You spend weeks preparing for a holiday, you look forward to getting away from work and home and before you know where you are, it is all over and all you have is the memories and a few credit card bills still to arrive. As trips go this was both busy and essentially relaxing. Busy because a Mediterranean cruise is about the places you are visiting rather than the time you spend lounging on some deck (particularly at the end of October when the weather is hardly hot). But also relaxing because you get to receive a particular level of service, food and general hospitality we wouldn’t usually seek or receive. I wasn’t sure how I would like a cruise, I wasn’t sure what my teenage son would think, but actually we all had a great time. This doesn’t make cruising cool for a 16 year old who has told his friends he just visited Italy, but actually I am not sure what there is to be ashamed about, but then I am a long way from 16 so what do I know?

I cannot describe quite how tired I felt before I went away. I had not been sleeping well in the couple of weeks leading up to the trip and was finding it hard to function. Yesterday as I returned to work properly (I had been to an out of town meeting on Monday) I did feel rested and certainly more alert. However there is that strange feeling you get on that first day, where nothing that is said or done can quite affect you, where everything just washes over you. Sadly that feeling doesn’t last for very long (usually a day in my experience). The good feeling was also tempered on the way home by the fact it was dark (clocks went back on Sunday)  and that petrol has now reached a pound sterling a litre. It is going to be a long winter!

For pictures of our trip, have a look in the side bar as I have uploaded for the first time to Flickr.

Well the Mediterranean.  Tomorrow, before dawn we set off for Barcelona to join the Royal Caribbean cruise ship Voyager of the Seas. From Barcelona we will be visiting the south of France near Nice then travelling on around Italy and visiting places such as Pisa, Rome, the Amalfi Coast and Palermo. I hope to return with some photos to post here, so great tales of our journey and hopefully feeling somewhat more rested that I do today.Life in the NHS resumes in a little over a week.

I have never been what you would describe as thin. Even as a teenager as someone who is tall and has a reasonably large frame I wasn’t your size 8 model type (I am talking UK sizes here). But as a young person I was never over weight in real terms. I have always liked my food, my mum gave us good home cooking and I learned both from her and at school how to cook meals from scratch. As a young wife I experimented through my cookery books cooking all kinds of lovely dishes, my tastes are more in the savoury than sweet; I am no chocoholic. As a young nurse I did a pretty physical job, there was no need for nor did I have the inclination for exercise for exercise sake (you will never seem me out running for example). I am a nurse, I understand about nutrition and what is more I am an educated individual with reasonable common sense, yet earlier this year I found myself at least 3 stone over weight and needing to wear size 18 clothes.

If I am to believe the latest report on obesity though it is not my fault. The problem lies with modern lifestyles and the fact our bodies can’t cope with the way in which our meals are presented to us, with the use of the car rather than our two feet etc. There is no escaping the obesity problem that faces us in the first world. Rates are rising alarmingly, indeed locally 30% of children are already overweight when they arrive at school at 5 years old. There are people out there who either don’t know how or don’t want to prepare good healthy meals, who are unable or unwilling to take exercise on a regular basis, there are children who are not allowed out to play by their parents for fear that they will be abducted but who are equally not given the chance to exercise properly by those same parents. But I am not in that category. The responsibility for the size I was on August 1st lay with me. It was due to over eating, over drinking and a lack of useful exercise. At 45 years old I was a recipe for heart disease and diabetes waiting to happen (thank heavens I am not a smoker)!

Since August I have lost 14lb (a little more than that I hope, as I am due to get weighed at slimming world), and I am on the way to a slimmer and healthier me. I have increased my level of exercise and I have begun to look closely at what and how much I put into my mouth. I actually do not need crisps and cakes every day, I actually do not feel hungry between breakfast and lunch because my fruit and yoghurt breakfast fills me up. I do not need a plateful of food and because of that I can eat most kinds of foods and still lose weight. It is a struggle. It is easier to just eat what is readily available, but who said life had to be easy. What I am clear about though is that just as being over weight is down to me, so is being slimmer. This may come as a shock, but obesity in middle classed people is not the fault of the government!

