Business as usual

In the middle of a chaotic reorganisation we carry on regardless. We are busy supporting our network groups, arranging workshops and training, recruiting users to help with service developments and reporting on things that have been done. We are busy full stop. We work hard and we work pretty long hours between us. But, you might ask and I often ask, why? Why are we bothering to put so much effort into things that we don’t know will continue in the future?

Well partly because we are kind of required to do so. There are rules in place, there are requirements on us and they haven’t gone away. There are also people out there, clinical people, who still need our support to be able to meet together and discuss how they can continue to improve things for people with cancer. There are campaigns for early diagnosis that we are still involved with and detecting cancer and doing so as soon as possible is a priority area. We are also trying to create some kind of legacy, to make sure that what we do, what has been done continues. While people in high places continue to work out how the new world will work, we carry on working in this world.

We are interacting now with the new CCGs; the board members, GPs who are finding out about their responsibilities to their populations. They find that we do useful work, have knowledge they can’t hope (or want) to learn. They wonder how, come April they will be supported in making sure that cancer and end of life care is best commissioned.

We prepare to apply for jobs. The adverts were meant to have been released last week, now apparently it will be this. The top job will be appointed to in the next week or two and then that person (and who knows who else) will interview us sometime in the run up to Christmas. In the new year we will know more about what those with jobs will do in them and we will discover if we continue with business as usual in the old set up.

It all feels a little unreal. But of course it is real. These are real people, with real jobs, real mortgages and bills who shop in real supermarkets and go on real holidays. It is easy to write off those who work in some kind of administration. But the fact I left clinical practice enables others still seeing patients to spend as much time as possible doing so. If there are fewer of us doing those supportive jobs, either fewer patients will be seen or else fewer patients will be able to be sure that advances in implementing best practice will take place.

Those of us who get jobs in the new world of strategic networks will work hard to make sure this doesn’t happen of course. But there are no guarantees. Of course I may be wide of the mark and the new systems may be an improvement on the old ones. Lets hope so for all of our sakes!

Happy New Year!

So 2012 has arrived. It is good at this point in the year, i.e. at the start to reflect back on the good, bad and ugly of the previous 12 months and to look ahead to the coming months. 2011 was pretty eventful. In June I was interviewed for a job which finally in October I was able to start. In December I was at last allowed to stop doing two jobs at once, just as well as the new one has just got pretty busy. There are lots to do to help support the improvement in services for people with cancer. I just hope that this job can last past the end of my secondment (March 2013); as the year goes on that should become clearer as we await a report on the future of clinical networks which is due in the next few weeks. The great thing about a new job is that it means you have new things to learn, and things have moved on massively in the world of cancer care since I was working clinically so my learning curve has been pretty steep. I actually look forward to going to work each day and that is a pretty good thing.

I am also pleased to report that my dad, who was coincidentally diagnosed with cancer around the time of my interview, has completed chemotherapy and at present seems to be doing well. This is a huge relief as the cancer is secondary and probably cannot be cured. It was great to see him eating and drinking well and buzzing around us all as usual. Fingers crossed that the scan he had a few days ago confirms this.

My son, who is studying in California for a year is home for Christmas. It has been great having him home even if it seems to have doubled the amount of washing and ironing I have to do and has increased the food bills considerably. He goes back on January 15th, but this time we can look forward to seeing him just a month later when hubby and I visit for his 21st birthday.

So I start 2012 hopeful that this might be a reasonable one for me personally. At work we continue to live through the protracted process of the new NHS Bill which is not yet law, but which is causing a fair amount of change for the sake of change. The GP commissioners are flexing their muscles but at the same time discovering that commissioning is not about telling people what to do and expecting it to just be done. From my new position within a clinical network which will be part of the Commissioning Board I am finding all of the PCT related stuff interesting. People are not surprisingly positioning themselves and that is always fun to observe!

New years resolutions? Well probably best not to promise anything but I will try to blog more (but then I have tried that before).

I wish everyone who takes the time to read this blog post a happy and healthy new year. I hope 2012 is full of promise for you too!

At last

After being interviewed for a new job, a secondment, at the end of June, I have finally got started in the role. For the last two weeks, and for probably another two weeks I am in effect doing two jobs. This is an approach I would not recommend but sometimes we have to make sacrifices in order to get what we want from life.

