On agency, dignity, and systems that get in their own way.

Last week I had a sore throat.

Not a mystery. Not a complex clinical puzzle. A sore throat, some pain, and a reasonable concern that it might be infected. I went to my local pharmacy.

I have 42 years of experience living in my body. I have a fairly good sense of when something feels off and what I want someone to check.

I wasn’t asking for a prescription or a diagnosis. I just wanted a pharmacist to look and rule out infection.

The assistant was friendly. Genuinely so. But the conversation went in one direction only.
Have you tried anti-inflammatories? Yes.
Have you tried a throat spray? Yes. I’d really like the pharmacist to have a look, just to rule things out.

The pharmacist can’t see you right now.
I said I’d wait. Five minutes later the pharmacist came out. I explained what I was looking for. They reached for a piece of equipment and then stopped. The machine for looking in ears is packed away.

I said I wasn’t worried about my ears. I just wanted someone to check for infection in my throat.

Sorry, they said. I can’t help you with that.
And that was that.

Here is what I kept thinking about on the way home.

It wasn’t the pharmacist’s fault. It wasn’t the assistant’s fault. What happened was that a system designed to help people had quietly, incrementally, made it harder for anyone to actually be helped.

Two small barriers. A piece of equipment packed away. A script that ran out of options. And a person who came in with a clear and reasonable need left with nothing.

That’s how agency disappears.

Not with a big refusal or a difficult conversation. Just two small interruptions, and you’re done. You disengage. You leave.
Now think about that dynamic when the need is bigger.

Think about someone trying to access support for housing. Or mental health. Or work. Or education. The systems that exist to help with those things are often far more complex than a pharmacy counter. The barriers are more numerous. The scripts run out faster. The equipment is always packed away somewhere.

And the people trying to navigate those systems often don’t have the energy, the confidence, or the access to keep pushing. They disengage too. Except the cost of disengaging is not a sore throat you end up seeing the GP about. The cost is a life that stays stuck.

This is one of the things I think about most in the work I do now. Not just whether a service exists, but whether it is actually designed around the person using it. Whether it restores agency or quietly removes it. Whether the person leaves feeling more capable or less.
Small moments tell you a lot about a system. The pharmacy told me quite a lot.

If you are leading an organisation and you want to think about this honestly, I am always glad to talk.

You can find me at robgallagher.co.uk.