Former NHS Nurse and manager now contemplating the NHS from outside

Archive for the ‘News and Current Affairs (general)’ Category

Why are more people going to A&E?

That seems to be the question which is currently challenging health politicians and the media. Of course it is not a new question for those working in healthcare, since it is perfectly possible to track each and every attendance and episode of care that takes place. Even before I stopped being a commissioner at the end of 2011, senior managers were scratching their heads about the increase in ‘unplanned care’ and trying various methods of ‘managing activity’.

There is no doubt that attendance in emergency / unplanned care has increased, but why? The analysis we are given doesn’t tell us about when people attend, but in trying to answer the question, they point to changes in GP out of hours services. That suggests that there are no problems with the availability of GP services ‘in hours’. However, when a new Urgent Care Centre was opened in this County, it was discovered that faced with the chance to attend and be seen immediately rather than wait for an appointment at some of the less well run GP practices, people chose the former. It wasn’t all about out of hours services at all.

The lack of ownership by GPs in out of hours care is also blamed, but many out of hours services are literally owned by GPs as well as provided by them (it just isn’t obvious since they are contracted out). Of course, if you contact these services you are unlikely to see your own GP, therefore you might as well go to an urgent care facility. When you get there though, you might find yourself triaged into a GP service, where the same doctors providing out of hours care are also based. Funny how that isn’t mentioned.

Patients and their individual needs, are quite rightly being recognised as central to health provision. But with that recognition comes the realisation that people will use those services in the way that feels right for them. That might mean accessing emergency care for things that they perceive as needing attention now, even if those providing the care don’t think that is what is needed. If you feel you need to see a health professional and you know you have to plan to need it to attend your own GP surgery what will you do? Probably access a place you know is always ready to take you.

Then there are the telephone advice services – first NHS Direct and now 111. In deciding to change the focus of these services, a decision was made to completely dismantle the former in order to start up the latter. As NHS Direct ran down, then more people were referred to A&E. Everyone knows that assessment and triage of the patient are the most important parts of deciding what is wrong with someone, who is best placed to help them and what should be done. The more experienced the person doing this is (on the phone or in person), then the more effectively that problem will be dealt with. It stands to reason then that if you get rid of qualified staff before the new system is in place you are asking for problems.

Finally something that no one has mentioned. Children are some of the biggest users of emergency care. They become ill quickly, in an unplanned way. Parents rightly worry that they need attention right now and take them to A&E. We know that the birth rate has been rising steeply, we know school places are under massive pressure. I wonder if some of the increase in attendance relates to the increased number of under 5’s?

Like most issues in healthcare, this is complex. I doubt there is no easy answer nor a single cause. The propensity of politicians to blame in turn the previous government or GPs is simplistic and plainly wrong!

Is this the best way to cut the deficit?

No one doubts the need for deficit reduction. If I think about the difficult decisions I had to make 5 years ago or so, when I realised that my personal debts meant that my monthly payments to creditors practically outstripped my income. Something had to give, and that something was my credit cards and loans. The experience was painful, and sacrifices were needed. But today I have just a small amount of remaining debt (other than the mortgage and every month I have money to spend. Christmas, which used to be a time to dread has come and gone and I owe no more today than I did last month.

The nation’s debt is thankfully much greater than anything I could conceive personally, but the principles are the same. The causes of this are well written about, but in my opinion not worthy of mention since it can’t help us now. The Government takes an interesting approach to trying to balance the books. Reducing the size of the public sector I can understand; it hurts me to say but a lot of jobs were created and money was wasted. You need to be careful about the ways in which you cut services and with them jobs, it creates uncertainty and fear and leads to risk aversion. More jobs are lost and less created because of this. If jobs and services don’t spring up elsewhere then some of those people become unemployed or else take lower paid, lower status jobs. This in turn means that those who might have taken those jobs are shifted further down the pile. The most vulnerable in society suffer most from this approach.

In turn the Government has taken a look at the growing benefits bill and decided that this can and must be reduced. dependency on the state needs to be reduced (even as someone who believes in the welfare state) I can hardly argue with this desire. But by starting with the most vulnerable in society this Government risks the label so often given to the Tories of the past. It feels nasty to target benefits to disabled children and those with cancer. Especially in a week when Cameron has said that he would like to see the 50% tax rate for those earning £100k to be abolished even though it is bringing plenty of tax revenue into the exchequer.

Tonight the House of Lords has shown it’s worth and voted for changes to the Welfare bill associated with these elements of cuts. It is a shame that they haven’t shown the same approach with the Health and Social Care Bill!

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!

Too Little, Too Late!

