Published: 26/09/2002, Volume II2, No. 5824 Page 13

Nigel Edwards casts his eye over diaries kept by three chief executives

'If these were beds, we'd be having the equivalent of a trolley wait - It is jammed is not it?'That is the verdict of NHS Confederation policy director Nigel Edwards after examining the three-day diaries kept by three chief executives brave enough to submit their doings to the scrutiny of HSJ.

The results - only a part of which are reproduced overleaf - show how crowded the agendas of both acute and primary care trust chief executives are.Mr Edwards points out: 'Thinking time or time to reflect is not really there.'

In general, Mr Edwards says, the chief executives are 'being pulled in all directions', though this particularly affects Nottingham City PCT chief executive Samantha Milbank. 'Perhaps the more heterogeneous nature of a PCT and its geographical dispersal creates more pull.'

Certainly her diary shows up time spent travelling, while her acute trust counterparts are able to do what Kettering General Hospital trust's Geraint Martin describes as 'swing by a couple of wards and catch up with general managers'.Mr Edwards attributes this partly to the relative convenience of single sites, with their handy corridors and lifts.

Common themes among the three emerge. 'A lot of what they are doing is focused on the immediate future, 'Mr Edwards says.

The three also have to go through 'constant changes of gear', he adds.

Long-term work includes Ms Perry's private finance initiative project and Ms Milbank's local improvement finance trust scheme, both of which bear out warnings that such schemes are costly in management time. 'It is have a PFI or see your family, ' says Mr Edwards.

Ms Milbank snatches time with her children at 6.30am, while Geraint Martin ends his diary:

'Leave at 6.30 to go to gym in an attempt to avoid heart disease and lose weight. 6.45 Go home instead and see kids before bedtime. 7.25 Arrive home and wish had gone to the gym. At least negotiating with children on bedtime switches you off from work.'

All three chief executives have seen their finance directors at least once over the three days, while accident and emergency is clearly a big pull on the acute trust chiefs.

And they are directly involved in service modernisation.

Ms Milbank also contributes a lot of time to services hosted by her PCT hosts, such as the secure services commissioning group covering three strategic health authorities or East Midlands NHS Direct. 'What's noticeable is how onerous this can be, ' says Mr Edwards.

And the PCT chief executive points out: 'The bit I did not put in is the bits that I did not have a chance to do that I should like to - getting 'out there'with the front-line staff and partners more.'

She also logged her weekend activity: 'The consequence of back-to-back meetings over the last three to four days is 214 unopened e-mails! Forty three per cent are PCT related, 8 per cent SHA or Directorate of Health and Social Care, 18 per cent national and 31 per cent other local issues, partners and PCTs.'

Ms Perry raises a dilemma that many must feel. 'It is my first acute trust. I am new and I do not know if I am doing it right.What is the right thing? I visit the wards - I think That is very important...' Mr Edwards says that is a key point. 'There is not necessarily any road map. Chief executives have to find their own way and they do not necessarily know whether what they're doing is right.'

The role is much more varied than many assume, he says. But all our diarists 'make good use of their time'.

Thanks to Geraint Martin, Samantha Milbank and Claire Perry.