First the rant. I receive emails from the Health Service Journal (HSJ) though am not a subscriber to the actual journal (previous journal buying has resulted in piles of them waiting to be read while the direct debit goes out of the bank every month), and periodically I take a look at the news alerts. Today I was drawn to a story about the money that is levied for education and training for everyone who is not a doctor known as the multi profession education and training levy (MPET). This money originally comes from NHS organisations (at source like income tax) and is given to the Health Authorities to be allocated for education purposes. It is this money that goes to pay for the tuition fees and bursaries of student nurses and also to help pay for education for those of us who are healthcare professionals (in the broadest sense, a professional but not a doctor or dentist). Last year there was practically no money, and considering the fact that the current NHS agenda is about service redesign and reconfiguration that is a situation that cannot continue.

The HSJ reports today that some strategic health authorities are planning to divert up to 11.8% of the budget to what is described as ’strategic resources’. Surprise surprise, the health authority within which I live and work is one of them.

“NHS East of England director of workforce Stephen Welfare said: ‘We have managed to transfer some funds from the MPET budget to front-line patient care services across the region, while ensuring that the number of people who will have access to education and training remains unchanged from last year. Patients and clinicians in our hospitals will welcome this efficient use of resources.”

My response: Last year we saw practically no money so it is no reassurance that levels are the same for this year, secondly, we have had frozen posts and cuts to services so I wonder how happy our patients and clinicians really are!

On a happier note, I am thrilled to report that my dissertation is FINISHED!!! I have been to the book shop and bought a novel (well 3), and I intend to read and drink wine tonight – so there!

So the BBC weather man tells me as I am typing this, So much for global warming. Don’t get me wrong I know this is an important environmental issues but it is on days like this, when I have my central heating blasting out on 29th May that my cynical side emerges. The good thing about the wash out of a bank holiday has been that I have made enormous progress on the dissertation and for the first time I actually believe it will be done by Friday. I now have a few changes to make to my data analysis section, then have the limitations and conclusions to write up and that will pretty much be it. I have so far written more than 17,000 words and that in itself seems like something of an achievement and having read it all today even if I say so myself it isn’t too bad at all.

The end of all this couldn’t come sooner, as my job is starting to get busy and I really need to be able to concentrate on it. Isn’t it just typical that just when I start a job where commissioning maternity services is part of my role, then hey presto it rises to the top of the health care agenda. This means that it is an exciting time, because I hope it means that a service that has been terribly neglected for a long time will at last receive more investment. But only if we work closely with our providers to make sure that is what happens. The birth rate in our local area is increasing, but we are working against non clinical managers who think that demand could be better managed! That is why, and I know it is controversial, there should be ex clinicians working in managerial roles in health care.

With just my reflective practice module to complete (once the dissertation is put to bed) I have just about 6 weeks to go before my holiday and I have to be honest and admit I am feeling a bit on the weary side. But when you consider the job uncertainties that occurred at the beginning of the new year, the new job I started in March and now finishing off my MSc I am not surprised. A pleasant offer at the weekend, my in laws want to treat us to a cruise later in the year, so things just get better!

Apparently my last post was Punitive: Online dictionary definition: Inflicting or aiming to inflict punishment; punishing

So this suggests that asking questions about the conduct of a group of doctors is in some way wrong? It is ok, however to suggest all nurses who call themselves practitioners are failed doctors acting above their station!

Give me strength!!

Meanwhile my day has been spent writing up my dissertation, 15,000 words and counting….

Any death that may in any way have been preventable should be thoroughly investigated, system failures identified and changed and if necessary people who were found to be lacking personally or professionally held to account. Yesterday it was reported that the death of Penny Campbell, which occurred over an Easter weekend, happened despite being seen by or speaking over the phone to 8 GPs from the Camidoc GP Co-operative. Much has been written about many aspects of government policy that in people’s opinion is harmful or just downright wrong and indeed I have heard people on the TV news speak of the government ultimately being responsible for the death of Penny Campbell. But is that really the case? Why haven’t the UK doctors of the blog world been discussing this case as they surely would have if any kind of nurse co-operative had been involved.