Contrary to what the government might like us to believe, and also contrary to what the Department of Health might think General Practitioners are not the only doctors working and living in England.

This quote from the DH follows the exceptional meeting of the British Medical Association (BMA) today:

We are disappointed the BMA has decided to take this step, including now opposing elements of the Bill they previously supported, rather than work constructively with us to improve services for patients. The BMA’s own survey shows their position is not representative of many of their members, who are keen to be involved in our proposals. The reality is over 5,000 GP practices, covering two-thirds of the country, have already signed up and have started to implement plans to give patients better care.

I have a few things to say about the comment – firstly, when was it the job of the DH to comment about policy that isn’t actually law yet? Secondly it suggests that all doctors are GPs and that the BMA leadership has had the support of their membership in agreeing to the policy change. My understanding (and I am sure someone will correct me if I am wrong) is that it is because the rank and file membership of the BMA did not actually agree with the stance of the leadership that today’s meeting was held.

But of course the Bill has been published and it is progressing through parliament. No doubt this and other criticism might lead to a few tweaks of the finer details (plus a few more major changes) but essentially the GPs of England are to be the commissioners of health services and no extraordinary BMA meeting will change that.

It is my belief that even if Andrew Lansley was to be told that this policy would result in half the doctors in England resigning and a catastrophic deterioration in health outcomes he would not change his mind and alter the Bill significantly. Bloody mindedness prevails and we are on a collision course for people to line their pockets, for people to set up their own little businesses and for the dismantling of the NHS as we know it.

What is clear is that none of the health unions in this country can make a blind bit of difference to this mess at this stage; the titanic is already approaching the iceberg and those on board can only hope for a safe trip in the lifeboat to shore!

Pay more, work longer, end up with less

What a cheery week this is turning out to be.

Gadaffi is busy overseeing the murder of his own people, politicians across the world are busy scratching their heads and wondering what to do without seeming about to create another Iraq. Meanwhile we find that petrol is now £6 per gallon (remember that measurement?) food prices rise by the week. Soon enough we will all need banker style bonuses to make ends meet.

Fat chance. This is 2011 in the UK. This is the year (or perhaps decade) to bash the public sector worker. We are apparently all lazy people on massive salaries who push a pen (or certainly sit at a desk) all day inventing rules for rules sake. Not only to we turn up late, leave early, have too much holiday, perhaps get paid overtime and some other unnecessary benefits but at the end of it all we can live it up on a grand gold plated pension for 40 years or something.

I joined the NHS pension scheme when I was 18. Every month since then I have paid 6% of my salary into this pension. I have no idea what 30 years of paying into the scheme equates to. What I do know is that for some time I have known that we are all on borrowed time. The final salary must go, the early retirement must go and we must all work longer.

Strangely enough even in 1980 we were being taught about a demographic time bomb. We were told that as the baby boom generation aged then the population of the country would age. As time went on and diseases were cured, or better managed with an ever ending stream of new and ever more expensive drugs we were told that that time bomb was ticking so loudly you could hear it a mile away.

Even as the private sector abandoned their final salary pensions (many of them ones that the employees didn’t even have to pay into) we failed to recognise that one day that would be us.

I was never going to be able to retire at 55, but 60 seemed reasonable. Now who knows? No one in my family lives to a  particularly old age, though both my parents are alive (aged 73). My lifestyle is reasonably healthy so perhaps I will live long. I pay £250 per month in pension, this is more than my hubby can afford to pay into his private scheme so I am in effect paying for 2 of us. He does a manual job and at 52 is already weary.

On retirement we won’t have a mortgage but could still be financially supporting our son since it gets harder and harder for young people to afford to buy property etc. We would however like to be able to go on holiday and enjoy ourselves while we can.

You have to fear that in the next 20 years the norm will be for no retirement and a philosophy of work till you drop!

Time to confront the lies being peddled

This letter appears in today’s Guardian:

Feel free to ask me to justify that Nottingham city council pays our chief executive £160,000. She voluntarily took a £20,000-a-year pay cut when she took up the job three years ago. Ask any council leader to justify what their chief executive is paid, but please stop comparing them to the prime minister. The prime minister, in addition to his £142,000 salary, enjoys free housing, free transport and a range of other living-cost benefits. Then there’s his pension. Now that he’s been in office for more than just three months, he’s entitled to half his salary, index-linked, every year for the rest of his life. It’s all part of the package, even though, like Gordon Brown before him, David Cameron has decided to turn it down. Of course, he can afford that kind of grand gesture, since, like 17 of the 22 others in his cabinet, he’s already a millionaire.