I am a Master of Science! Today I received my official mark sheet for my MSc in Strategic Leadership, and so if I so choose I guess I can go around putting MSc after my name. I used to work with someone (manage them even) who put all the letters she had from her academic courses on the bottom of all emails. I found this slightly odd and just a bit pretentious. I wanted, as her manager to tell her to take them off, but felt I was being petty. Interestingly now she has a new manager she has stopped this practice, not sure if the two things are related.

Anyway as I was saying I am a master. I have been wondering whether I really want to go to the graduation, and after much reflection, debate with my husband and general adding up of the cost of gown hire etc, decided to give it a miss. I went to my BSc graduation and thoroughly enjoyed it. I took along hubby, teen son who might not have been a teenager then and my parents, who as you might expect were very proud. But having been and done that, and plus thinking of how much champagne and food I could buy if there was no £41 a time for the gown and silly hat and no £19 a time for guest tickets the decision has been made. No award ceremony is going to make me more masterly after all!

A blog linked to me the other day and in the process called Life in the NHS ‘tame’, though ‘worth a read’. Now I am not offended by this, but it has made me think. You see, in real life people say I am quite scary. I am knowledgeable in the things I do and I am not renound for my great tolerance of fools so to be accused of being even slightly tame comes as a surprise. But of course in my blog, (as I have discussed before) I struggle to be myself. In a way I would have loved to have been writing this when I was in proper clinical practice. Even with the constraints of patient confidentiality I think writing about the trials and tribulations of nursing would have been much easier than writing about management and some of the encounters I have these days. You see, when you do a job which covers a whole county, and when there isn’t anyone else doing the same specific job it becomes just slightly tricky to discuss subjects with any degree of openness. I want to say so much, to tell the reader about what it is really like to be trapped in middle management between the powerful and the great (or those who think they are) and everyone else. But it would be true to say that I am a little (well more than a little) nervous of doing so.

So in the mean time, I will remain tame, but I am also masterly and that cannot be a bad combination!

This week in the UK the Health Care Commission have published a report into what was described in the media as ‘a serious outbreak’ of Clostridium Difficile at a Hospital in the southeast of England. Between April 2004 and September 2006 over 1100 people developed the infection and some 90 people died. The Commission found evidence of poor infection control practices, poor cleanliness within the NHS Trust hospitals and evidence of poor care of the patients who suffered from this awful condition. They also identify that the buildings which made up the hospital were old and in a poor state of repair, that beds were placed too closely together and that high bed occupancy and a shortage of nurses had contributed to the situation.

In a world where blame needs to be laid at someones door it would be easy to accuse nurses of not caring, cleaners not cleaning and managers failing at allocate money to the right areas of the health system. However, like most things just blaming one or two groups of people for individual failings would mean that people missed the point. In my very humble opinion what we have here is a whole system failure, many years of under investment (or at least in the right areas) and an obsession with counting the number of people with one infection while failing to notice that people were in fact dying from something else under their noses.

If the hospital was in a poor state of repair, then one wonders why that might be. Is this because for years there seemed to be no investment in the upkeep of hospital buildings at all. I worked in a hospital myself where no walls were painted or fixtures and fittings replaced for a good 10 years. In addition, each re-organisation is going to close this place and open this one, and I guess if you always think yours is the hospital to be closed and moved to or merged with some where else you might not bother with the decorating.

If the cleaning is poor, maybe it has something to do with the way in which in house cleaning services were contracted out to the cheapest provider. Maybe it has something to do with the poor wages paid to staff and the fact that they just get treated as mop machines. Maybe they are poorly trained and don’t understand about infection control.

