I have to admit that I am not all that good at throwing things that are obviously rubbish straight into the bin or recycling. I tend to pile junk mail, journals and bills up, then have to hide it all somewhere if someone comes round and I want to give the impression of being a neat and tidy person. Before Christmas I had a small box full of this kind of stuff which was placed in the spare room out of the way, and in the last few weeks a couple of other piles of paper have grown too. This is bad behaviour I know, but now you can’t just throw rubbish into the bin (without shredding it or checking it should be in the recycling bin) I have become lazy.

Tonight I needed something I thought was in the box, and have ended up on a major decluttering mission. What is a worry is the amount of papers that have arrived through my letter box unsolicited (no sadly I don’t mean my credit card bill, though I can’t say I really wanted that either), no I mean all the offers of loans and credit cards, all the offers of money off dog food (I have no dog), vouchers for a pound off my shopping at Marks and Spencer and then there are leaflets. Fast food providers (pizza, curry, Chinese and even a company that can deliver a full English breakfast and roast beef dinner!) not to mention leaflets from the council telling me what they do with my council tax money and how they won some kind of best blooming contrete jungle award (I think that was about flower displays).

In these times of global warming, potential drought and scarce natural resources why are we still being sent this stuff? I think that if I didn’t recycle I would send at least one rubbish bag to landfill each week just stuffed full of paper.

Today I have been on a kind of bonding, team building away day type of experience. I think it was meant to calm the worried and anxious and help us focus on the challenges ahead (whatever they are). Actually it wasn’t too bad, certainly it was good for our team and it was good to get together with some of the people in our directorate I don’t really know all that well. It also gave me the opportunity to spend some time with my new manager, who I am pleased to say is turning out to be good to work with. Tomorrow I am back to university, for our assessment day, so that should be an interesting one!

Tony Blair has just been on The Richard and Judy chat show trying to sell the new NHS to the public. In this brave new world people will be able, according to Tony, to see a GP at 3pm on a Saturday afternoon or at 8pm on an evening. Perhaps these consultations will take place in a supermarket or at a train station. Apparently there are 4000 extra GPs in training, and there are already 10,000 extra doctors and nurses already working in the NHS (minus those who have already left since they were recruited). Apparently also hospital consultants are soon to find that life exists outside of the safety of their acute hospitals (no not the local private hospital or golf course).

All of this is fantastic news, I can still get that job in my local supermarket, but perhaps not on the check out, I could perhaps become a practice nurse. Maybe I could job share with a shelf stacker? I wonder what that would do to my agenda for change pay banding?

The problem with all of this is that I am not sure the providers of this healthcare are quite ready for this brave new world. I am not sure 4000 GPs are enough, I am not sure that there are enough nurses who are able to support these services. I am only too happy to tailor care to the patient’s needs, but does that mean every patient? How can we make sure our aging workforce are up for this challenge and how can we meet the wants of every individual who uses the service?

Tomorrow we find out more about our own department’s brave new world. Who will work where, what they will do, where they will do it. The only problem is that in such a changeable environment will things look the same by the end of the week?

That is because I drank a little more red wine last night than a) is good for me and b) I intended and I blame the sudden call from my brother and his family to ask if they could come over and the invitation that I offered to them to ’stay for dinner’. This is despite having a near empty fridge and even emptier cupboards, but what the heck! I have been leading a pretty frugal life in terms of food and alcohol, mainly due to the 2 stone in weight I would like to lose (7lb down actually). I guess this accounts for my throbbing head this morning! The news has slightly depressed me further, as apparently the Health Secretary has decreed today that everyone will receive 5 health checks throughout their lives, this will please the NHS Blog doctor no end and further endear him to Mrs Hewitt! I will pre empt what he might have to say this morning by wondering how exactly your average GP will see quite so many well people as well as the sick? I am also slightly depressed that I have bypassed the first 4 checks and only have the 50 year check to look forward to - yipee. I suppose it is too much to think that all people who could do with being told they are at risk from diabetes or heart disease, or who smoke will go for such a health check? Still bless Mrs Hewitt for taking the suggestions of the public and putting them into practice, I wonder what other ideas she has!

Work has been ever so slightly depressing, as several colleagues from a neighbouring trust were given redundancy notices earlier in the week. Although this could be a good think for us (there is likely to be some ‘joining together’ as part of the changes to PCTs and providers), I find it quite a wake up call about the safety of jobs in the NHS. I have always thought that if this management lark didn’t work out, there was always nursing to return to. At the moment though you would need to do a bit of spot the job to find a place in nursing, not sure I can afford to be a staff nurse again, and not sure I wouldn’t be just a little challenging of authority!