The system of out of hours care in this country is a mess. When responsibility for it was handed to PCTs they were ill equipped to take on the role, but in the mean time some good services have grown up, many of them run by GP cooperatives, though you do hear of some stories about doctors flying over for a bit of weekend work for the most amazing sums of money. Camidoc though reports on its website that it has been running since 1996 and that it has 300 GPs in its co-operative. It says that some nurses are now being employed but that previously the service was run by GPs.

The report into the death of Penny Campbell criticised the systems and processes of Camidoc and the way in which the local PCTs monitored those systems. But who created the system that meant that each call to the service was treated as a separate episode of care. The department of health perhaps could do more to make sure patients notes are available to the out of hours service (I am no expert on this but perhaps that is the reason behind connecting for health), but at the same time why does one out of hours provider not have a system for highlighting that a person hasn’t been seen or spoken to before? Gordon Brown appears to accept that changes need to be made to the way out of hours care takes place, but in this instance I am not sure that the department of health / government can be expected to take full responsibility for this failing. I would welcome the comments of GPs in this matter, because I am wondering where the professional voice is in relation to this issue. Am I being a cynic here?

By the way, I am writing about this topic without a great deal of knowledge, it not being my area of specialism (if I currently have one) so am happy for any information which tells me that my opinion is wide of the mark on this one!

A bunch of about 40 elderly people, some as old as 90 have got together to form a group called The Zimmers and perform My Generation which is apparently to be released as a single next week for charity.

I only hope I am like them when I reach such a ripe age!

Until my dissertation is due in and I am struggling with it all. I have only written about 700 words since the weekend, and I am struggling to put one word in front of the other. I intend to work hard on it over the weekend, and at 11,700 words am making reasonable progress but it would be fair to say that I could have worked harder. Doing a masters course at the same time as working full time is no mean feat, but I find that I struggle to be motivated after work to get down to the books and actually writing stuff.

To keep me going I am now thinking of all the things that I will be able to do when I no longer have to read books about leadership and action learning and when I no longer have to write about methodologies and data analysis. So here follows a list of things that both need to be done and can be done after Friday 1st.

1.  Housework – I have had the dyson out this evening, but all cleaning in the last few weeks has been superficial, I don’t want to do housework but it will have to be done and done thoroughly.
2. Buy and read a newspaper without feeling guilty. I usually only buy them at the weekend, but there is nothing better than curling up on the sofa with the newspaper on a sunday afternoon (well maybe there might be but you can’t have everything)
3. Read a book that hasn’t been sourced from the university library or bought from the reference book section of amazon. I want to read novels, nothing too deep and meaningful, but a novel just the same.
4. Go out for the day at the weekend, visit places and people without thinking that I should be at home doing something more important.
5. Get stuck into my new job and read about the things that go with it without thinking about the other reading I need to do for my dissertation.

So just a week and between 4 and 9, 000 words to go. I for see a heavy weekend, but I do see the light at the end of the tunnel! Photo from here

Both have been about applying for jobs, about an attempt to make fundamental changes to the way in which things are done in the NHS. One, is about medical careers and an ill thought out online job application process for junior doctors and the other is an ill thought out reorganisation in primary care trusts which involved more senior managers. While the broad agenda of Modernising Medical Careers will no doubt continue, the application debacle was pulled and not before time. I am no expert on this matter, but I have watched the whole sorry affair unfold in the press, on various news programmes and for the most part on the many medical blogs which have covered it both from a personal point of view and from disbelieving but angry senior doctors who have campaigned for the process to be abandoned. some of the people involved in all this, even if they manage to secure the jobs they want will be suffering from the effects of this for some time.

Commissioning a Patient Led NHS on the other hand has not been well publicised. Who after all cares about the reorganisation of the PCTs, and of the resulting potential job losses to managers. It involved online applications for the most senior people, interviews and then the lucky people starting their new jobs. But it has meant others have spent the last 18 months not knowing what they would be doing after 30th June 2007 and I am sorry to say that some people still don’t know. Some like me have had to start what is almost a new career on a lower pay band (all be it on protected pay for a period of time), others may have to accept the first job that comes along and others may in the end be made redundant. Even those who have jobs (like me) feel damaged by the experience, confidence dented, career in a bit of a strange place. Other colleagues who have no job may well never recover from this whole mess, they have been mucked about, ill advised and told by the union (Royal college of nursing) that there is really nothing that can be done.