If insufficient money has been spent then maybe it is due to the poor financial management that has taken place across the system, maybe it has something to do with the target driven way in which they are asked to manage. Maybe the fact that at the time of these problems the local health economy was one of the most over spent in the country and was being forced to pay this money back.

Maybe the shortage of nurses is directly related the poor financial position of the trust and the health authority, which led to vacancy freezes, to poorly staffed wards, to nurses who couldn’t cope and to poor care.

If staff failed to treat Clostridium Difficile as an illness on its own perhaps this is because they didn’t understand what they were coping with, maybe they were overwhelmed with having to care for ill people who were suddenly developing diarrhoea. Maybe they didn’t know how serious it was because the government asked them to count MRSA not C Diff.

I am not working in clinical practice, so do not have recent experience (thank goodness) of looking after someone with C Diff. However, I have heard a few local horror stories of patients being discharged and the district nurse discovering that actually far from being well and ready for discharge their patients are in fact very ill with something quite unexpected and unassociated with the problem they were admitted with. It has taken far too long for people to sit up and listen and notice. Mangers have been trying to save money, to save the jobs of politicians and mean while the health care system has been collapsing around their ears.

My hope is that this report will be read by everyone around the country who provides care to people, who cleans wards, who manages wards, units or services. Most of all I hope it is read by those in charge of NHS trusts and by those who work at the department of health. I hope that the person at the bottom of the pile (i.e. the nurse cleaning up the patient and the cleaner cleaning the floor) is not the one to take the blame because in my opinion the responsibility lies with all of us. Last of all, I hope that people who need hospital care and their friends and family will take notice of the instructions for hand washing, for sitting on beds, and for other general precautions and not imagine that this has nothing to do with them!

That I am happy. I am over the mess that was CaPLNHS, I am motivated, I am enthusiastic; yes probably I am slightly nauseating! This week our organisation was a year old, and celebrated by sending itself a card with a lovely looking cake on it. The staff were displeased, there was a card, but where were the real cakes? We could have accepted more money wasting if it had meant cakes. Of course, I no longer eat cakes as I have now lost 14lb or indeed one whole British stone and am on my way to slimness.

But back to the title and purpose of this post, which is to let you share in my happiness, to let you see that I am now glad to be alive and happy to work in the NHS. My job is actually a good one and what is more is pretty fun to do (well it is fun when there are no members of the paediatric medical profession and patient form groups involved) plus I am being allowed to do other things that I like to do, like teach on leadership courses and help out at away days for community matrons. Of course I will be allowed to do these other fun things so long as I am nice to paediatricians and PPI people and also as long as I do all the proper children’s commissioning work I am meant to do (which of course I do).

I no longer feel sad, I no longer feel like my brain is in a fog and I am once again giving people the benefit of my advice, support, and wisdom. Until this week, I really didn’t know how awful I felt at the beginning of this year. I have never before encountered a change process that knocks the ‘get up and go’ out of me. I am pleased to announce though that I am looking to the future with enthusiasm in a way that I didn’t think I could.

Of course, all of the above could be scuppered by a) the current government changing their direction though if yesterdays plans / report is anything to go by it is pretty much more of the same old spin or b) that there is a general election next month, and that we get a new government that changes the system. However, I refuse to let myself get depressed any day soon after all I am off on a cruise in only 2 weeks!

Over at Nursing Voices the competition to win an iphone is in full swing. I am pleased to report that debate and discussion has been going pretty strong, but we still need more people over there to join in and guess what? It really isn’t too late, the competition still has a couple of weeks to run and the winner could be you! Now for those of us in the UK to win an iphone would be pretty special, seeing as I don’t think they have quite arrived here yet. If there is one thing, in my humble opinion that is still missing from the debate over at Nursing Voices, that is the voice of the Brit and that means those of you who are nurses and are British and sometimes read the drivel that I write. So, instead of reading on, why don’t you pop over there, register and start posting now what can be easier and what can be better?

