Former NHS Nurse and manager now contemplating the NHS from outside

Archive for the ‘Maternity’ Category

Patient involvement in the new NHS

My last two jobs have heavily emphasised the involvement of patients in healthcare. When I was commissioning maternity services, those patients were called women and now in the world of cancer they choose patients and carers over the more common term ‘users’. Both of these areas of healthcare have, for many years placed the experience of patients using their services at the centre of planning and delivery of services. At times those involved have felt that professionals pay lip service to this prescribed requirement. But I know that my senior midwifery and nursing colleagues have taken their role seriously as have I. Putting what is discussed in meetings into practice can be difficult as real events take over and people struggle with the realities of their job.

Most of the NHS Trusts (providers) have specific Patient and Public Involvement committees and groups, but these are not specific to a single condition or disease. Maternity is definitely different from the mainstream, given that in the main pregnant women are not ill and are not patients as such. Cancer (rightly or wrongly) also considers itself to be different with unique needs.  Peer review measures for User Involvement require us to have a User Partnership within the Cancer Network, laying down a number of ‘measures’ relating to both the experience of patients and the involvement of service users and carers in services.

The new NHS throws all that we know about this kind of service (or disease) specific involvement will take place. I have had the pleasure of working with some amazing people in both areas over the years. They work hard, give up so much of their own time, often in conjunction with running their own busy lives. Sometimes in the case of my current user colleagues, they continue to manage the after effects of cancer or to battle recurrences of ill-health. They are not surprisingly a little anxious of what will become of their efforts once PCTs (who have been statutory expected to manage Maternity Services Liaison Groups) have been abolished and Cancer Networks have been subsumed into Strategic Clinical Networks.

Will the clinical networks be able to support real patient involvement within the entirety of their portfolio (cancer, maternity, children, mental health, stroke etc etc). Or will it be left to the NHS Trust, CCG and other more general Public and Patient Involvement groups to pick up the mantle. Will the stalwarts of maternity and cancer involvement join in with them, will some of them who are part of the Links mechanism become part of the Health and Well being Boards. Does it matter if this is about general patient experience and involvement or should their be something special for specific groups. Or will we lose something from all of this and will some of those committed individuals walk away. From some of what I have heard, many are disgruntled and hurt that the work they have done so far will apparently be lost, and they might just.

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!

Promoting bigoted views

I am not really a fan of radio phone in programmes. This is not because I don’t think people shouldn’t be able to enter into a discussion about current affairs on a media forum, but it is because they seem to encourage narrow minded views to be expressed. This lunch time I happened to be travelling to a meeting when Jeremy Vine was discussing the idea, apparently promoted by NICE that pregnant teenagers should receive their antenatal care in school. The usual formula was followed, firstly he introduced a couple of ‘experts’, in this case a policy expert and the Chief Executive of the National Childbirth Trust. This was followed by a series of phone calls, emails and texts from listeners. I only caught a small amount of the first part, but while both speakers expressed some interesting and reasonably balanced views actually where was the real patient expert? Where also was the voice of the teenage pregnancy midwife?

What was worse however was what followed; a flow of old fashioned views and opinions which essentially said that teenagers who became pregnant should be separated from their peers for fear that their loose ways could be caught. It was also stated that young mums tend to be scroungers who sit together smoking and generally getting up to no good.

I have had the pleasure to meet and work with a number of people who work with young people who become pregnant. I know that these are people who specialise in helping and supporting young women, their partners and families through pregnancy and beyond. I have been told that school is not always the best place for clinics and that seeing young people in more neutral settings away from the older clientèle works. I also know that in most areas in the UK any individual school is unlikely to have more than 1 pregnant teenager at any time.

I welcome NICE bringing up the issue of vulnerable pregnant women including teenagers, but wonder quite how some of our media outlets come up with their ideas around what makes balanced and informative broadcasting. Jeremy Vine’s first email on the subject was from a woman who suggested that pregnant teenagers should be given a good thrashing; I am sorry but that is neither balanced and informative.

1997-2010 what has changed?

In 1997 I was a proper nurse; well a nurse seeing patients. My head was firmly down and the work was hard; my patients had rheumatoid arthritis. My job essentially was to start them on heavy duty medication for their disease, monitor their progress on that medication and to provide advice and support. It was a good time for me, I was competent at my job and the work while busy didn’t overwhelm me. The medications we used was reasonably tried and tested and the new wave of drugs now used to treat this disease hadn’t arrived to test our budgets. The internet was reasonably in its infancy, and the main source of healthcare advice for patients came from the written rather than the virtual media.