I moved desks, within the same building, on 3rd Oct and since then have combined induction into the world of cancer and palliative care with managing what I can physically do in the world of maternity and acute children’s commissioning. I am really pleased to say that the new team have been really welcoming, my old team gave me a good send off and all of the people within the network that I have met so far have been friendly.

My new job started with a 2 day meeting in London which was great for giving me a grounding on current issues in cancer services and also in working through some issues about how we can best approach the issue of needing to make sure the voice of the patient / user / carer heard in the way services are planned and provided. I think that hopefully there will be lots for me to write about on this topic once I get my brain properly into gear.

As for the old job, there is plenty that I would like to write about how you should not manage people, and about the emotional mechanisms a person may use to cover up their own short comings and make you feel guilty for them. However that may be difficult and what is more I think moving on rather than going on about it might be more healthy!

The Health and Social Care Bill has this week progressed further on its slow and painful journey to some brave new world that is only clear to people like Andrew Lansley. But it is now inevitable that it will soon be law; it pains me to say but the sooner the better now. We cannot continue with all of this uncertainty and what is more the PCTs are busy making the necessary changes to make it happen and it would be a crime to put the brakes on and go into reverse now. My hope is that the review of clinical networks comes out clearly saying that they need to be developed and strengthened and that what is more that my job needs to be made permanent. There is no way on earth that once I say a final goodbye to commissioning that I intend to go back. But I guess they say never say never!!

Increased choice? Unsustainable demand?

Politicians of all colours are now very keen to offer us increased choice in healthcare. There is an assumption that if you can choose to ‘buy’ your healthcare from anywhere you like then this will lead to the best becoming better and if a provider is not good enough then they will see that they need to improve or else suffer the consequences.

Choice, or perceptions of the ability to choose have been evident in education for some years. The schools that have been perceived to be ‘good’ are over subscribed, they are staffed by excellent teachers and people move house to be able to send their children to them. In some areas, where people are particularly mobile and affluent this may be the case. In healthcare choice in relation to maternity has been a particularly popular phenomenon with some people. Choice of the place you have your baby, whether this is home, a midwife led unit or obstetrics unit, or whether it is about choosing one hospital provider over another is very important to some people. Exercising choice can be a tricky thing. For one thing you have to know what choices are available, and in maternity you have to understand something of your own level of risk in exercising that choice. Perhaps your pregnancy is medically or socially risky when it comes to making some of those choices, perhaps you don’t have the means to travel 30 miles to a chosen different hospital. Perhaps also the services in your area struggle to attract the right mix of skilled staff, not because they are providing a poor service but because they are geographically situated close to an area where staff can attract higher pay.

If you are pregnant, then one thing is sure you will need some kind of maternity service, and it will be the duty of your local healthcare commissioners to make sure you can access it safely. Those commissioner will be required to make sure that the maternity services offered are safe, adequately staffed and that those staff are appropriately qualified to fulfill their role. Maternity Matters gave us a role in promoting choice and in making sure that those choices were available and that people were assisted in making those choices. When though does choice become a want or a demand? When does choice and the way it is exercised by the few mean that those who are more able to move, more affluent, more able to make choices have a detrimental impact on the many?

As a nurse working in a PCT I am obliged to take part in one of the much maligned prior approval schemes that are popping up all over the place to manage the demand for healthcare. ‘Low priority’ treatments such as removal of  non cancerous skin lesions and varicose vein surgery are judged against a set of criteria set by a panel of doctors and approval is given or not for surgery to take place. What strikes me most about the way in which cases are presented is the extent to which GPs and surgeons struggle to tell patients that their problems don’t quite meet the criteria. Often they will write that the patients ‘wants this surgery performed’, and I am left wondering; yes, but do you think it needs to be performed.

I had the pleasure of setting up a new nurse led service a few years ago for people with rheumatoid arthritis. My job was to manage the day-to-day issues that arose for patients coping with a long-term illness, while taking potentially lethal drugs and still needing to deal with normal life. We set up a great service with a help line, monitoring clinics, home visits etc. What it taught me though was that where you create choice and opportunity you will also create demand and to a certain extent want. The people who shout loudest will often if you are not careful get the biggest share of what is on offer and that may be to the detriment of those who cannot shout and indeed may not even know what to say.

