So it is nearly the end of March and every Trust in the NHS is playing the same game. Yes the country that invented the four hour emergency target will be measured on its performance at the end of this month. So whilst we try our best to see everyone ina timely fashion throughout the year we make extra efforts this last month of the year, March. And that is because the incentive funding linked to the four hour target is based on performance in March – and to hell with the rest of the year. So FRACMA candidates, here is an exam question for you……

“You are the new EDMS of a health service. The service will receive 0.3% of its annual budget only if it meets the target of seeing and discharging more than 95% of patients attending ED within four hours, in the month of March. What strategies would you put in place to ensure you meet that target?”

And yes, every trust across the country is doing exactly that. We are usually between 90 and 96% month on month, an achievement most HHS in Queensland would kill for, but that is not good enough. We have to spend extra money to be sure we achieve an arbitrary target for the month of March, a month that is still essentially winter.

One of the interesting things I found when I arrived is that there are no clocks in the offices or meeting rooms. Nor are there any boxes of tissues. We provide our own tea, coffee, milk and washing up liquid. I suppose that saves quite a bit of money, and you do get to choose your favourite brand! It costs me about £10/month so assuming the staff is 2000 that is £20,000/month, £240,000 a year, not to be sneezed at. And it does drive a number of people to the coffee shop in the atrium, which feeds back into the Trust, win win.

Brexit update. Would love to give an update but the chaos deepens, just when we all thought it could get no worse. Official communication from “The Centre” is that we should continue to plan for No Deal. My taxi driver summed it up. Two of his family voted leave and two voted stay. The country was almost exactly divided into two. However now the division is not so even, now the lies have been exposed. Where to next-no one can tell us. May has promised to resign if everyone agrees she has done the impossible and got a plan MP’s can agree to. Counterintuitive. Conservative MP’s have agreed to resign if Boris Johnstone is made PM. Many have jumped the gun and resigned already. The country is just resigned.

My first thoughts working for the NHS are a jumble of admiration, dismay and puzzlement at the mixture of differences from Australia. Probably some of these differences are simply being in a stand-alone children’s hospital, but others will be universal. One of the main differences compared to working in Queensland is the pride people take in the organisation they work for. Whilst staff in Queensland often talk about “Queensland Health” with open hostility and frustration, the staff in the UK are proud of the institution that is the NHS, despite their frustrations. Does that hostility mitigate against improvement? During the 2012 Olympics the NHS was showcased as part of the opening ceremony. That reflected the pride that all of Britain takes in the NHS. The public “ownership” of our NHS encourages a partnership approach with the patients/consumers/clients of that health service. Whilst the NHS is the “National” Health Service it is quite clear that there is nothing national about the health service at all. The service is divided up into Trusts which cover areas of varying size and varying demographics. As a result the provision of services varies from trust to trust, depending on the services commissioned by the Clinical Commissioning Group. In Liverpool that group is comprised of both doctors and lay members. Of the ten doctors all but one are GP’s. The NHS is in a constant state of reorganisation, even having changed structure between my interview in October 2018 and my arrival at the end of January 2019. So if you want a whistle stop tour of the NHS then watch these, bearing mind it has changed a bit since then!

https://www.kingsfund.org.uk/audio-video/how-new-nhs-structured

https://www.kingsfund.org.uk/audio-video/how-does-nhs-in-england-work

So I don’t want to be political but it is impossible to ignore the biggest constitutional crisis since we beheaded Charles I. And so to Brexit….. Well first of all we are officially advised to call it EU exit. Of course no one takes any notice, but that is the British for you! So, three quarters of our drugs come from the EU and of that the majority comes through the port of Dover. The Centre (NHS HQ in London) has arranged for drugs to be flown in to avoid Dover. Legislation has been passed to allow community pharmacists to change medication to similar formulations, not generic but similar. After an immediate outcry anti-epileptic medication was exempted from the legislation – as any good medical student would have advised, antiepileptics are not substitutable. Our hospital has a full time team with responsibility for Brexit preparation with weekly briefings for the Executive team. Replicate that across the NHS and you can see where the £350m/week is going!