I am beginning to repeat myself here because it seems that this whole culture of blame, lets take no responsibility for anything that happens to us thing continues unabated. A BUPA survey of 1000 people has apparently identified that the responsibility for hospital acquired infection rests squarely at the feet of hospital managers. Apparently 80% of those who responded feel managers are to blame for the high levels of MRSA / C - Difficile while only 0.8% think doctors are to blame and only 0.08% blame cleaners. There is no mention of nurses in the report I read, but I wouldn’t be surprised if the rest of the blame lies with them, since nurses take a lot of flack these days.

The idea that BUPA, an independent health care provider is fuelling the anxiety of people about the state of NHS hospitals is interesting, since I bet BUPA don’t mean their own inpatient facilities. I don’t know if they are subject to the same healthcare commission visits and inspectors or if they have to have matrons to oversee cleaning like in the NHS.

No one doubts that a clean hospital is vital to ensuring the confidence of the general public, but I personally would go back to government policy for my first port of call if wishing to porton blame. Back in the 80’s and 90’s cleaning services where auctioned off (other wise known as tendering) to the lowest bidder and at the same time capital investment was so poor that routine maintainance often when undone. At about that time I worked in a hospital whee the public toilets where in a poor state. They looked dirty even though they were regularly cleaned and in order that the situation could be improved the whole facility had to be ripped out and renewed. We might blame the hospital management for this state of affairs but it actually relates to years of underinvestment where public toilets even in a hospital were the lowest priority.

As with everything else, there is an unwillingness to take responsibility. Back to those toilets, how often do you see people leave such a facility without washing their hands. Where do they go to afterwards? Perhaps for an appointment or to see a loved one. We all have a responsibility to prevent hospital / healthcare acquired infection. Yes managers have a responsibility for maintenance and ensuring cleanliness, for employing the correct staff and training those people in the principles of infection control. They have a responsibility for ensuring that standards are maintained. But actually responsibility lies with us all.

No one doubts that a clean hospital

Disappearing John is worried that too many nurse bloggers are angry. PixelRN thinks perhaps that she is one of those angry nurses. Me? well I think I could have been angry, or more likely burnt out but that I got out just in time. I am proud to call myself a nurse, but I am pretty much done with patients. My life is spent dealing with angry nurses and angry doctors. Yes indeed it seems that everyone out there is unhappy with their lot in life. What is more none of the problem with whatever healthcare system people work in is their fault, it is the fault of someone else. I encounter nurses all the time and generally they are unhappy with their managers, the management (whoever they are), life in general and anyone who has led them into their current predicament. Doctors, and mainly I am encountering paediatricians, obstetricians and GPs, who are either fed up with the government and their targets, the PCT (my employers) and me in general as apparently I am the PCT.

I happily am not angry with anyone at all. I would however like some people I encounter (or indeed see on TV) to understand a few things:

• Healthiness should be something we all want, we should not need the government to tell us what we should do at all times of the day and we should not need to be prescribed a healthy lifestyle. Those of us who work in healthcare should be prepared to help and teach others to know how to do that, but what we don’t need is the Government telling us at every level and at every stage exactly how to do that.
• I have had to learn how the NHS in 2008 is financed and run, it would not hurt you doctors do understand it too (I don’t like it either but it is part of life). If your hospital trust gets funded through payment by results then there is no point asking me for money for a specialist nurse. If there is any change of money being available you already have it (or have the opportunity to earn it).
• Infections are not always something that can be avoided in so far as the cause of them might be complex and not just caused by nurses and doctors forgetting to wash their hands. If antibiotic misuse has been rife and cleaning has been contracted out for years then a deep clean and a bit of alcohol gel will not rid the world of MRSA.
• Since the last reorganisation I am just a pleb, I am not (and indeed nor have I ever been) responsible for all the ills of the NHS
• If you are an ordinary nurse then get on with nursing your patients. Remember that you chose to do this, no one forced you, remember also that to be a specialist nurse / nurse practitioner / consultant nurse it is useful to have served at least some time as a bog standard ordinary nurse before you get yourself better educated and declare yourself somehow better than your peers.
• If someone gets the job of their dreams and feels that they are making a difference then please be happy for them, don’t act as if they are some kind of pariah who needs to be undermined and spoken about behind their back. They have got where they are because (generally) they deserve it and what is more their patients need them.
• If you are offered clinical supervision, a time to get away from patients to discuss the issues of patient management then take that time, use that time and don’t make out that you are far too important and busy to attend such a thing.
• To those who work in TV, well not all nurses are killers, not all nurses are uncaring bitches and actually most of us care about what happens to people. Showing us one example of an unhappy / ill served patient does none of us any service at all.