My main source of learning around that time related to things clinical. I studied for a qualification which allowed me to perform joint injections. But really I had little need for government policy. It wasn’t until I decided to change jobs in the autumn of 2001 that I was required to even understand government policy. This didn’t make  me a bad nurse, just a nurse doing her job in the environment within which she needed to work.

Jump forward to 2010. Now my job is about commissioning health services. It is about making sure that the services which are provided for the local population not only meet their needs but are of the quality that  local and national policy tells us they should be. We now have the National Institute for Clinical Excellence to give us clinical guidance and we have the Care Quality Commission to monitor standards. For someone commissioning maternity services we have Maternity Matters (about choice and quality). We also have a public who know what they want, know what they are entitled to and know where to look for evidence that they are not getting it. Policy is now important.

Imagine then a day where one Prime Minister causes East Enders to be cancelled and another arrives. Imagine a day where DH staff are told that policy is suspended while it is decided what the policy for health now is.

Over the last week I have wished I was back with my patients; trouble is, can a nurse in 2010 ignore policy and keep her head down?

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

swine2I 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

aprilfoolWe 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!

The NHS long hours culture – a system running on goodwill

nurseThe other day I sat next to a senior midwife who told me that none of her fulltime staff is under 45 years of age. The younger midwives find fulltime work too tiring. Another told me that she was at the conference in her own time, and that midwives who want to attend a function I am organising in a couple of weeks will need to do so on their days off. The midwife establishment and staffing levels just don’t allow for much in the way of release for training, sickness or days off. On Thursday I needed to speak to a local Head of Midwifery, her PA told me that she was on annual leave, she had been into the unit that morning till 11am but had gone home now (it was about 1pm at the time). Nurses who blog on the internet also describe a long hours culture, one where people take no breaks and hardly have time for a glass of water or trip to the toilet in 12 hours. Even within the office environment it is considered more important to meet your deadlines than anything else even if meeting that deadline means staying till 6pm or more likely taking the work home and spending your evenings or weekends doing the work.

I am pretty sure that the individuals working long hours in the NHS do so without particuarly being TOLD to stay behind, to work in their own time, but it becomes an unwritten rule it becomes part of the culture. One where if you don’t work in the same way as those around you then you won’t fit in, maybe the opportunities for promotion won’t occur and maybe that promotion would just involve even greater long hours working. What happens if the responsibilities you have outside of the workplace mean you actually need to leave on time? What happens if you have a medical condition that means missing meals or fluid are detrimental to your health?

Yesterday I visited my husband’s elderly granny in a hospital not far from here. The ward was full of elderly ladies, most of whom looked as if they had high levels of dependency. When we arrived her IV had tissued, the nurses came to her speedily, they took her observations, made adjustements to her care and detected that she was becoming hypothermic and acted accordingly. While this was going on, I saw only one other member of nursing staff on the ward. The care seemed to be good but I have to wonder about the pressure the staff are under on that ward. I came away, as I often do, wondering if I shouldn’t get back into clinical practice and do some shifts on a unit like this. Trouble is, my working week is pretty intense as it is. I have deadlines to meet, I can’t take breaks, though because I am desk (or meeting bound) there are opportunities for food and drink to be consumed. When I get home I am tired and sometimes there is work still to be done. Why on earth would I work extra in those kinds of conditions when I could be at home ironing and cleaning?

If the NHS pretty much functions on goodwill, what then will happen if that goodwill runs out?

Commissioner – friend or foe?

When I entered the world of commissioning I had pretty much no idea what it was all about. Ok, so I am not stupid and what is more, I have been education lead which involved identifying need, looking around for the best kind of educational input, buying it and getting people to do it. Little did I know though that within 2 years I’d be running round like a blue arsed fly in the way that I am now. The most interesting part of the job I’d say is the way in which we have to play the whole good guy / bad guy scenario out with our providers. So in the morning I am working with a bunch of midwives to make sure the particular pathway we are looking at will best meet the needs of the female pregnant population, be affordable, be safe and meet some kind of NICE guideline. In the afternoon I am being hounded by the SHA to submit an action plan from a Trust that is performing badly in some way.

Yesterday I attended a workshop on Teenage Pregnancy which was attended by people from health, the local authority  and the voluntary sector, who provide lots of good interventions to young people either in trying to prevent pregnancy taking place or in helping to pick up the people if it does. I was asked to do a short presentation on commissioning. This I duely did, but the end result was being approached by an endless stream of people with services they wanted more money for, who had a good idea they thought would meet need or who generally thought I could be their friend. What I discovered was that the services we provide are a complete mismash. They are often not properly commissioned or funded. They rely on good will and they often have to be withdrawn because money runs out.

