagues will attest, I’m not a details kind of person. I like the challenge of big ideas, of creativity and innovation, of moving forward at pace. My approach to the world has sometimes seen me come unstuck, usually because of an unintended consequence hidden in the detail of my decision-making or actions. However, whilst I might suffer the consequence of not paying attention to the detail, there are others who will expressly do anything to avoid any of us looking at the devil in the detail.

Think about the great ‘cost of living giveaway’ announced by Rishi Sunak last week. The newspaper headlines looked great. How many of you, like me, just for a moment thought you would be actually receiving a cheque for £400 in the post? 

The devil really was in the detail - none of us will actually get the £400 in cash, it will be paid in monthly instalments as a reduction of our monthly energy bills. Of course, for those struggling with the ever increasing cost of living, all of this package will help. However, personally, I think this is a bit of ‘sticking plaster’ and won’t do much to fundamentally alter the vulnerable position many people are in.

The cynic in me fleetingly wondered if the timing of the ‘great giveaway’ announcement was to distract us from the ‘lawbreaking by lawmakers’ news last week. Sue Grey’s long-awaited report was published last Wednesday. It may have contained a little too much detail for some people. For many others this detail will have reinforced the sense of outrage they have at what was going on at the heart of government while so many others were obeying the rules. 

And don’t get me started about the Prime Minister’s rewriting of the ministerial code last week! Removing the phrase exhorting ministers ‘to uphold the very highest standards of propriety’ and the seven Nolan principles of public life: integrity, objectivity, accountability, transparency, honesty and leadership in the public interest from the Code’s foreword probably tells you all you need to know about the importance of reading what is or what is not contained in the detail of such codes; and what it might mean for the way the current governmental leadership will behave and make decisions. I don’t think it bodes well for anyone.

Now if you are thinking this week’s blog is a bit of a polemic, you would be right. The political outcomes of last week have left me feeling very angry. It is not just because of the direction I fear some of these machinations are taking us in. What continues to be important, of course, is to maintain a careful Foucauldian eye on the creeping intervention of the State into our everyday lives, the erosion of our freedoms and the right to determine our own destiny. I’m not particularly politically active, but I’m sure like many others, I will continue to share my views and feelings on what I think is an ever precarious place for the UK to find itself in.  

My anger is also a consequence of the apparent disregard shown in some of the past weeks’ revelations to the work many of my colleagues have been doing for the past 27 months during the Covid-19 pandemic. It was such a difficult time to be a health care practitioner. My colleagues continue to work hard at providing high quality, safe services. These are colleagues where being aware of, and acting on the detail, can often mean the difference between a good life or a good death, and the difference of minimising the harm from trauma, disease or health inequalities.

Last week, in my Trust, I heard of the detailed approaches and actions being taken to eradicate falls in hospital, and ways to reduce the number of folk acquiring pressure ulcers. And across the North West region, I head of the work being done to move people living with a learning disability or autism out of hospital, and back into a community setting. All of these different initiatives were being carried out by knowledgeable, skilled and experienced colleagues. They understand both the strategic direction and also the importance of recognising that when translated into practice, it will be the attention to detail at an individual level that will really make a difference.  

My colleagues and many others across England, are beginning to bring to fruition the personalised care ambitions set out in the NHS Long Term Plan. For these colleagues, the ‘devil in the detail’ means finding out ‘what matters’ to every individual they encounter in their practice, and then wrapping an approach to care around them that best meets these needs.  

Ok, my anger has dissipated; writing helps me with this. Normal service will be resumed next week.