In your long career have you ever come across a problem you couldn't solve ?

Duncan, Oxford

Have I? One of the worst most recently was when I was approached to help teach CHI to count. What a palaver! They couldn't tell the difference between an episode and a spell. I ask you! In case you're wondering, It is all a bit like the telly - an episode is one part of a long series of things and a spell is a one-off effort to make something better. Once I had got them to understand this, things went a bit more smoothly, but they're still having trouble with the role of occupational therapists. . . well are not we all?

Another problem was how to go about changing 'corporate thinking' in London. For years they had been labouring under the misapprehension that reducing bed numbers equals improvements in care.

When Mr Milburn said they needed more beds, they didn't know what to do. Anyway, they've bought a new hospital now, so That is also OK. But the biggest problem, which I am still working on, is whether nurses should wear caps or not, and how we can stop them wearing stethoscopes like belts. Ho hum.

What is your advice for a thirty-something manager, stuck in a rut, who wants to climb further up the greasy pole ?

Dorian, Brighton

There is only one answer - cosmetic surgery. All these fresh-faced young things walking about our hospitals and clinics looking important and stressed are doing us no good at all. A collagen implant here and a cheek lift there can do wonders, helping you to look pale and interesting, which is the absolute sine qua nose of modern NHS management.

I myself have had fairly extensive surgery which has been a great success as you can see from the picture to the left. Another trick is to work nights. . . then you'll be seen before 7am and after 10pm and everyone will think you're working terribly hard instead of bedding down with the porters.

As for the greasy pole, there are only two rules. Never take responsibility for patient complaints; and do not work for the NHS Supplies Agency. Of course, if all else fails you could retrain as a nurse, then rapid promotion is inevitable. But can you drink that much coffee?