Commissioning for me is opening up more questions than there seem to be answers to. It is enabling me to meet some great people, but I would say beware those who make friends with me, sometimes I have to performance manage you and then you appear not to like me quite so much.

It just gets worse

Yesterday I wrote about the woman in California who has given birth to octuplets. Today it seems apparant that the commercial world we live in means that a bidding war may have broken out to obtain the mother’s story. Reading the story as outlined i today’s observer is quite horrific – a bankrupt grandmother, a woman appearing to health providers when already pregnant with 8 foetuses, no partner, no visible means of support.

The world as we know it is in a complete mess. But it is not the bombs of terroists or the acts of a terrible dictator that have brought us to this point. Instead we have emerged from a couple of decades when we thought we could have anything we wanted, never mind the cost. The only value we seem to understand these days is financial. How did we lose sight of the important things in life.

Imagine the basics of life. What is important to you? Health? Family? A roof? Food on the table? Honesty? Trust? Happiness?

Where  in all of this does material wealth and the ability to over ride need over want originate? At a meeting last week colleagues spoke of women misunderstanding the point of the ultrasound scan performed 12 or so weeks into pregnancy. People are thinking of this event as a way of perhaps predicting the sex of their baby, of a way of seeing it wave at them. Actually this is provided to check that there are no abnormalities. To me this is indicitive of the way we have been living our lives recently.

Eight babies – why?

8-babiesHaving treatment to produce a much wanted child when you are unable to conceive naturally is something we have grown used to. At one time, when medicine was still learning about assisted conception there were a many multiple births. But time has moved on and now more embryos that are implanted during procedures like IVF survive, it is no longer necessary to implant quite so many. Plus it is entirely possible to remove some in order to promote the viability of those surviving. Even in this country, where we have a national health service such treatment is not without financial cost. Many people have been denied NHS fertility treatment, though that position has improved recently. But it is not just the assisted conception that you need to consider if you are planning to have a number of embryos emplanted in your uterus. To most people the idea of giving birth to 8 babies is nothing short of abhorrent, but apparently not to a woman in California who delivered that number this week.

On hearing the news this week I was amazed that this event had happened and perhaps a little fearful about what might happen to the woman and her babies. What kind of problems might they encounter, supposing all of the babies continued to be healthy. How on earth would you cope with such a large family? That amazement for me is quickly turning to disgust. This apparently is a woman who had already had 6 children. This is a woman who lives with her parents and is not part of a stable relationship. This is a woman who doctors allowed to undertake this treatment, who had a large number of embryos inplanted and who was allowed to continue with the pregnancy in tact. I do not know how much the hospital bill for the lady is, I do not know if she is paying this herself, but the drain on resources is not purely financial. A neonatal unit that is provided for an area will be seriously stretched if one woman fills it with 8 babies at once. Doctors, midwives and nurses devoting hours of time to one woman and 8 babies cannot be with other women in labour on the same day. The whole thing is almost beyond belief.

When I wonder did it become our right to conceive a child (or many children), to decide that we could put our own life at risk and put each and every one of those babies lives at risk by carrying them all until labour. When was it ok to have a ready made family of 14 without the kind of support systems that every child needs? I hope this lady can give her family the level of care that they will need and that they deserve. Personally I cannot imagine how this can be possible.

Infant mental health

wee-hat-on-baby-blue-1I have been puzzled by this one for weeks (well either side of my holiday since I never gave it a thought while out of the country), how on earth can people talk about the mental health of an infant? Surely a baby in the first days and weeks of life cannot be affected by its relationship with its parents so long as someone gives it food, keeps it warm, and lets it sleep and cry. Of course as often occurs these days since I do a job working in areas where I am no expert, it turns out I am wrong. I am about to embark on a bit of a project around maternal mental health. There are NICE guidelines and locally we just don’t meet them. A piece of work then to bring together all interested parties (midwives, mental health workers, people from primary care etc), map services, plan the pathway, look for gaps, find money and all will be well. Hmm well of course I never thought it would be that easy, and today a conference on Infant mental health told me that the maternal side of things, the antenatal and postnatal period is just part of the issue.