So it is the weekend and fortified by wholemeal toast and 2 cups of coffee not to mention writing this blog, I am off to face the weekend shoppers in my local Sainsbury’s to replenish my cupboards, wonder if they need any check out operators?

Thirteen Things about me and my life I trained as a nurse at the Middlesex Hospital in London I qualified in 1983 I am married to the boy who lived across the street After I qualified I worked on a private ward where I cared for people who came from all around the world. The neurosurgeon used to go to Cyprus on holiday and bring back any number of greek people requiring brain surgery I got married in 1984, we have one son who is 15 next month We have lived in our current house for 14 years, moving when our son was 3 months old I worked in the coronary care unit of a district general hospital after I got married I was a district nurse for 11 years and would secretly love to go back to it (maybe I will if my job ends up being made redundant) The worst part of my current job is the 24 mile journey (which today took 2 hours due to an accident on the motorway The best part of my current job is that I am able to combine some teaching with mentoring, and planning education programmes I am a big brother bore (sorry!) I am pretty fed up with my agenda for change banding, but am going to work on my appeal this weekend In 2 weeks we move office and I must start some packing up tomorrow! Links to other Thursday Thirteens! I am trying this for the first time, having found the idea on Mrs Aginoth’s Blog 1. (leave your link in comments, I’ll add you here!)

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It is no secret that the whole NHS is in a complete mess when it comes to it’s finances, this is despite record levels of investment into the health economy as a whole. My own budget is not over spent, but anything that is left over when 31st March comes, will go into our local black hole. The stationery cupboard in our office is practically empty, we are not allowed to order more than the bare necessities when it comes to paper and envelopes and some of the folders I store meeting notes in are on their third or fourth owner. We have a vacancy freeze in, and if any one were to leave in what ever department it is highly unlikely that they would be replaced. No bank and agency staff can be employed except in the most exceptional circumstances.

Get the picture so far? We are up to and probably over our over draft limit. Imagine my surprise then that we are apparently committed to a particular provider for our diversity training for the next 2 years and someone has agreed that we spend approximately £24,000 over that time on said training. This is despite the recent evaluation which showed that while the course is ‘a fun day’ it is not thought to meet the needs of managers and staff in teaching them about equality and diversity. Now don’t get me wrong, this is an extremely emotive and not to mention important topic which we have a requirement to provide education and training on. It is also useful to get people to train using role play, and this must be done carefully and using experts. But £24,000 for 2 years work? Does the person who signed the contract also pay the invoice from their budget? Of course not, it has been sent to me for sign off.

I cannot under estimate the low morale which is evident everywhere I go within our trust now. People feel under valued, and feel uncertain about the future. I am putting on a brave face, I am making the right noises, I want everything to be alrightbecausese actually I know that it should be. There is no reason that we can’t provide the type of health service that the public need and deserve. But sometimes I wonder how we can over come some of the barriers placed in our way. End of rant, and off to a meeting about education and development in the near future; more naval gazing? But at least with a nice lunch (hope that doesn’t make me a hypocrite!)

Late one night this week I was flicking through the TV channels I can access on the TV in my bedroom (only 5, as we have no satellite reception there), when I chanced upon a programme demonstrating disease processes through the medium of autopsy. I had heard about this programme before when the first series was on, but wisely avoided it, as the sight of some unknown deceased person’s inner parts was more than enough information for me at 11.30 at night. I have to come clean here, since I left clinical nursing, I have become ever so slightly squeamish about blood and gore, especially when shown to me on TV. Mind you, some of the behaviour depicted on hospital dramas mind you makes me want to throw up at times!

British TV is not quite as obsessed about medical drama as it is about Police drama, but at times it comes close! We have had programmes set out in GP surgeries (one of which is still on in the afternoon, and of course am never able to watch), programmes about a district nurse, programmes set in accident and emergency (Casualty which is home grown, as well of course as ER from the US). The one I save my loathing for though is shown every week on BBC1, it is a spin off from Casualty and is called Holby City.