Laziness is what might be happening to me. Just when I was thinking that winter was pretty much over, and with it being Easter spring was on the way, it goes and snows. All my spring like thoughts of cleaning, walking and getting just that bit more energetic are put firmly in their place and I end up spending a long weekend practically hibernating in my own house eating chocolate and hot cross buns and drinking wine. Imagine my surprise yesterday then when I step on the scales at slimming world and discover another pound has emerged from somewhere. These diet clubs must love people like me, who lose almost a stone and a half and then seem to take delight in paying for the pleasure of putting 4-5 of the pounds back on.What a relief then that today I have woken on what is my penultimate annual leave day for the 2007-8 year to find that it is sunny and pretty warm (well it says 10c on my computer temperature thing and after the -1 day time temperature last week that is pretty hot) so I am now raring to go. New weeks resolution has been turned on the eating and drinking front and any day now I will get myself going on the exercise front. I have a garden to be dug, plants for summer to be thought out, I have a house that needs cleaning properly (the sun shows up all that dust I’ve been trying to ignore). If it is possible for a new years resolution to start on March 27th then I have several ready for the off. If only I hadn’t started that great new novel and if only I could actually stop myself from being quite so lazy then we would actually get somewhere.

I am sure if I sat eating chocolate all day long then I would be very fat indeed. But like most people, I do know this and therefore I am able to walk past a vending machine or a shop and resist, or else buy something more healthy instead. But imagine a world where we are not allowed to buy anything that is bad for us. where in order to be allowed to purchase chips or sweets or a can of coke with sugar in it we had to demonstrate that our BMI was within normal range? Far fetched? Well I am actually beginning to wonder if it is any way something of science fiction when for our own good we are constantly to be told what we can and cannot buy.

I accept that the population is becoming fatter. I accept that our sedentary lives, our over reliance on the car and our willingness to stuff our faces with food too high in fat and sugar is causing this. However, please do not tell me that vending machines in hospitals are going to contribute to this? Apparently if I can buy a mars bar in a hospital then it is giving out the message that this kind of food is ok to eat when it jolly well isn’t. Where on earth will this end? Today Sainsbury’s were selling their Easter eggs off  at half price, so they can make way for barbecues, garden hoses and other summer equipment (the fact that it snowed at the weekend appears to have gone unnoticed) I am not sure this move is wise, given that there seems to be a belief within the Department of Health that fatness is caused by Chips and Chocolate alone.

This weekend we were advised that women who drink a glass of wine a day will get breast cancer (therefore we are advised to drink less), that if we can see cigarettes over the counter of a shop we are sure to buy them (therefore they should be kept from view), and now today that if we can buy chocolate and fizzy drinks in a hospital vending machine we will get fat (hospitals in Wales are already to ban them). To be honest I am getting pretty browned off with being told how to live my life, and to my mind there must be a better way of getting your message across than the way you are doing at the moment!

Found this great cartoon, which if you have a cat or know cats you will relate to. Cartoon by Simon Tofied. Link found here

As to whether you think it is a good or bad thing that people get moved from hospital to hospital for their treatment. Of course if those people are either pregnant women or new born babies. Maternity services are currently being reviewed. People are pretty confused, because before Lord Darzi stepped up they were proclaiming the merger of smaller units and the formation of larger ones and now Lord Darzi is also talking of smaller, particularly low risk, midwife led units. Meanwhile everything is pretty much in a state of flux, I know this because the commissioning of maternity services falls in my remit.

The recent press stories about lack of beds / staff to safely care for mums and babies could be thought of a really bad, since it shows that units are up to capacity and not able to cope. It shows that perhaps there are insufficient midwives, obstetricians and neonatal nurses and doctors. Well yes it is true that units find it difficult to attract well qualified staff and even harder to retain them. After all while the actual work is fulfilling I’d imagine, there are plenty of reasons why people might not want to continue working in such high stress environments. There are simple things like the politics with a capital P of policy and the politics with a small p of what goes on internally, there are also the stresses of the litigious environment, the apparently thankless task of trying to care for women and babies against the backdrop of increasing expectation. In other words you are often onto a no win. Perhaps the fact that a woman who pitches up to have her baby induced and is sent to the hospital 20 miles away is a really bad thing. Perhaps the fact that 32 week triplets cannot be cared for in the same unit is a bad thing (well certainly for the parents that is not good at all).