The way in which parents interact with their children affects their emotional health and well being from the beginning. There is evidence that the brains of children isolated in orphanages in Romania were damaged by their experience of isolation. Some of the behaviour we complain about in young children directly relates to the way in which they have interacted with their parents from birth. The way in which we attached to our parents affects the way in which we parent our children. The children of mothers who have experienced post natal depression continue to have attachment problems throughout life! Sometimes in our working lives we have lightbulb moments. Today a whole Christmas tree of lights came on for me! This is a major piece of work because although some good things are going on out there they aren’t joined up, there is no equality of service and what is more the services that exist are underfunded and probably not really commissioned as such.

Thank goodness I have the weekend to reflect on all of this stuff because I tell you I need it!

Catch up part two

A long absence from the blog is always going to require more than one shortish post to catch up, so in the absence of a great title, this is part two. My other interesting encounter of the week was a day spent at an event to do with teenage pregnancy and the government target to halve teenage pregnancy by 2010. This is a complex area of work for those who have been part of this whole thing for the last 7 or 8 years. Many areas seem to have had good success, but others are struggling. We are living in a culture where sex for young people seems pretty much the norm and where despite the publicity and availability of various forms of contraception plenty of girls still don’t use them. This means not only pregnancy but also sexually transmitted diseases like chlamydia.

Interesting as the actual conference was (and as I am only just getting involved in this area of work so it was very informative) that is not really what I want to talk about here. Instead my focus is about the extent to which some people lack insight into the way in which they behave and are prepared to allow people to see their behaviours towards others, and the long running arguments they are involved in where ‘partnership’ is meant to be happening. We were sitting on tables together with people from our own geographical area, alongside others from neighbouring areas. As the new person, I was keen to find out as much as possible, but what I found out was fascinating. Two particular colleagues spent much of the time engaged in what appeared to be a long running dispute about the sharing of information, the lack of engagement of one party, the unwillingness to work together and the feeling that they should tell and dictate rather than share and collaborate. Sadly the main aggressor (and I choose that word with care) was from my own organisation, and sadly also other people sitting nearby were party to what i can only describe as the washing of dirty laundry in public. Sadly also this is going to have to result in me getting involved in areas I would rather not do when I get back to work. My take on such disagreements is this, say what you like to each other so long as the doors are closed and people from outside don’t know how much you despise each other. But please don’t act in a way that demonstrates that you are in turn aggressive and then defensive and which appears do demonstrate something quite unpleasant about the way in which you work in your organisation.

I am sorry to see this morning, that Mousie has taken down her blog. in the context of that, I have thought long and hard about the above post, and have been as vague as I can without it not making sense (I hope). It seems our colleagues in the NHS are waking up to the presence of blogs, which is great, but also makes being open and honest difficult. For now though I continue.

Catching up

I ought to be much better at blogging by now, and what is more, if I can blog regularly even when completing a demanding masters course then I am not sure anything I do now is much of an excuse. Having said that, I do still have things to say, and amazingly more people have been reading particular posts even though I haven’t had much to add lately.

So onwards and upwards. I’ll try to be a better blogger (honestly I will). So what is new in the world of the NHS and also what is new in the world of Julie whose life is spent working in the NHS? This week at work has been particularly interesting on the work front. On Tuesday I attended the launch of a new strategy for midwifery supervision. This has led me to think about the difference in the accountability process for midwives against that of those of us who are nurses in the UK. Supervision of midwives is statutory and is considered pivotal in safeguarding and enhancing the quality of midwifery care provided to women and babies. In nursing, supervision is more of a desirable thing, it also adds to the practice of nursing, but there is no statutory duty for supervision. What is more, a supervisor of midwives is required to sign off the annual notification to practise of individual midwives. Nurses require only to sign off their own notification and to say that they themselves are fit to practice. A supervisor of midwives is an experienced practicing midwife who has undertaken a post graduate course, she (not being sexist but most will be women) will have self selected or been nominated but have gone thorough a process of selection by the local supervisory authority who in turn are accountable to the Strategic Health Authority and then the Nursing and Midwifery Council.

Some of the roles of the supervisor include:

  • Providing supervision to approximately 15 midwives
  • Signing off notification of intention to practise
  • Providing guidance on maintaining registration and updating opportunities
  • Investigate incidents
  • Report to local Supervisory Authority where there is a professional conduct issues
  • Be available to support midwives in discussing practice issues
  • Provide 24 hour supervisory cover
  • Arrange annual review meetings with midwives
  • Engage and communicate with stakeholders
  • Provide midwifery leadership
  • Participate in audit
  • Maintain records of supervisory activities

I understand why supervision of midwives is important, and I also understand the increased risks associated with their practice over those of many nurses, but what I don’t understand fully is why there is nothing like it for any nurses at all in the UK. I’d welcome comments from other nurses on this one.

