'I am like a pig in the proverbial. I am no longer part of a demoralised, cynical workforce, ground down by the inevitability of stasis and rigidity'

For the last nine months, my family has been living in a rented house with a patch of concrete that passes for a 'patio garden' in estate agent parlance. As a result, every night around 10pm, I take the dog for a walk. As he relieves himself - with an air of refinement - on some unsuspecting shrub, I am able to contemplate the day. Even such a simple task has become almost pleasurable.

Why am I telling you this? Have I retrained as a dog-walker or canine urologist? Well, I suppose the main message is I'm demob happy. I left the NHS two months ago after more than 22 years and the experience of working for a corporation has been truly invigorating. I have been taken outside my comfort zone and, like a domesticated animal in the jungle, have acquired an acuity I thought I had lost.

In spite of being on the steepest learning curve since I qualified, I am like a pig in the proverbial. I am no longer part of a demoralised, cynical workforce, ground down by the inevitability of stasis and rigidity. I can challenge my colleagues - in a constructive way of course - and we don't have to conform to any norms of a top-down regime that feels out of.our control.

Attitude shift

For the last 10 months of my last post, I had a printer that produced a large black smear down the right-hand side of the page. If anything needed to be circulated, I would e-mail it to my secretary for printing. An item costing less than.£200 could not be replaced as there was no budget.

This week I asked for a desktop computer as I was experiencing low back pain from lugging my laptop around. I had a computer on my desk within 24 hours - one no longer required by another member of staff. It wasn't because there was.any more money around, it was because the can-do attitude of the team I asked had not.been ground to a pulp. The staff were genuinely nonplussed when I expressed my amazement. They could not.understand the impact of years of increasingly stringent financial recovery programmes.

No two days in my new role are the same - whether I am modelling patient pathways, negotiating with seconded consultants, talking to GPs, staff in trusts, PCTs or the Department of Health, or visiting a walk-in centre or diagnostic facility. I have been assessing the competency of Hungarian radiologists and developing a clinical governance framework. When that becomes too tedious, I can get my teeth into medicines management in care homes or audit tools for services for children with learning disabilities.

Through all of this, I am developing a host of new relationships - internal and external - and many of the latter have a different edge to them. Many of my new NHS relationships are with organisations at the extremes. They may be enlightened trust boards that have sought our involvement as they can see the huge possibilities of a reformed market. Or staff in challenged health economies or organisations, where independent sector treatment centres.and other independent sector facilities have been imposed to address waiting lists, or facilitated by GPs in the absence of a more primary care facing service.

I am disappointed, though perhaps not surprised, to observe that the bigger the problem, the weaker the clinical engagement and the more able the medical profession seems to be to bury its collective head in the sand.

Stage a revolution

The moral of the story? Change. Do something different. Question where you are. Build some stimulation into your day and day job. For me, the experience has been exhilarating. This isn't a cynical attempt to give good publicity to my new employer, or for that matter suck up to the boss. This is an honest attempt to encourage those of you wondering wistfully to really think about taking a new opportunity.

Seeing the world from a different angle brings with it freshness and insights that are undervalued. Remember, risk is the currency of the gods. Even if it is.a job swap or a chance to shadow somebody. Carpe diem. At worst, it may make you appreciate what you are.doing - at best, who knows where it could lead?