I wonder what it is about our professional organisations that means they appear no longer to represent those who pay for them to exist. Ok so I am not your average nurse anymore, but I still pay up my subscription each month as do many other nurses who are now managers. It would be nice to know that they are out there supporting us, but then if the BMA can’t do the right thing for junior doctors I think I am barking up the wrong tree!

Just back from an evening out with some former (and current, to be honest) work colleagues. These are the kind of events that I kind of dread going to because first they are usually midweek and secondly these are not necessarily people I would choose to mix with socially (not all just some). But in fact they are events that once I am there I quite enjoy. I have to be honest and admit that I tend only to chat to the people I want to at these things, though of course I am pleasant and say hello to everyone else, but you can’t speak individually to 17 other people in 3-4 hours flat. I am quite an outgoing person but actually not so good at small talk, so I have to want to spend time with someone to feel able to get stuck into a conversation with them. Plus as you get older, I find that you do less things because it is the right thing to do and more things that you want to.

During the working day, I have been to Newmarket which is a kind of market town well known for horseracing which is about 70 miles from home. Today was about Maternity Matters, the government choice agenda for maternity services and involved bringing people who provide maternity care, those who commission it and anyone else vaguely interested in it together. Generally interesting stuff, but as usual you are left wondering how it will get done, how will it get done and is it worth getting done before the agenda changes to something else. It also makes you wonder what people really mean by choice, because if it is about making sure a mum to be gets the safest care then that might mean no real choice is available. Thinking back to my own experience of maternity services, I developed complications which meant that I required in patient care before delivery, monitoring throughout and all of the high tech input of the whole team. I was never going to get my delivery at home and would never have wanted it and to be honest never felt that I missed out on anything. However the experience wasn’t all that pleasant and is related to the reason I only have one child now. Still life in commissioning is certainly turning out to be interesting!

If we are to believe everything we read in the newspapers and see on TV all teenagers are essentially hooligans who hang around street corners preying on old ladies, beating up young children and generally being unpleasant. As the mother of a teenager I would never claim that my son isn’t a nuisance at times, but he is well brought up, generally considerate and has a great bunch of friends. The same goes for my 14 year old niece who on Saturday went on the bus with 3 friends (a boy and 2 girls) to her local shopping centre. While there they were generally harassed by a large group of youths who were generally much older than them. They became concerned about the antics of the group and told the shopping centre security people who told them in no uncertain terms that there was nothing that could be done. Outside though things got nasty and they were threatened with knives and chased, the children rang the police and were told by the operator (who mistook hysteria for children mucking about) to grow up and go away. Having been followed to the bus, but once on board able to get safely home, they realised that they had had a lucky escape. Ok so they should have contacted a parent, but they thought they were doing the right thing in contacting security and the police. My sister in law is in the process of getting the police to investigate the matter, but the whole episode is a sad indictment of the way we treat teenagers today. We assume they are the trouble, not the potential victims. We treat them with disdain and fear then wonder why they act in the way they sometimes do. Teenagers are mostly not angels, but they are most definitely not the devil incarnate either.

Health services across the country are being reviewed. In many urban areas we have been spoiled by having an acute hospital with emergency facilities in pretty much every town. This may well have included a maternity unit, a full range of surgery and medical care, and in patient children’s services. Changes though to the way in which these services are managed and delivered are a foot and there are a number of causes including government policy, changes to workforce and the numbers of hours they work, the training they need to perform their job etc.