On the other hand you could  look at it like this. The units are recognising their limitations. They are recognising when they are full and when they have insufficient staff to do more. While the mother might be annoyed that she couldn’t have the midwife she thought she would get to deliver her baby, actually she has been kept safe and what is more her baby has been kept safe. Also if one triplet has been moved it is because it was safest to move that baby rather than a singleton baby who is more ill. These decisions, while not right in the widest context, are actually made on the basis of clinical safety for those mothers and babies as well as all of the mothers and babies in that unit today. For that we should be grateful.

The BBC news programmes, particularly those shown at breakfast time and during the early evening when coverage is meant to be local have become obsessed with seeking the views of individual people. Indeed when a news item is being covered often an example of whatever it is that is being shown is either demonstrated in VT or live on the sofa as it were. So this morning, there was a report resulting from a FOI request from the Conservative Party that said that last year over 40% of maternity units had closed to admissions at some point as they were full / had insufficient staff to take more people about to give birth. This story was illustrated on the BBC breakfast news by a single mother who had planned to have her baby in one hospital but who in the event had been required to attend somewhere else.

The views of individual people are really important in demonstrating how real people are affected by what is going on out there, but I just wonder how representative the opinions and experiences of once person can be generalised across a population? If I have to queue up in the bank to pay in a cheque does this mean that all banks are employing less counter staff or is it just that I happen to have popped in at a busy time? If my postman arrives at 2pm with my post (as happened today) is this a sign that all post deliveries are slow and rubbish? After all, on my way to work I definitely see a postman delivering post near here at 8.30am? Perhaps I am being victimised and should contact the BBC immediately? Or will the BBC contact me when it is time for them to cover the poor service provided by the post office?

People often say that there are two groups of people, those that do it and those that write about it (and often teach it too). Sometimes in any given subject those two worlds meet, neigh collide. My dissertation last year was about evaluating an action learning programme, so as someone who does it, facilitates is and also has written about it (though hasn’t been published as yet) I guess that causes me to slightly straddle these two worlds. It would be true to say that I am slightly sad, given that I was more than a little bit excited about the prospect of meeting some of the people I have quoted in my dissertation and in other academic papers but I was and I did. Yesterday I returned from an intensive 3 days at the Henley Management college where the first ever International Action Learning Conference was held. Henley is a great place for a conference, it is right by the river Thames in a beautiful part of Oxfordshire and the College itself provides a range of older and newish buildings within some great grounds. From my bedroom window I could see the ducks being dragged up the thames by a strong current and young men in boats getting in some rowing practice in the opposite direction.

The conference itself was a mixture of slightly confusing academia, not always fully understood by the other academics in the room or indeed themselves at times and people’s accounts of the practice of action learning within various areas of the world including Bosnia, Wales and the USA to name but 3. As always, I left with a few more questions than answers and not all of those were about what I heard. Where did that man get the jacket that looked like it had been converted from a rug, why do some men where sandals without socks in March, and why do some people act like they have never seen wine just because they are not paying to drink it at the time? I also wonder why rather than create this them and us attitude they don’t work out how practitioners could help academics make themselves better understood and how practitioners could add a bit of theory into their practical ideas, or is that too simple?

So what about the men of my essays? Mike Pedler, John Burgoyne and Joe Raelin? Well it was great to know that they were pretty ordinary men who were able to speak in a way I could actually understand. It was great that they are prepared to challenge the assertions made by others and to give the impression that they don’t know it all yet. It was also interesting to note that some published academics still fall down at the same places as other less esteemed people. 45 powerpoint slides should never be shown to any audience in one showing, much less in a short lecture meant to be about 20 minutes and then followed by discussion and questions.

More telling on my return was that my family don’t know how to unload the dishwasher much less fill it again. They just washed up their dinner plates but nothing else. The kitchen (and teen son’s bedroom) was cluttered with plates, dishes and cups. They were apologetic but I get the impression not sorry. They obviously don’t want me to try leaving them for longer than 2 nights since they would never cope. I think they need some training on this matter but I fear I might have left it too late to start!