My main complaint about this programme is not about the blood and gore aspect, though at times we are offered more than enough of that, but the way in which people might be given the completely wrong idea about how the NHS functions in 2006. The main annoyances are:

1. Patients come into hospital and are found to have a problem which might be medically managed, or might require an operation, they are only seen by the surgeon who has them under the knife more quickly than you can shout ‘hang on a minute’.
2. A patient can have an operation as major as say a heart transplant or coronary artery bypass grafts, and be fully awake within 10 minutes of arriving back on the ward (maybe there have been advances since I last recovered a post op patient but I am not sure that is one of them).
3. The nurses are all under the management and control of the doctors (In the UK nurses manage nurses and doctors manage doctors).
4. Doctors can sack each other, sack nurses, sack other staff. Likewise they can hire complete strangers who just walk into the building.
5. A doctor can arrive from Africa, and next minute be operating on a patient, after all Holby City is always understaffed (wonder why).
6. If someone develops MRSA, then it is the fault of the Matron / nurse, who will be sacked because of it!
7. If a nurse prescribes a drug to a patient when she is not a registered prescriber, that is illegal and breaches the nurses code of conduct. But in Holby the consultant decides that this can be brushed under the carpet because they are short staffed.
8. On the maternity unit there is only one midwife and one consultant to deliver all the babies. They are pretty much both always present at every birth, and they both also pitch up to gynaecology operations too.
9. All nurses and doctors call all patients by there first name (and often visa versa)

I could go on, but am getting bored with my list. I guess I could give up watching this complete load of rubbish but the trouble is I love a good moan, and it is not all that badly acted. Also I guess it is a good respite from reality!

Ten Top Trivia Tips about Julie Turkey!

1. Julie Turkey will give a higher yield if milked when listening to music.
2. Abraham Lincoln, who invented Julie Turkey, was the only US president ever granted a patent.
3. Contrary to popular belief, Julie Turkey is not successful at sobering up a drunk person, and in many cases she may actually increase the adverse effects of alcohol.
4. Julie Turkey will always turn right when leaving a cave!
5. Julie Turkey will often glow under UV light!
6. Julie Turkey is the only bird that can swim but not fly!
7. Astronauts get taller when they are in Julie Turkey.
8. The word ’samba’ means ‘to rub Julie Turkey’.
9. It’s bad luck for a flag to touch Julie Turkey.
10. Julie Turkey has often been found swimming miles from shore in the Indian Ocean!

The only 3 people within my life who as far as I know are aware that this blog exists are my hubby, son and a friend. Neither hubby or son are bothered enough to visit with any regularity and in fact I would need to show them a particular page if I wanted them to look at it. What is sure though is that those people all know that my name is not Julie Turkey (and I promise it is not!), and yet someone found this blog through such a search; how weird!

Mind you the fact that any one visits at all, apart from those who come here through one of the traffic exchange sites I use is a mystery to me. But it is great that I do have a few semi regular visitors who contribute to comments, it also gives me regular places to visit in return (in a virtual way of course). I have never been all that good at writing diaries in the past, but actually I enjoy writing about my life (work and home) here. Trouble is, the work part is quite tricky right now, and I am not able to talk with the freedom I would like about work things. In some ways the NHS feels like it is a bit of a turkey itself, or is that white elephant, or is that millstone? I am not entirely sure.

We are involved in the biggest reorganisation of services that there has been, well since before 1980 and that is how long I have been around. What is different this time, is that not only do we have to recognise that many of the jobs which are around now, will have to change, but also that we have no idea if many of them will even exist in a years time. In 1997 when the Labour government came to power they introduced systems which led to more people being employed in management, clerical and other areas. This was so that trusts could do what the government told them in their direct and controlling way. For example they said you will introduce clinical governance, and we will check you have done it and all your staff know about it. So they employed clinical governance managers, risk managers, health and safety managers. They set up committees for these people to report to and admin staff to support them. Now, quite rightly we are asking what do these people do, and how to they make the healthcare of individual patients better. But when the media shout about the waste of money and the increased numbers of this kind of staff they fail to recognise that these are real people with real mortgages doing real jobs which have been created not by them but by other people.

So ends the rant of Julie Turkey!

One of my student colleagues is having a few problems with serious family illness, flu symptoms himself and probably also a lack of having done the preparation he would like to have done for completing the essay which is due in tomorrow. Apparently the only option other than him having to redo the assignment if he doesn’t submit, failing and resubmitting then only being awarded 50% is for us as a ‘learning community’ to decide for the submission date to be moved to next week. Great news I hear you cry, well yes fantastic, but I have pretty much finished my essay and am feeling a bit frustrated by the whole system. Still I’ll finish off my conclusion and will then have the next week to concentrate on my real life and work!