My current job means I am now involved with the review of maternity and children’s services in this area. The things that we know are that for reasons of clinical safety we have already had to move children’s emergency and in patient services and that another hospital trust will probably be doing the same soon. We know that the maternity units which currently take place on two sites per acute trust will also need to change, so we will look at the birthing unit ideas. In consulting we will ask real people who might have a baby and try to find out if they would want to have a baby in a place where there is no onsite paediatrician or obstetrician, we will also work with clinicians to look at the potential models of care. But if it is not going to be viable either clinically or in terms of the number of delivers (i.e. financially) then it won’t happen and services will be centralised. People might not like this idea but unfortunately we have moved away from small is beautiful and we cannot adequately staff or indeed improve services in small is beautiful. This doesn’t mean that free birthers will be the winner and it doesn’t necessarily mean that more women who shouldn’t do so will have their babies at home but what it does mean is that other people and not just doctors and midwives will get the opportunity to give their opinion and influence the decision. Cynics may think that ‘managers’ will just make the decisions and consult with no one, or at least consult then do as they please anyway, but actually I don’t think they will. We might not like the government’s choice agenda but we have it and we have to get on with it.

But the way that we say them. Two things this week have prompted me to think about the things that are said and the way in which they are said and the importance of how they are interpreted by others. Last night I was watching a UK hospital drama, well more like a soap seeing as it seems to be on all the time. I don’t think it portrays hospital life exactly as it is, well I know it doesn’t, but haven’t worked on a hospital ward for so long that it is best I don’t make any assumptions. A very unpleasant patient and his family were portrayed on last nights episode (now as we know not everyone is nice so it is possible that sick people can be unpleasant), and during heated conversations he told the black female doctor that he preferred to see the organ grinder not the monkey. Now this was meant and taken as a racist comment, but it can also be used as just a derogatory comment used in anger, I know this because a patient once used it on me.

As a specialist nurse I worked in clinic with the consultant. Patients were booked in to see me, usually to start on new medication, discuss progress with their condition and the like. They were always able, at the very least to have their cased discussed on the spot with the consultant and often to see him if necessary. On the day in question a man with recently diagnosed rheumatoid arthritis arrived to see me to start on new medication having seen the consultant a week or two before. He walked, or limped in, sat down. I began to ask him about his symptoms and talk about the proposed medication and in response he looked me up and down and said, hmm well, actually I would prefer to see the organ grinder and not the monkey. A little stung, but keeping my composure I told him that I would go and speak to the consultant right now and left the room.

The consultant was incensed and marched down the corridor to the consulting room and told the patient in no uncertain terms that he would not accept that kind of behaviour, that I was very experienced, but that I always consulted with him. Then calming down he examined the patient who had a particularly swollen and painful knee. A stroke of luck then ensued, because he said, well we need to get you on these new tablets and Julie will go through them now, but also you need your knee aspirating and injecting and Julie is fully qualifed to do this for you. When the man returned 6 weeks later for a follow up he was full of praise for me and from then he often came to my clinics, and never grudgingly.

The second incident is completely different but if anything more disturbing. Apparently if you are applying to adopt a second child in an area near to here, then it would be best if you called your first child’s real mother their ‘tummy mummy’ and not birth mother. Because if you are using the wrong terminology then it may put the process in jeopardy. Never mind that you are making a pretty good job of bringing your 4 year old up and that child is happy and well adjusted. Some social workers still seem to like the power they have and that is all I will say about it.

It was with great sadness and a sense of irritation on her behalf, that I discovered yesterday that the Fat Doctor blog is no more. Some wicked person had found it, printed the whole thing out and shown it to her boss, now that is below the belt. For those of us who blog about work, and in particular those of us who have professional responsibilities to uphold we are always in a precarious position. Fat Doctor provided us with some wonderful insights into her life, yes her work life but also about her home and family life, her childcare arrangements and of course her illness. I know that those of us who read her recently will miss her and hope she will be back very soon.

The thought of being discovered and outed is on my mind a lot now, so I am becoming increasingly worried about blogging about work per say unless I am talking about things personal to just me or so general as to not really matter. It does tend to cause your creativity to suffer though. Why am I worried? Well I am now doing a job which is specific and only I do for the whole county. If anyone who knew me well were to find this blog it would take them just a few minutes to discover it was me and while I don’t think I have broken any codes of confidentiality, professional practice or indeed moral responsibilities to my employer it is still a consideration. Hopefully I don’t know anyone quite as mean as the person in Fat Doctor’s office, but you never know.