My grandparents on both sides were pretty working class by any estimation. My maternal grandparents, particularly were no strangers to poverty having both come from North East England mining families. Indeed my grandmother was part of a single family as her father died in a mining accident when she was just 5 years old. It is interesting to me that I now find myself feeling quite so middle classed. Ok so I was brought up in a stable family environment, and have been married to the same man for almost 24 years. I am also a professional person (well in my eyes), since I am a nurse and have 2 degrees. The lives of others sometimes show how different things could have been.

More than 3 weeks ago a 9 year old girl, Shannon Matthews, disappeared on her way from school following a swimming lesson. She was from an estate in an area that is perhaps more deprived than average and she came from a large extended family. It is not for me to judge the morals of a woman with 7 children by 6 partners, it is not relevant that her current partner is only 22 while she is 32. However it does mean that pretty much everyone in the area appears to be in some way connected with the family. There were rumblings this week that the case was not being given the same attention as that of Madeleine McCann who disappeared last year in Portugal. The insinuation being that Shannon is not from an articulate, middle classed, professional family, which is true, though at the same time Madeleine was also only 3 and you would imagine not used to wandering the streets at home let alone Portugal alone.  Both mothers though have also in some way been blamed for their daughters disappearance, Madeleine’s after all has been accused in some quarters of actually murdering her daughter.

Thankfully Shannon has now been found. However her discovery is pretty much as strange as her disappearance. She was found in the drawer of a divan bed in the flat of her mother’s current partner’s relative. He is a man who has had more than one name and I guess must have been known to Shannon. During her disappearance there were reports that Shannon was unhappy at home, and that she had told friends she did not want to go home. There are obviously wider issues here. But what is certain is that someone somewhere needs to make a better job of safeguarding this young girl than has happened to date.

A colleague who I have been working with for the last year is leaving her temporary position in a couple of weeks. She was brought in to sort out a failing department, to reorganise the management structure, to review working practices and to generally improve things for patients and staff. She has been essentially successful within the confines of a hospital trust with a large deficit, with poor ratings and within a structure dominated by senior managers including a CEO who are in temporary positions themselves. She has been popular with colleagues (staff and managers) and the general consensus is that things are improving. Why then does she not wish to apply for the permanent version of the job and why has she been blamed for a poor health commission report when it would have been a hell of a lot worse without her?

Sadly when things are not as good as they might be it is easy to blame individuals or teams of individuals. Those who do the blaming though, many of them in extremely well paid jobs with salaries most of us can only dream about should sometimes be made to question why such failures take place. The institute for the study of civil society, in their civitas review, state that the root of the problem with the NHS lies not with the doctors, nurses or even managers working within the NHS but with the system within which they work. A system that proports to be patient led, and driven by those working in the front line but instead is highly controlled. The government wants to control all aspects of our lives, it believes it knows best and needs to tightly manage the purse strings. Despite massive increases in funding health services appear to be little better for your average patient than they were before this government came into power.  After almost 11 years in office that is a sad incitement. Civitas maintain that while some patients might have noticed shorter waiting times, and better treatment, inequality in health provision and in outcomes are more rather than less likely.

One of our main targets for this year is the 18 week referral to treatment time. On the face of it this is great. By the end of this year most people should be able to expect to receive treatment for their illness / condition within this time scale. This means that there should be an end to waiting for investigations and for surgery or some other treatment. But already inequalities are appearing. Apparently while 82% of elective patients in Blackpool will be seen and treated within 18 weeks in Hastings that number falls to 33%. My own work with paediatrician colleagues has identified that in the first instance you need to actually be able to measure who is waiting (in 2008 some hospital trusts don’t seem to do the most basic of data collection) then you need to be able to challenge the way in which people are referred, and the way in which investigations are routinely waited for. Unless you want to massage the figures, change the referral systems so that they become exempt from 18 weeks or to hope that your part of the health system has small enough numbers not to affect the over all figures then you have to be prepared to challenge the whole way in which the health system works and that is no easy thing. Particularly when you are entering a new phase of reorganisation, when staff are being judged constantly through government directed measurement schemes, when people are constantly having to report to a higher place, plus amazingly enough try to care for patients.

People quite rightly deserve better from their health service. But also we as people who work within the NHS deserve to be treated as if we actually know what we are doing. We deserve to get on with the job without having to constantly tick boxes, because, and this may come as a bit of a surprise to government, while we are ticking boxes to meet the 18 week and other targets we are just tickling at the edges of what needs to be done to make health services better for everyone. We all have a vested interest as we are all consumers of health services at various times in our lives.