I was due to support a staff member today in a meeting with her manager and a facilitator. Apparently this person is not doing her job to the manager’s satisfaction, trouble is, the manager had not told the person by this lunch time that she was to be met with in this way. We of course cancelled the meeting, but what is going on with some people? Don’t they realise that the key to getting the best out of your staff is to actually communicate with them!

It is only the 16th January and my bank statement today informed me I had run out of money. I wonder what I can do to get more of this stuff? I have tried the lottery with minimal success, and am not really bank robber material; any suggestions?

This has been a strange week, or perhaps it is me who is strange! At work we have been affected by ongoing computer network problems. We can now see the files that disappeared from the system between Christmas and New Year, but we can’t actually save anything. We were told yesterday by the IT dept that they are “working vigorously to solve the problem”. Now that is almost more of a statement than any of us in our office can cope with, knowing some of the individuals involved! I actually don’t think I know many vigorous workers, I know some committed people, some people who run around following their tails and sadly some people who say they are far too busy to read part of a document and give comments until ’sometime next week’.

I have engaged with my fellow students, and had the bit of the essay I had done so far, praised, now that was very nice, trouble is until yesterday I hadn’t written any more and it needs to be in to the university by Tuesday afternoon. That will be the main part of my weekend then.

My main preoccupations however have been around my own family, because I have this week spent about 5 hours on the telephone to one of my sister in laws who is going through a tough time with my brother. It is really good to know that you are considered someone who can be contacted when times are difficult for someone, and I wouldn’t have done otherwise. But it is amazing how draining it can be talking, well pretty much mainly listening to someone else for over an hour at a time. What feels weird is, that although we get on pretty well, I think we have spoken more and for longer this week than last year when we spent 2 weeks on holiday together as a family.

To keep up the caring sharing theme, I have also visited the colleague with the broken toe so I could help her to decide what to do for her MSc dissertation. Not to mention been lost in the countryside around her house which is in deepest Buckinghamshire, so much so that I was wondering at one point if I should have brought a blanket and flask to go with my packed lunch which was in the car already.

Ah yes and last but by no means least I have met with my new manager, who was suitably impressed by the amount of work I do, I wonder if she went away thinking “now Julie, she is working vigorously!’

One of my team is off with a broken toe, as a result of a workman, taking up her kitchen floor dropping his hammer on her foot. Her day was further ruined by the discovery that the tiles under the original flooring contain asbestos and will need a professional team in special suits and masks! Life is full of risk, some of them greater than others and our ability to measure risk is sometimes wide of the mark. I guess she should never have offered coffee to a man holding a hammer, but then why would you imagine it would land on your foot?

One of my big problems with the way health issues are portrayed relates to risk, i.e. how likely you are to suffer from the illnesses portrayed is inversely proportionate to the level of hype found on TV or in the newspapers. This can lead to the idea that we are all about to die from bird flu (well at least everyone who lives in Turkey), all children with cold hands and a non specific illness, may have meningitis and that all women will develop breast cancer and require Herceptin While all of these illnesses are undoubtedly terrible, not to mention life threatening, I sometimes wonder about the damage stories which are demonstrated in such a scary way can do to the individual person’s ability to assess risk.

According to Cancer UK, since 1999 Lung Cancer and not Breast Cancer has become the most common cause of death by cancer in women, and it is a fact that smoking is the single biggest cause of death. Yet speaking to my 14 year old son, an amazing amount of girls of his age now smoke. Any illness considered self inflicted is not going to be portrayed in the media in the same way as something which appears to be completely without blame not to mention something as emotive as breast cancer. You wonder what would happen if an extremely expensive drug came along for the treatment of lung cancer, whether the newspapers would offer the same support they did to the women trying to get hold of Herceptin.

People like my brother in law who has Motor Neurone Disease, are never going to be seen as worthy of this kind of media attention, yet such diseases are not caused by smoking or eating the wrong food and cannot be cured. Of course it is also a much rarer illness, but is horrific in the way that it removes the mobility, agility, dexterity and self respect an individual with the condition had. This and other more common diseases which cause great levels of disability are where the bulk of NHS care is taking place, but you wouldn’t really know that.

I found the NHS still seems to be there, functioning as ever through the medium of emails, where would we be without them? 105 (probably not all different) people sent me one during my absence. I am sure I wouldn’t have had that many phone messages and letters awaiting me if the email had never been introduced within the NHS, but I guess it is a way of knowing that you have been missed by at least someone. I never know whether to start from the bottom or the top of the pile, or whether to sort them by sender. If you start at the bottom, you find out you deal with things which somehow have ended sorting themselves out over the course of a week. There is also the problem of people starting to reply to your replies once they see you are back in the office, which then creates more work and stops the unread email list from seeming to go down. Ah the joys of an office bound life!