Whoever is in charge, whoever does the work of commissioning or buying healthcare, whoever provides it, there will never be enough of it to go around if someone doesn’t take the responsibility for making sure that decisions aren’t only made because of what is wanted, where it is wanted and whom it is wanted from. That of course is what makes my job interesting if not tricky!

A bit of a mess?

It seems that the Health and Social Care Bill, the legislation designed to cut bureaucracy and fix an NHS that is not quite broken is in trouble. For months now, health unions, professional bodies and respected ‘Think Tanks‘ have described deep flaws within the proposed legislation. To us, despite the length of the numerous papers produced so far, firstly as white papers, consultations and discussions and now as a Bill, it has produced many more questions than answers. How will specialist services be commissioned and managed? How can we be sure that GPs will be willing and able to commission all of the services needed? How can we prevent GPs being part of businesses that are set up to provide services and then giving them huge profits? How can we be sure there will be sufficient levels of accountability? Will there be enough money / people / resources in the system to actually do the work? Will patients really get more say in their care? Do people really want choice or do they actually want a well-functioning local hospital which they can access? Can we be sure this isn’t the thin edge of the privatisation wedge?

It turns out there really are more questions than answers and apparently the bill is to be delayed while more of the answers are explored.

Meanwhile people within the much maligned PCTs are leaving. Last week we had 3 retirement lunches in one particular meeting room, two on one day.  2 colleagues within my own team have found new jobs and will be gone by summer, a third has an interview at the end of next week. We all check the job adverts weekly or even more regularly. The GPs that are currently sorting themselves into consortia are beginning to worry that even if they have the management budget to pay people there may be insufficient useful people around to employ within the new system (that is if they actually employ them since it is now rumoured that there will be some kind of commissioning hub).

I might be a PCT employee but I am not daft. Greater GP engagement and accountability in commissioning would be welcome. Less of a head count in the PCT was desirable and probably necessary. Perhaps public health might be better placed in local authority. But it actually didn’t need to be as nasty as this.

What next? Maybe little will change? Maybe progress will slow? The damage is already done though. We have been tarred as useless managers who do little for the actual patient. When actually I believe we have the potential to do much that is good. We wait and we will see!

Celebrating 30 years

Last Saturday I enjoyed a great lunch with some of the ‘girls’ I trained with. Just over 30 years ago in October 1980 28 of us arrived at John Astor House to start our careers in Nursing and in the NHS. Some of us never made it past the first year, but 24 qualified in 1983. This was only the 3rd time we have managed to get together in all of these years, though of course various of us have met up with each other at various times and some remain firm friends. What is more at this event there were just 9 of us, what with family commitments and the distance of oceans. What was gratifying was that of that 9, 8 are still working for the NHS and 8 are working clinically. I was the only one of the group not in daily contact with patients.

30 years is a long time, but strangely as we chatted over our wonderful lunch a stones throw from where the hospital we trained in used to lie, the years slipped away and we remembered days and nights on the various wards, nights out together and the amazing responsibility we were given at such a young age. We agreed that our training had been a good one, and it had prepared us well both for our careers and for life in general. We also agreed that some of the changes within our profession had not been for the best. We also wondered about the impending change; apparently for changes sake.

Ben Goldacre today in the Guardian (and on his Bad Science blog) says that there have been 15 NHS reorganisations in the last 30 years, this means that we have lived through each one. Some of those will have passed us by, after all, when you are busy working clinically, caring for patients you can often continue to provide that care as the world seems to move around you. This was the case for me until about 10 years ago just as I prepared to move into a managerial position. My employer merged with another and a number of managerial changes took place. This was around the same time as the PCTs were formed and that was where I headed for.

I left clinical practice at that time because I was weary. My job was a struggle as my patients needed access to new medications but these were expensive and they and we seemed to be fighting unendingly for them. The work was hard and I seemed to be allowed to expand my practice to take on an unending number of tasks. Fearing burn out I thought a job in education within the new PCTs would allow some relief and what is more it would mean I could make a greater difference to more people.

Clinical work, and for me, nursing remains amazingly important work. In some ways I would like to return to it, but in what capacity. Generally my student colleagues work part time and have husbands earning far greater wages than I do. If I return to practice I will have to take a pay cut, and essentially I am not sure I can afford to do this. I also don’t really know what nursing job I would want to do, or if my body would stand up to the pressure required of it.