Cllr Jon Collins

Leader, Nottingham city council

I’d like to see an estimation of the real salary of the Prime Minister because the anger and hatred being demonstrated by the government on this matter is getting out of hand!

What is this big society?

When you work in the public sector as I do, you cannot help but come across some amazing people. I don’t mean those people who work as nurses, doctors, therapists, social workers even managers and who as many do carry on working after others have gone home, who go that extra mile. No I mean people who, on top of their usual lives actually do things for others because they want to, not because it is their job, but because of a sense that they can and should do more for others. Around us there are people who help out in schools, hospitals, charity shops, take people places, visit the elderly and disabled or who sit on committees and make a difference to the way those with jobs view the people they are there to support.

In my current job I come across many people who work hard but who aren’t paid for that work. Some do so knowing that they are already financially secure, that they have already had their careers or that they want to give something back for an experience or event that changed them. Generally these people do this work because they want to, not because anyone has told them it might be a good idea.

The voluntary sector doesn’t actually come for free. Charities need organising, charity shops pay rent, and those organisations which appear to function through good will actually needs people to recruit the volunteers, train them, galvanise them and maybe pay expenses. They need to check people working (even free of charge) with the vulnerable have suitable training and support. Voluntary organisations need premises to operate out of and they need to be able to provide services for others. None of this is free.

Good will is a valuable comodity, and people who expect others to provide services using it do well to remember that. Good will doesn’t come completely free, there is a cost. The big society is made up of good will, but if you think it is something you can have in lou of something that should be paid for then you are mistaken.

David Cameron would do well to remember that!

Tuition fees – politicians just don’t get it!

Yesterday I watched a clip of Nick Clegg meeting a group of students. He was quite brave to sit in a room with them given the pledge he and his party made before the election and subsequently ripped up. I guess the students had made their own pledge not to rip into him physically but they certainly had plenty to say to him about his broken promises.

On one hand we are told the country is in the worst debt ever. A debt so bad that we could soon be another European basket case (along with Greece and Ireland). A debt so bad we are all paying for it in VAT, petrol tax and any other tax you might mention. On the other hand it is quite ok to encourage students to take out the biggest debt ever known to students ever. This assertion is made on the basis that the government promises that no student earning a low wage will ever have to pay much of the debt back. Well I have a few thoughts on this matter.

  1. We are told that if you go to University you will earn more in your lifetime than someone who doesn’t. I guess you just have to hope that you don’t earn too much more.
  2. While many students are able to apply for means tested benefits to add to their sustenance loan, many are not. Many of those people’s families are not rich and struggle to support their off spring. This is because part time jobs are now like gold dust since unemployment in the population of under 25’s is 20%.
  3. The student loan is not the only debt. There are overdrafts. When your student child lives on their overdraft you get sleepless nights and you end up sending them even more money you really can’t afford.
  4. Just because today’s government tells today’s students not to worry – your repayments will be low, the debt won’t affect your ability to get other credit in the future, it will be written off after 30 years – how do we know we can trust them.

My dearest student son, still a teenager for a few more days, is off to the USA this Autumn to study. Fees in the USA really are high, people really do struggle to send their offspring to them, debts really will be high. I recognise that we are lucky on this score. This does not however make it ok when it is pretty obvious that our current government cares little for the long term needs and prospects of the young people of this country today. After all many of the cabinet are already millionaires and when their children want to go to university they will just be able to write them a cheque!

Picture: Greece may be a financial basket case but it is a lovely place for a holiday!

Robin Hood? I don’t think so

If we are to believe the rhetoric of that little group of upper class Tory boys now in power, the country has been saved from ruin. what is more, those who have the most will pay the most and those in most need will continue to get the help they need. The comprehensive spending review took place on Wednesday and political commentators, economists and media moguls remain divided on just how fair the whole thing was. We all accept that the country is in debt and that we will all have to contribute to getting us out of that debt. What I find hard to accept is the short memories so many people have. It is almost exactly 2 years since the credit crisis struck and there was all party support for the need to bail out the banks and prevent the country from going completely to the wall. Indeed the whole world seemed to be in freefall. I remember well sitting on a plane travelling between San Francisco and Las Vegas and watching a Dow Jones in absolute free fall. I remember hotels at my destination with pretty much no one spending money on either gambling or  shopping.

So back to this weeks CSR and the emerging debate over who will lose out most. The coalition government are saying that the richest will pay most. This may be true but I bet you anything you like that proportionally 10% of the income of someone on £100,000 a year is worth more than 10% of the income of someone on £10,000 a year. I am no economist or mathematician but that much even I know.