This morning though was spent in the company of a group of health visitors, exploring some advanced communication skills with our family therapist. This was day 4 of a leadership course I have put together for this group of staff who are in the middle of a restructuring of their service and the way it is delivered. It is a difficult time for a service like health visiting as they are having to come to terms with the prospect of a service targeted at those in most need rather than one which tries to be there to do everything for everyone. They are also having to admit that there are parts of their role which can be done by people who are not qualified health visitors. This is being done in the middle of a vacancy freeze and severe financial constraints, so their jobs as leaders within the service is not an easy one right now. We had to end early due to sickness levels within the team, which gave me the joyful chance to see inside my email inbox today!

More emails when I got home, this time an ever increasing level of panic amongst my fellow students about our impending essay deadline. I was feeling reasonably calm, but am now wondering if I shouldn’t be getting into more of a state over it. It is hard to know in this kind of situation whether you should own up to being reasonably confident, then risk finding out should have been panicking with the rest of them. I wouldn’t mind but this is only the start of the course, there are another 8 or so assignments to go yet!

Friday already, I guess that if you take a week off that is punctuated by a bank holiday and where teen son doesn’t return to school till Wednesday, then it is likely to go quickly. Just to reassure you it has. In fact it has gone so quickly that I could get used to this life, or could I?

I know there are plenty of people out there who think the place of a wife and mother is in the home tied to the sink and cooker, but I have never been one to enjoy such a life. I tried the staying home bit after teen son was born (15 years next month), and found it hard to fit in with the mums at ante natal and clinic. I was living in an area of town with a high level of social deprivation and a lot of teenage mums at the time and was 28, so I guess that is not such a surprise. So I was glad to return to work when he was 5 months old. That is not to say I didn’t miss him, and for the first time faced the dilemma between staying with a dying patient a bit longer after work and rushing home to my baby!

Any way I digress. Not to be out done by hubby before Christmas, I am going to offer up my list of completed / half completed chores for the week:

Tuesday - well hard to get going, and get motivated as hung over (not literally form the new year weekend) but took teen son to visit his cousin at my mums. Brad lives far enough away that we probably won’t get together before half term. Did the most massive pile of ironing on my return and left it strategically placed till hubby got in from work!

Wednesday - Up early to take Teen son to his friends house to walk to school (I know he should walk all the way but I am soft). Started the much planned essay on organisational culture, which is the first assignment for my MSc in Strategic Leadership. Completed about 900 words, then decided that the Christmas tree was dead so got on with dismantling it and then did some cleaning.

Thursday - Slightly less early start, as Teen son had a GP appointment at 8.40. He has been suffering from acne for about 2 year now and has recently started on minocin. Which is meaning we are getting to know one specific GP (who I have also previously worked with) very well. I have trained myself over the months to let teen son do the talking and to understand that the doc is seeing him not me. He is getting close to the age when I may not be invited in to the consultation so it needs doing. We also collected a form for a blood test which is teen son’s first ever. We will go to the local hospital after school on Friday as the appointments at the surgery were right in the middle of school time. It should also be quiet then, but not sure who will be most nervous him or me,also not sure if he will want some hand holding or if he will be too old for all that stuff. I bet I will have to buy him something in the shop afterwards though just like I would if he were 5 (chocolate probably).

In the afternoon I took my car for it’s first service. It is marvelous that a car can now go 18,000 till it needs to visit the garage; not so great when you get the bill of £200. Still hopefully it will be another 18 months before it needs another one.

Friday - Only 11.30 am so less to report, but I am up to 1600 on the essay (over half way) and now need to do some serious housework. Ah a woman’s work? Never done!

In fact I’d go as far as to ask the following questions:

What is a nurse?
Are all nurses the same?
Are nurses turning into mini doctors?
Should nurses know their place?
Are nurses less intelligent than doctors?

These all arise for me from a discussion which has been happening today over at Dr Crippen’s Blog, please take a look to get acquainted with the facts, as I am not sure I can go into it all now.