I also happen to think that it is important to have people who have worked as nurses and to whom nursing and the care of the patient is important, working within management. When politicians belittle those of us working in PCTs they appear not to know or care about this and apparently think that we were born in a pen pushing role and have little or nothing to contribute. What is more, they don’t seem to value nurses in the same way as doctors and GPs at that. I wonder if they will yet receive the awakening they need before it is too late!

What to do next

There is no getting away from the fact that while I am online most nights, browsing facebook and generally stalking my own family I am a very lazy blogger. This is not because I have nothing to say, indeed some of what I might say could be reasonably interesting to more than just myself. It is just that often I don’t even think of it and when I do I worry about saying the wrong kind of stuff and getting discovered by the PCT higher management. I have just been reading some blog posts by other healthcare bloggers and getting discovered by your hierarchy seems to be a common fear and apparent reality to quite a few. One good thing about the demise of the PCTs might be that gradually those who might discover you drift away as people ‘move on’ to bigger and better things and have other people to consider.

It has been 3 months since the Health White Paper and in that time people have started to leave. So far we have ‘lost’ our Chief Executive and 2 other directors, as well as a variety of other senior management types. When your organisation has a limited life as ours does it is not the thing to recruit / replace people, especially when you are looking to save money. Oh no you just spread the work of the departed among those who are left. This suggests that by the end a few low paid workers could be doing everything, still at least someone will be able to switch off the lights on the way out.

Work is now underway to help the GP consortia’s as they form to be able to take on the work, and with it the employees who might assist them in the future running of the NHS. Nothing is yet clearly known about what it to be involved as there is as yet no health bill but the clock is ticking and I am sure we won’t have long to wait. The work I do will apparently be part of the new national commissioning board, but how this will work and who might be employed by whom and where is not known. What is becoming clear though is the way in which further money will be saved by paying staff as little as possible.  My pay is still protected from the previous reorganisation, and if I stay as I am in March 2012 (just before the PCT ceases to exist)  my pay will drop back to the lower level and I will lose £350 per month. In the new world however, I won’t be able to apply for a job with a pay band above that new lower level (this has been decided by very senior managers at the SHA, who will also need new jobs). This means that I need to consider moving jobs before these rules kick in.

While I am still reasonably happy doing my current job, it probably is time for a change, but there are really very few jobs around. There is no point moving to another PCT (for obvious reasons) and suitable jobs in other Trusts seem far and few between. This is because despite what we are told about health budgets being maintained, every health organisation has savings to make plus with so many people looking for work there are many more people that there are opportunities. That is not to say I am not looking and that when the right thing appears I won’t apply for something new, because I will. I am pretty nervous though; who wouldn’t be?

 

I become a union activist!

The Joint Negotiating Committee met this week. The meeting was mighty odd for an RCN member not currently actually practising as a nurse. Still I am a nurse and to prove it my annual re-registration fees will be due in November.  I also pay my RCN fees monthly and my job is going to be at risk, therefore it is time to become something of an atavist!

This occurred because the PCT is a commissioner (all be it one with a short shelf life).  The requirement that the provider arm of the PCT must become separate from its provider  arm necessitated that a PCT staff side was created. I as a person who cares about their own career and that of others in a world where the current government has decided to create a new health service felt the need to join the new Staff side.

So back to the JNC. It was me and 3 men; 2 from Unison and one from Unite though he thought his union was one of its previous incarnations. My RCN colleague was busy on business in Antigua (something involving a pool or beach and a pina colada I believe).  This did not help me to fulfil her request that Mr number 1 Unison person was not allowed to be the Chair of Staff Side. However I am now a member of the risk committee (this sounds like something both important and necessary; oh the irony!)

The meeting was dull and do you know, there was nothing exciting or special that I learned that I didn’t already know. What is more I sent apologies to something actually more important – I gave up my afternoon for a half hour meeting which followed something of a fisaco of a real union actavist trying to make people think that the whole thing might turn out to have some importance.

I am not convinced, but I am on the other half sad. This is a real issue, we are real people faced with either the loss of our career and livelihoods or else the loss of something greater our dignity! Hopefully by the time of the next meeting in November we will actually know what is likely to happen to the health service and also my RCN friend will be back from Antigua!