Rounding up the week

I prefer to be the kind of blogger who writes about a specific topic most days of the week, but just recently it has felt that life (at work mainly) has been so busy that my thoughts about potential topics are not clear, and that the work I have been doing has been so specific to my job and geography that it has been difficult to sit down and produce anything worthy of posting to the world wide web. Hence a round up of the week according to Julie.

It is interesting that when I started my job, and for much of last year that job seemed to kind of jog along at an easy pace, while I learned new things and got on with doing what was expected of me. Of course for half of last year I was also studying and writing my masters dissertation which made life in general pretty hectic, but the actual paid work element seemed pretty reasonable. All of a sudden (the kind of sudden that builds up over a few months) I seem to spend my days rushing from one place to another (either actually rushing within a building or driving from one part of the county to another) and getting little time to sit at my desk and start and finish things. I also seem to get more than my share of emails which I can now see on my blackberry as they come in, and phone calls which tend to accumulate on the newly installed telephone system’s voice mail.

So what happened during this busy week that culminated in me missing part of yesterday evening by falling asleep for 2 hours from 9.30pm? Monday was a pretty nice day since I attended the PCT vision and values day. When you have been in the doldrums and no one seems to think much of you what better way to try to make your staff feel better valued than to invite them along to tell them stuff and invite them to feed back their thoughts and ideas. Nice conference centre, ok lunch, whole executive team presence and about 100 staff. I would like to offer up some cynical wisecracks about the whole thing, but actually I thought it was pretty well put together, and if every one of the 3500 members of staff we have attend this thing over the next year as they say will then maybe there is a chance that morale can be lifted and we can make people feel it is worth working hard for this organisation. We shall see! The after lunch energizer was from drumcafe.co.uk, the best thing I’ve done following lunch on any day recently!

Tuesday and I was providing the requisite PCT support to our maternity services liaison committee. No matter how often I attend these meetings, and no matter how efficient I am at sending out the papers in time, no matter how nice the lunch I provide, I am never going to feel like some of those people place any value in me. Sadly the lay members of the group, people who believe in natural child birth and who seem to think all of the NHS is the devil incarnate have not been to the vision and values day, they have not experienced drum  cafe since they are not employees. I shouldn’t come away feeling the way I do from each meeting, but I always feel like I have failed them in some way and usually they appear to think I have.

Wednesday was important because I knocked off early to prepare for the champions league final, shopping, cleaning the house etc ready for a gathering of family in support of hubby who is a chelsea fan. Good news was the 3lb lost for the weigh in at slimming world, also had a good chat with my sister in law. Bad news was the penalty shoot out and hubby’s subsequent unhappiness.

Thursday, and an afternoon contributing to the emotional health and well being strategy. At last a move away from what we do to help mange mental health problems in children and young people towards how attend to the emotional well being of the wider group of children and young people. Great idea, but lots of work there for colleagues working in that area.

So to Friday and the conclusion of the maternity review that started last week. A long day, doctors, midwives and people who think that local health services have been stolen from them to listen to. For the second time in a week I encountered members of the public who spoke to me as if I was some kind of dirt on their shoe. Just because I work for the PCT, just because I am part of the NHS does not make me any less of a person than anyone else. What is more, it would do those people well to realise that those of us who work in healthcare also use it, and being a manager does not make you some kind of a monster. At least my manager appreciates me, she bought me flowers before shooting off home early and leaving me to my late finish. You can’t have it all after all!

Agree to disagree

On Wednesday while my heart was racing and I was willing it to return to normal and hoping to stop being dizzy I sent an email to about 6 key GPs in my PCT area. There is to be a review of maternity services and they, along with midwives, obstetricians, actual people who recently had babies and others have been invited to contribute. I have received 3 replies to date, the first from a GP I know who says – yes, love to be involved, the second from a GP worried his population are poorly served by services right now and a third from one who thinks it is no business of a GP.

This is the fascinating, interesting and often amazing world that is primary care. No two GPs in no two surgeries seem to actually agree with each other. For each sensible, measured response, someone decides to fly off the handle. If you try to involve them, then you can be accused of bothering someone who is busy with too much else to do but woe betide you if you don’t actually send that email or make that call.

This means that every time Dr Crippen flies off the handle, every time Dr Rant is apoplectic with rage, then somewhere a GP is thinking that this is rather a good idea and another is wondering why anyone has actually bothered! This is why I love health management so much!

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