I seem to have been experiencing one of those periods of time when other things have got in the way of blogging. It is not that I am short of ideas, just that I have either been too tired and weary of an evening or else had no time to get the ideas down onto this blog. Over the weekend though I intend to catch up with news, and to write about a few things that seem (in my opinion and the opinion of others) to be wrong in the NHS. So, watch this space and as they say; patience is a virtue.

I have always had a rather over sensitive sense of smell and a stomach prone to want to chuck up its contents if that smell was unpleasant. I have also been sensitive to unpleasant sights in that I have tended to come over faint in inappropriate places. I prefer to be too cold than too hot, as again I have at times been a little prone to coming over weak at the knees in hot situations. This person is and has been a nurse? I hear you cry. How on earth then did she ever get through 3 years of nurse training and then over 20 of clinical practice? Well actually when faced with a situation where I might embarrass myself in front of a patient or indeed a colleague I have been able to cope and make myself keep on my feet without throwing up. I learned how to hold my breath at times, to breathe through my mouth and for quite a period of time to not be put off by anything unpleasant for example bodily fluids such as vomit and faeces.

But it is now about 6 years since I last had to deal with any kind of unpleasant task in the line of duty. Of course much less time has passed since I have had to deal with such stuff at home, but actually I would now rather not. This morning the cat threw up on my living room floor. It was only because I hadn’t yet eaten anything that I didn’t come out in sympathy with the cat. I have actually started to avoid seeing even fake blood on TV and certain smells are beginning to make me nauseous in a way that never happened before. If I was planning to go into nursing now, I’d tell myself perhaps not to, because I am not sure I am made of the right stuff, although I do of course have other vital skills that would still make me a good nurse.

I don’t have an easy relationship with my mum and never have. Something about her has irritated me for a very long time. She says we are very similar, indeed our birthdays are only a day apart; it could be that she is right and our temperaments are similar or it could just be that once, about 45 years ago I ruined her birthday. My teenage years, into my twenties were fraught with misunderstandings, tears and with frustrations, don’t get me wrong there is no doubt that her heart is in the right place most of the time, but communication has never been a strong subject. After all why tell people what is on your mind if you assume they are telepathic. My mum isn’t a strong person emotionally, or these days physically. she relies heavily on my dad for day to day support, for getting anywhere and just for being. I am not the daughter she would like, I don’t take her shopping without a prompt, I don’t always invite them over when I should and apparently I failed on mothers day this year (though on each of about the last 25 I have seen her, cooked dinner, bought the best present I could think of). The trouble is nothing is actually said, well not to me. Things instead are implied, are spoken to others and generally I am made to feel awful. I try to broach the topic with her but always it ends in misunderstanding and usually tears on my part. I have been a daughter for over 45 years and apparently I still haven’t learned how to do it!

It is a year, pretty much to the day since I started my current job and to be honest I have found it a challenge to learn a whole new area of knowledge, get to know new people and to earn myself some credibility in the field of women and children. Many times I have wondered what I am doing spending my time learning about how maternity and children’s services should be commissioned. I have questioned the need for me to act as some kind of administrative support to the local maternity services liaison committees, or as the target of the wrath of paediatricians or GPs who want to apparently blame me for the perceived ills of the PCT. I have wondered why it is that our maternity services couldn’t have been held up as some kind of perfection by the healthcare commission rather than ‘most weak’, and why everyone can’t just get on nicely with each other rather than trying to score points off of each other.A few weeks ago what I have always considered pretty much my dream job was advertised, one which would allow me to return to the arena of the district nurse, my first love and one that would get me back into managing people, something I also enjoy. So when the postman brought me news of an interview at the weekend why wasn’t I jumping for joy. Why instead was I filled with foreboding at the idea of actually performing well at the interview and being offered the job. I can’t quite put my finger on it, but something just feels wrong. I have spent much of the last 4 days considering things and I have realised that I have unfinished business here. I still have lots to learn, I still have work to do with the two new heads of midwifery locally, and with our other providers. I still have work to do in learning how to be a commissioner, in performance managing the services, in getting paediatricians to work together, in getting GPs to recognise the importance of our local maternity and children’s services.

Tomorrow I am going to tell HR that I am withdrawing my application. I hope I have made the right decision, and that the very fact that I have spent 4 days thinking like this means that I have. Only time will tell.

The picture above is the real Status Quo, i.e. Rick Parfitt and Francis Rossi, kings of 2 chords or whatever it is. I have seen them live when they were on with Queen in 1984 at Knebworth. So there you have it!