Of course you might not be a nurse, and you might have been to nursing voices, posted and returned. Which is a pretty good thing because I have more to say!

What do you know about AIDS? A disease of the present? Something that happened to gay people in the past? Well, from the programme I watched on TV the other night it seems that for many people AIDS is truly rooted in the past. I was a student nurse in the early 1980s at a time when we were first finding out about the awful disease that was killing young men at a rate of knots. The first few patients I cared for died of illnesses for which there seemed to be no name, but there was panic amongst many of their friends who were quite rightly scared, but not for the reasons they thought. They couldn’t catch this illness by visiting and sitting close to the beds of their friends by holding their hands. Many of those people were already infected and didn’t know it. 25 years on though, there are apparently gay men out there who thing they are in no danger, there are still more who have sex with men because they have HIV and want to try to catch it. There are heterosexual couples who think they are immune, there are people sleeping with Africans who have no idea of the risks. Then there is the stigma. There are people out there treating people like lepers because they have HIV, they are daubing paint of peoples houses and shouting names at them in the street.

We have had 25 years or more to get used to this. People, thousands of people have died and some of those have been famous enough to make people sit up and notice. But still the young people (and those who are older and should know) appear to be completely in the dark about how to avoid HIV and AIDS, that they should practice safe sex and that you cannot catch AIDS from a cup of coffee, or holding hands. We have email, we have little pieces of plastic to communicate with each other in the street, we have music blasting in our ears from another little plastic box and yet we cannot seem to get the message. Something is very wrong there!

I use Firefox as my internet browser and have done for a good while, but I can still use internet explorer being as I have a windows powered laptop and of course Bill decrees that I shall have it already installed. It was a bit of a surprised to get a message from Max of MaxEnurse telling me that he couldn’t see the content of my blog since I changed it last month. Everything was looking fine to me, and no one else has mentioned anything, but I checked things out using IE anyway and what do I find? Well he is right, the whole page was mixed up, and whats more all the very valuable and interesting words I had written in all  of my posts were missing. Now we can’t have that can we?

So I have changed the look of my blog again. But my lovely nurse picture is gone; not sure how I put her there or how to put her back and while you can read my posts there is still something of a mess at the bottom of the page showing up. Now if anyone is some kind of an expert then please tell me what I might be doing wrong, also what do you think of the current blog look?

Well no real excitement actually, just busy with real life and no topics that spring to mind easily for discussion. The world of commissioning is interesting and is pretty much keeping me out of mischief. The only problem is that the issues I am dealing with are pretty specialized and for that reason often difficult to share on a place like this. My job is about services for children in the hospital and about maternity services. It would be true to say that our local hospitals are not perfect, that there are definitely things to be improved and as a commissioner it is not me that can do the improving it is me who is charged with getting other people to improve the services so that they are the quality that the local population need and deserve. I am a relative novice to the world of health care for children and mothers to be but I am enjoying finding myself as an advocate for them, and learning more about the issues we have in getting things done in that area.

There is so much about my work I would like to discuss here, but I am finding that actually the individual problems and issues that arise there are more difficult to disguise than any patient problem I have ever come across, and that is saying something.

In just under 3 weeks I am to become a lady who cruises and so I am concentrating in my spare time efforts on planning the whole experience. Before you begin to wonder (based on my recent posts about money, debt and cars) my in laws have decided we are to be treated to this cruise and therefore to a cruise we will be treated. My research so far has informed me that for some people traveling on cruise ships and then talking about it is like a full time job to some people.  There are people on a cruise forum I have been visiting to get information and advice who have 3 or 4 trips booked into the future at any time. It is surely like another world, and it is one I had never considered entering but find somehow oddly compulsive. Apart from the chance to see places like Rome, Naples and Pisa the main thing I am interested in about this whole thing is in actually coming face to face with these people who go on cruises and in seeing them in action. I am looking forward to getting to a warmer place, to getting a bit of a break and to generally getting away from it all.