I have to admit not having yet digested the full extent of all of the actions proposed in the CSR, after all I am meant to do more at work than read the news pages online. But I have been extremely interested to see the reaction of a couple of people who are disabled and who are advocating for other disabled people. There is a view held by some people in this country that everyone on benefits must be some kind of scrounger. This view has been encouraged by some of the right wing press and seems to have been believed by the government who seem keen to slash the benefit budget and to get as many of those scroungers as possible back to work. This is a massively short sighted view and one which takes no account of the diversity of illness and disability. What is worse it assumes that adults who live in residential care should stay in doors and never want to go out. It assumes that once you have an illness or disability then your condition stays the same and can’t fluctuate from day to day. It assumes that there is some kind of job out there waiting for you. It suggests that all disability is physical.

My brother in law has motor neurone disease. At the point of diagnosis he worked for tesco. They were keen to be rid of him from their pay roll (though his retirement (at 41) benefits were generous). At the time he was in shock, he thought he would be dead pretty soon and so accepted the situation. He lives with his parents, he doesn’t have a family to support but this situation has been difficult. Even if he had wanted or needed to work who knows how he would have gone about it. One day he may need residential care, his parents are elderly and may not be able to cope much longer. shall we assume that he will no longer wish to go out and about, to visit the cinema, to go and see family and friends?

Like Bendy Girl I am quite astounded that David Cameron has such little understanding of disability, the costs associated with disability and the needs of disabled people and their families. Unlike Bendy Girl I didn’t vote for him. I never quite believed the smarmy exterior and even though Gordon Brown had lost his way I didn’t think he would abdicate himself of responsibility for those most in need. And I know that neither he nor any of the labour party would. Only 4 and a half more years of this folks! finally Rhydian James gives a further insight into this issue.

This story will run and run.

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?

 

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.

An obsession with pay

Today the BBC is running a Panorama programme about public sector pay. Suddenly there is a major obsession with the public sector itself – somehow and suddenly we are all fat cat, faceless bureaucrats who earn too much and have a gold plated pension waiting for us to retire. Apparently some 9000 people who work in the public sector earn more that the Prime Minister who apparently just gets by on £140,000 or so. I wonder though if this is just a distortion of the bigger picture. After all, David Cameron currently lives rent free in a top notch residence in London with a country home thrown in for weekends. I doubt somehow that he needs to meet all of the usual costs associated with the life of a regular family. What is more, I wonder if that is his entire income?

Most of us who actually work in the public sector are increasingly unlikely to see a salary as high as £50k let alone getting on for 3 times that. What is more, I have discovered in the last couple of weeks that if I end up with a job at all at the end of the process to abolish my employing organisation I will be lucky to maintain my current income let alone get any kind of pay rise. What is more I await an increase in VAT and other taxes, food price increases and a threat that my son’s student fees will rise beyond recognition before the end of his course.

Of course many people who work in both the public and private sector earn less than I do – my husband for instance earns less than me for a longer working week and a more manual job, but that doesn’t make me any less valuable to the NHS than he is to  his company. I have recently been looking at jobs outside of the NHS. To be honest it is only my own anxieties and lack of confidence that prevents me applying for similar level jobs elsewhere. I have to say that if I did jump ship and could get up the confidence to promote myself in the private sector in the way I probably ought to be able to I wouldn’t actually need to take a pay cut.

Pay inflation is not a good thing for the economy, I understand that. But destroying the confidence of those who work for the state employers by suggesting they are over paid will not help anyone though!

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?

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……

In a world of uncertainty

Let me be clear (this is the way that first of all politicians then the journalists they speak to daily now speak) things are pretty unclear. Yesterday Gordon Brown resigned (though he won’t actually go until a new leader is elected) and the Liberal Democrats negotiated with both the Tories and the Labour party in an attempt (perhaps) to form a government. In this world of 24 hour news, of newspapers that can make direct, pointed and unpleasant attacks on individuals we are used to journalists who know what is going on and who are able to tell us whatever it is straight away. These people are getting fed up with knowing little, being told less and what is worse having to wait. Their way of trying to get people to make decisions on this situation is to say the public are getting fed up with waiting and want a decision to be made.

I guess I am biased but I am prepared to wait. I do want people to decide, but I want the decision to be a lasting one. The last thing we need is for the new MPs to arrive in parliament only to be unable to do anything because no bills can be passed.

In the NHS we sit and wait. We know there is now less money in the system but essentially we don’t yet know how much less money. But it is only May and there is still time to spend less than we thought we had in the first place. There is still time for jobs to be restructured so that there are less over all, and I am pretty sure whatever the shade of purple the joint colours of the new government are that will happen.

On a positive note, only 12 days till I go on holiday – keep away ash cloud!

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