On a more positive note though, at the start of my course I started categories entitled reflective practice and post graduate, the entries to which I will soon be using as the basis for my reflective practice portfolio to be submitted at the end of my course later in June. I am really what might be described as a last minute person, and that is why it is a stroke of luck, because everything else that might go into it is actually stored in a pile of papers on the spare bed! On another positive note, my dissertation is now 8600 words and I am ready to move on to my methods and findings. I can now take back to the library all the books on philosophy that made me look clever but which are pretty hard to read.

What has happened to Fat Doctor and others will not put me off blogging, but I intend to be careful. Mind you we have a summer of teenager antics to come yet as he is in the midst of exams right now but then will have a very long summer to get into mischief, plus there will be his prom to post pictures of. Maybe this blog could be renamed…….. or maybe not, I work in the NHS and I am going to write about it!

I am the proud owner of a new laptop! Last evening between setting the chilli con carne to cook and then eating it I went to a local electrical store and collected it. I might tell you (and yes I am biased) that it is a pretty good machine, well it will do what I need it to do and what is more as is often the case with things electrical it is about half the price, half the weight, slicker, faster and has more storage than my last one. I know this is all a bit geeky, but as someone who can surf pretty aimlessly for hours (all in a good cause usually of course) I have really missed it and it is good to be back in the land of the blog.

My work this week takes me into the realm of antenatal and post natal screening. It is amazing that we can detect so many serious conditions through a simple blood test either from the mother or from the baby by a heel prick at birth. Introducing a new disease to be screened for does though cause discussion to take place at the most detailed level, which is important because everyone needs to know the processes involved but sometimes you are left wondering if people like the sound of their own voices.

Today I am organising the local maternity services liaison committee (MSLC), which every area has to have so that health professionals and those using (or formerly using the services) and others interested in all things baby can get together. Anywhere where you get such a diverse group of people together is extremely likely to be the source of a future blog post. Dare I say that it is more entertaining than being in a room with 25 doctors, midwives and health visitors, particularly where the seats are none too comfortable and the room would be more suitable for about 10. But that is all part of lifes rich tapestry isn’t it?

The thing with a new job is that it often allows you the time to get to know what you are meant to be doing, to meet new people and find out new things. People make allowances for you and allow you more time to get things done and allow you the opportunity to make a few little mistakes. One day thought all that has to end, and the amount of work you are expected to produce goes up. This is not a bad thing you understand, but it can kind of take you by surprise especially when you are trying to grab the odd 10 minutes to add to your college assignment.

So I now have more work to produce than enough, long documents to read to help deliver that work and meetings to pitch up to and show an increasing understanding of. I am not and do not want to be thought of as a manager who is a waste of space, heaven knows I defend managers more than enough myself. Of course I am glad to be busy, glad to have worthwhile (well in my opinion) things to do, so without further ado I am off to get it done.

My enforced break from all things computer seem to be taking their toll on my ability to string a sentance together on my blog. It has now been over a week since computer and therefore internet access was easy due to the terminal break down of my laptop and also to the fact that any access to the computer is meant to be restricted to writing my dissertation. Luckily no writers block there, though I need to get my finger out if it is to be done on time (7600 words and another at least 7500 to go and maybe more).

Usually if I am struggling to think of something to write about I just read other people’s blogs and websites and something strikes a cord and away I go. This is not something that can be done in 5 minutes flat though, and really I haven’t had the opportunity or time for any aimless (or aimfull if that were a word) surfing.  I am now ready to buy a new laptop but the wish to buy the right one at the right price is kind of slowing down the decision making process. Maybe I should just go and get one and be done with it, but well £450-500 is a lot of money (about what I plan to spend) and I don’t really want to make a mistake on this one.

Why are teenage boys so messy? That is today’s question. I am currently sitting surrounded by school books and papers, other peices of paper which appear to have varying levels of importance, drinks cans, an over flowing bin, clean clothes which he hasn’t yet put away and may not be clean for too much longer. Having said that, I was reasonably messy myself, but in a much cleaner way I am sure. This room is practically a health hazzard and if I was any kind of mother I would get my marigolds out now and start cleaning. Instead I think I will write a thousand words or so on my dissertation and keep my eyes to the front and on the screen.

So much for writers block – there is always something to get you going isn’t there?