Here we go again

So it is 10 days post NHS White Paper: Equity and Excellence: Liberating the NHS. The question is who will be liberated by Andrew Lansley’s document?

It is 3 1/2 years since the last whole sale NHS reconfiguration kicked me out of the job I had then and lured me into the dark world of commissioning. I have spent the last 3 years or so learning about the world of the commissioner, I have learned about the pathways of maternity and child health and illness and I have applied myself whole heartedly to making healthcare a safer and more effective place for the people of the county within which I reside. As a nurse I have been well placed to challenge practitioners about the work they do, to listen to the needs and views of the patient (including the professional service user activist). I have often wondered at the target driven world created by the last government, but actually I saw real improvement in services so went with it (mind you as an employee you do have to play the game to a great extent),

The NHS was not a big election issue. Choice about the type of healthcare you can access has improved along with waiting times, infection rates, cleanliness and the general feeling within the NHS. A particular group was unhappy of course but even though they had been given a greater role in health care it was quite possible to ignore some of the views of the GP.

No longer. Our CEO told us just days after the coalition was formed that GP was now king. And so it seems. The new white paper appears to allow GP consortia to be formed in place of the soon to be defunct PCTs and Strategic Health Authorities. So what of us the humble nurse turned commissioner types inhabiting the offices of the PCT?

Over recent weeks politicians have lined up to describe us, the hard working people working in the offices behind healthcare as faceless bureaucrats. We earn more money than anyone can believe, we have pensions which will make us rich and of course we do nothing for patient care.

Well Mr Cameron and Mr Lansley. I am still a registered nurse. My work is about improving patient care and the outcomes of that care. I have worked for the NHS for 30 years this year and each month I have contributed 6% of  my income to a pension scheme. I have been on protected pay for over 3 years which means I have had no pay rise. That pay is reasonable, but as the main breadwinner in my household it is important and necessary. I have a face and I would like you to pop round for tea one day soon and tell me why it is you continue to maintain that I am not worthy of my job!

More to come….. much more!

Change for change sake?

Just for the hell of it tonight, I decided to look at the key governement department for children’s services; The Department for Children Schools and Families. The following notice has been put up:

A new UK Government took office on 11 May. As a result the content on this site may not reflect current Government policy.
All statutory guidance and legislation published on this site continues to reflect the current legal position unless indicated otherwise. To view the new Department for Education website, please go tohttp://www.education.gov.uk

A re-branding has begun and I wonder what this will mean. The undoing of 13 years of policy, I expect. A change back to an idea that a child attending school is there to be educated, no more, no less. I wonder what money will be spent to toughen up the look of the department? What work done will be unpicked?

I am due to attend a Children’s Trust local meeting on Monday; is there any point? Will it all be unpicked in a matter of days?  What can be wrong with the logo as shown above?

I have an increasingly sinking feeling about this new government……

Hang on a minute….

Last night I tuned in to watch history in the making; who wouldn’t? For the first time the three main party’s involved in the election campaign appeared together on TV for a debate. I use the term ‘debate’ lightly since generally speaking it was less of a debate than a ‘let me tell you everything I have prepared on this subject’. If this had been a job interview then all candidates would have been marked down for not actually answering the subject. The main focus of questions, carefully edited and presented by neatly presented members of the public were national issues (by national I mean England, but that is a highly complex issue best saved for another time). National issues will always mean healthcare and of course the NHS. I have a few things to say about this. The first is something personal – it might stun people to know (and by people I mean politicians and anyone who doesn’t work in the NHS or isn’t married or related to anyone working in the NHS) but many many (indeed most) people classed as NHS managers are neither complete shirkers or people who earn in excess of £200k a year. Oh to earn a quarter of that sum and oh to be given anything of an inflation busting payrise. Ok so I am grateful for the cost of living rise received last year; my hubby works in manufacturing and he has neither had a rise or continuous full time work. We are lucky, in this recession he hasn’t actually lost his job. But both of us have continued to work hard, often in excess of the hours we are paid to work. Sometimes in order to cheer ourselves up and to break the monotony we have even been out and spent money we don’t actually possess. We have paid our taxes, including the extortionate petrol duties we have paid more for food and other consumables and we have sent our son to university. Please Mr politician whether blue, yellow or red, don’t assume that all NHS managers are some kind of dispensable scum who earn more than a prime minister!

