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Sick note, bank note

When the going gets tough, remember the three Ps. Pace yourself, pamper yourself and piss yourself laughing. Phil Hammond

It's not often I turn to a Roman satirist to make sense of public-sector reform, but Petronius Arbiter hit the jackpot with his observations on reorganisation: "I was to learn later in life that we tend to meet any new situation by reorganising; and a wonderful method it can be for creating the illusion of progress while producing confusion, inefficiency, and demoralisation."

If only this was stapled to the forehead of every health and education secretary, we might have been spared the absurd continuous revolution in service provision of the past 30 years. But then again, maybe not.

If you like a good conspiracy, you could argue that constant reform is a deliberate ploy of politicians to demoralise professionals and keep them in their place. Just about everyone working in the NHS or education believes that politicians should not be in charge but we are all too knackered and confused by the reform agenda to rise up, rebel and kick them out.

Change, and how it is managed, is one of the six areas that the Health and Safety Executive has identified as risk factors for stress. The other five could have been devised by the Professor of Common Sense at the University of the Blindingly Obvious (how demanding your job is, how much control you have over it, the support you receive, your relationships with colleagues and what your role is in your workplace).

Generally, the lower down the ladder you are, the worse the view and the more you get dumped on.

More contentious is to come up with a definition of stress. Is it a psychological reaction to excessive pressure or is it a biochemical entity, measured in cortisol and adrenaline levels? Or maybe it is a good thing, keeping us alive and motivated.

Certainly, the human body has a huge capacity to survive extreme acute stresses (car crashes, frostbite, Ofsted inspections) but only if we get time to recover. Stress becomes a killer when it is unremitting, and nothing is more unremitting than constant organisational change.

Unsurprisingly, chronic work stress is bad for the heart - look around the staffroom and spot the cardiac arrests waiting to happen. But it also increases your risk of diabetes and depression, knackers your immune system and eats away at the part of your brain called the hippocampus (so-called because it resembles a sea horse). The hippocampus seems to be involved in memory storage and spatial awareness, which is why we lose the car keys, find them and then crash the car when we are stressed.

So what can you do to protect yourself? Change generally only works if those who have to implement it have been consulted, feel involved and agree with it. So you should try to ignore most of the Stalinist missives from Whitehall. Having dumped most of it, you then get to choose between do or delegate.

Some change is good, but don't be threatened by politically unfeasible deadlines that have "statutory requirement" written underneath them in bold letters.

Just get together with neighbouring schools and come up with a far more realistic time-frame for your school profile, or whatever today's policy change is. It's safety in numbers - they can't sack you all.

Finally, when the going gets tough, remember the three Ps. Pace yourself, pamper yourself and piss yourself laughing. If that doesn't work, write to me with your change horror story and I'll send you a note for a year off with work-related stress Dr Phil Hammond is a GP and chair of governors at a primary school in Somerset. He can also be seen on BBC1's Have I Got News for You

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