One of the major problems with nursing in my opinion is that nurses really don’t know what they are meant to be any more. Now if a nurse doesn’t know what she (or he) is then heaven help the poor feeble minded doctor, not to mention the patient. When I trained as a nurse (and yes it was an apprentice style training) at a large London teaching hospital nurses pretty much learned how to care. We were there to assess the patient, but only in the context really of the care we would deliver, and to ensure there was nothing we needed to call the doctor to do for us. In those days we gave intravenous drugs, but did little else which could be thought of as the domain of medicine. We followed the consultant on his round (and it usually was a he, unlike today), made notes and carried out orders. We didn’t challenge what was said. If the doctor struggled to communicate adequately with the patient, we went back and quietly picked up the pieces. After all we couldn’t expect the doctor to be able to do that bit it wasn’t his job.

In the 1980’s something radical happened. Each nurse became responsible for their own actions, and even more radical, they were allowed, if they thought they had the correct knowledge and skill to do a lot more of the things previously done by a doctor. This led to nurses defibrillating patients, cannulating, giving more scary IV drugs, and even beginning to take on minor surgical procedures.

As time went by, nurses took on more and more of the work that had previously been a doctors. Not all nurses, and certainly not all nurses agreed with this. A lot of nurses see their place with the patient, administering care (whatever care is), and a lot of doctors feel that nurses are doing things that they have neither the knowledge base nor skill to do safely. Now someone has had the audacity to let nurses prescribe and for some this is definitely the thin end of the web. Now I have my own reservations about letting too many nurses, with too little real knowledge loose with a prescription pad and the BNF, but then I have seen some very dodgy medical prescribing so let’s not get carried away.

What we need in nursing is a proper career structure. Where you learn how to nurse before you move onto the extended roles, where you learn how to communicate before you medicate. I would like the nurses at each level to be educated appropriately for the job they are going to do and I would like to see them paid properly when they reach the higher levels of practice. In my own opinion I was a reasonably good District Nurse and a pretty good Specialist nurse once I had been prepared for the role. I wasn’t a doctor and didn’t need or seek to act like one. But what I wanted most was to feel I could give the best care to my patients. I wanted to be part of the specialist team (consultant, nurses, therapists) where we all had a part to play in the care of our patients and I wanted to make sure that the patient knew when he/she needed specialist care from us and when they needed their own GP.

The lack of structure, the lack of recognition for the work I did and unfortunately only too often the attitudes like the ones expressed over on Dr Crippen’s site got to me in the end and here I am.

Not sure I have answered my own questions, but no doubt this is a topic I will return to in due course.
Nursing NHS

Though sadly not sitting on a beach watching the sea, but you can’t have everything. Hubby is back at work, and teen son has grudgingly gone back to school to continue the education he declared yesterday to have learned sufficient from. This morning his 43 year old mother has been continuing hers, and I am pleased to announce that I have written the first 800 words or so of 3000. When I read back what I assumed was a load of rambling twaddle, I found it actually to be quite good for the first draft, so I have decided to rest the brain before I over do it.

Organisational culture is turning out to be a more complex, though interesting topic than I had realised. I am trying at this point to be broad minded and not think too much about the actual culture within the NHS but to keep to the general topic itself. One thing that I do know though, is that the NHS itself is not actually an organisation, it is hundreds if not thousands (if you include each individual GP surgery and clinic). I will offer more of an insight into the whole thing when I have completed the essay.

I have decided that I couldn’t wait until 12th night to take down the tree, as unfortunately it was dying and despite being non drop, needles were falling onto the carpet at an alarming rate. While some people find taking down decorations depressing and say that they make the room look bare, I find it helps to declutter the area and makes it look more tidy. It also offers the opportunity to properly clean up for the first time in a couple of weeks (no I don’t mean I haven’t had the dyson out, it just isn’t so easy with a great big tree in the way).

In my absence from work, the NHS news stories continue, as David Cameron, the new leader of the Conservative party has announced a party policy change, and a review of what will go into their next manifesto. Gone is the idea that the NHS should support people obtaining private health care, and in is the radical idea of health care being free for all at the point of need (something thought up in the 1940’s I thought, but perhaps I am so confused that it is new after all). Anyway he has 4 years or so to decide what the actual policy is before the next election so that gives Labour plenty of time to make plenty of changes to services in the mean time.

I think one of the things the politicians could do with thinking about is what is actually meant by need and who decides who needs what? In the new patient led NHS you would imagine these decisions will be made by the patient him or herself, but if that is the case then how much will that cost? I have the feeling that even if all government money as pumped into the NHS there would still not be enough to go around and managers in general would be blamed for this. I am increasingly at a loss to know what the answers to the questions might be as all I can think of is more questions. In fact there are so many questions that going back to my essay on organisational culture is feeling very inviting indeed.

NHS Organisational Culture