My second particular issue is with Mr David Cameron. Cancer is not the only illness to ever befall people who become ill and need diagnosis, treatment and care in the NHS. While Cancer is common and potentially fatal, it just plays to peoples (often unfounded fears) that people with cancer will struggle to be diagnosed, will be unable to obtain a lifesaving drug and die in great pain un supported by anyone. This is simply not true. What is more, the main problems facing healthcare today are unrelated to cancer but instead are about lifestyle choices leading to ill health, they are about people living longer and suffering from several illnesses simultaneously and what is more learning to live with them.

My main job is about trying to make sure that our local population has the best possible chance to access the best possible healthcare for the best value for money. If that makes me not worth the money I am paid then get rid of me. I predict that this will be one big false economy.

NHS 2010

What can I say? My latest post proclaiming an imminent return has come and gone. In effect my promises are as empty as those of most of the politicians currently infecting my TV screens. The post at the bottom of the page when I logged in this morning was written and posted last July. I am clearly useless, have little to say. Or else there is another deeper meaning? Well no doubt the reasons are not deep. I am just generally lazy, I spend too much time on the evil facebook (that post still gets me 600 hits some days – why?) and my general disgruntlement with the NHS pretty much disappeared during the last year.

The job, while not necessarily the best paid has been pretty fulfilling not to mention busy. I also think I have had a reasonable amount of fun on the way. I have been learning to live my life post-child-leaving-for-university. This has involved me doing more than work, cook dinner (anything involving pasta and curry though not together), wash and iron jeans and tee shirts (the clothes of a teenager) and act as a taxi service to a boy who ought to have passed his test by now. No, hubby and I have travelled the country (well been to a few sea side towns and London), stayed in hotels we can’t really afford and eaten in good restaurants. We have also been on a couple of longer trips abroad and generally enjoyed ourselves. Mortgage rates are low, the debts are reducing and some months hubby even has some overtime. Yes life has been good.

Now however we need to get real. It seems that some of us haven’t taken this recession seriously enough. We have enjoyed a period of growth (more money in our pockets and more money in the NHS). Now though all that must end. Firstly the new government (whichever gets into power) will need to tighten the belt (maybe higher VAT or national insurance or both), and the public sector will need to take a hit. The bottom line at work now is this: THERE IS NO MONEY.

This is a depressing message in whatever language you might translate it into. Reading between the lines of: The job of a commissioner is to redesign services to obtain the best value for money tells me that quality is pretty much out and saving money at all costs is in.

A lady interviewed on the London News last week caused a massive chill to move up my back and into my head creating a headache which hasn’t actually left me yet (though the virus keeping me off work today could be responsible for that). This person, a member of the London Assembly I think and who was a Tory said that NHS bureaucrats are dispensable (or something similar), she stated she saw nothing wrong in getting rid of folks like me. This is set in the context of my organisation which has told us it needs to save 30% on management costs (more on that in my next post) and a Tory leadership that would like to freeze public sector jobs as they become vacant.

Over the last few years I have often been critical of the target driven, central control exerted by the Government through the Department of Health. But at the same time there has been progress, and while I  might not think this if I was still nursing at the bedside, I do believe that Commissioners can be a good thing. “She would say that” I hear you cry. Well of course as I am one. But having people out there who ask doctors, nurses, midwives, therapists and other clinicians why they do what they do in the way that they do it can only be healthy. The idea of leaving “front line staff” to get on with what they apparently “know what to do best” is frankly scary. I am now just plain scared that on 7th May I will awake to Dave preparing to move to Downing street. I am scared mainly that this will be followed by a large amount of ‘throwing the commissioning baby out with the bathwater’ to save money.

We do need challenge and we do need people to wonder if services are being provided with the patient rather than the practitioner in mind. We do need to make sure that value for money is being thought about because in my experience not everyone treats public money in the way they would their own. Or maybe on second thoughts they do which is why the country and many individuals are in quite so much debt.

Back to the drawing board…….

Succession Planning

Exponants of leadership development and practice will tell you that one of the most important areas of senior leadership or management is to prepare for the future and plan your own leadership succession. At the moment a great deal of money and effort is being put into doing just this within the NHS. Our regional Learning and Development team have put together a fantastic programme for those who aspire to be Directors in the future. This starts off with a 2 day development centre. I am familiar with this as I work as a development consultant at these centres, observing the behavours of candidates as they go through a team simulation event. This is followed by a series of master class sessions, coaching, mentoring and peer action learning. It is hoped that the people who come out the other end of this process will be much better prepared for senior management that might have been the case in the past. Some people realise, having gone through the process that they are not suited for being directors in the NHS, and insight into this is important if you are not going to be the cause of chaos in the NHS in the future.

Given that a number of our PCT staff are currently going through this process and another few people completed the process earlier this year, I wonder why it is that none of us at the next level down are considered suitable for a similar piece of development. Within the commissioning team one assistant director has gone on secondment internally, another has left to take up a director post and a third is about to go off in a couple of weeks to that lucrative new job. The response internally has been to employ on a consultancy basis 3 individuals from an agency to take on the roles of these people rather than to seek to develop anyone from within. Permanant replacements for these people are unlikely to come from within because we have pretty much been warned off of applying. Even if none of us are ready for that step up, then how is it none of us are currently being prepared for promotion? Is it that our employers want to keep us in our places? Is it that they don’t value us and what is more don’t know what potential they have in their midst? It is not just my own trumpet I blow here either!

If you were going to name a new form of flu what would you call it?

I am pretty sure that if I entered a competition, to name a new form of pandemic flu, first prize a trip to Mexico my answer wouldn’t be ‘Swine’. But I guess that I  might not have forseen the involvement of the pig, so what do I know? The media here are loving this. Yes they would deny it, but if you can put on your front page that 750,000 people are likely to die, why be realistic? I travelled today on a train to London, no one wore facemasks, but then no one sneezed. I spent several minutes myself (currently suffering from hay fever) wanting to sneeze, but fearing panic dared not. Even if I had a tissue handy I had no where to wash my hands or dispose of my tissue and what is for sure I don’ t want to be thrown off a speeding train.

I am not trying to make light of this whole thing, since people have died and it is pretty worrying to those directly involved. However, I think the hysteria misleads and detracts from the seriousness of the situation. Plus please don’t let my reintroduction to clinical nursing be at the sharp end of a surgical mask dishing out antivirals!!!

The picure above particularly fits as my day in london was about a commissioning strategy for breastfeeding. Did you know that breast fed babies are more likely to be healthy and less likely to be obese? No? Well thats cos it is less interesting than a flu from Mexico caused by pigs and called Swine!!

So it is April

We have emerged from winter, it is officially spring and it is also, since last weekend, British Summer Time (which reminds me that I need to reset my blog’s clock)! I seem to have lapsed in many ways during the winter, I have allowed myself to put on weight, and must sort myself out if my new summer clothes are not too small before I even buy them (and no I won’t be buying any kind of bigger size). I have become lazy when it comes to my blog, and haven’t really written anything particualrly interesting about my own life, or the job I do for ages. 3 or 4 posts written over the course of that time have pushed my traffic up massively, but I am not sure anyone would return to read my blog until I buck myself up. I also need to get myself doing more things outside of work, with a son hopefully going to university in the autumn I surely need to get  myself something more interesting to do than sitting on the sofa reading a book or watching TV. I need to get out more, I need to explore the environment more and I need to get more active. I also still wonder if I shouldn’t be looking for a new job, and indeed have one eye on the jobs market. Work though is really busy, commissioning has become quite a lot more interesting because actually we now have to do more in the way of managing performance and in turn we are being performance managed much more by the Strategic Health Authority. Maternity is an interesting area to be working with, since it is pretty high profile, there are targets to meet and those who use the service are not backwards in coming forwards if they are dissatisfied with what is on offer.

I know I’ve said it before, but this time I mean it; During April I am going to post daily. I am going to talk about my struggle with food, because I do struggle not to eat things I shouldn’t. I am going to talk about wine, because I think I like the taste of it too much and sometimes use it as either a reward for things going well or as some kind of treat when things have gone less well. I am going to try and talk about work, though as I have said before this is less easy when you are the only person doing a job in the whole county. But I am going to try. I also have somethings to say about how it feels to be a middle aged mother whose only child is going to leave home this year and who is going to need to learn about being a wife in a home with no children again. So here goes, this is April 1, you are no fool and neither am I!