Three years ago my hospital was doing very well with waiting lists.

We had a sharp little deal going with a small local charitable hospital which did loads of work for us quickly and cheaply. When Mr Dobson came along he made us stop this arrangement and our waiting lists went up. Now Mr Milburn says this sort of thing is all right again, but the charitable hospital has gone bust in the meantime. What should I do ?

'Entrepreneur', Liverpool Unfortunately, Mr Dobson - though nice and brave - wasn't quite all there on this one. Luckily, Mr Milburn, who is nice and clever, has hit the head of the nail. Now the thing is, why are your waiting lists going up in the first place? As we know, the New NHS now has more nurses, more doctors and more policemen than ever before, and it treats people more or less.

What all this means is that you should be doing better with your increased resources. The answer, of course, is to set up a special elective surgery unit where you can whip through all those annoying little ops that bung up lists quite unnecessarily. Where, you may ask. Well, you need a small hospital-type unit, and as you have told me there is now an unused one in your area. . . See, I told you Mr Milburn was clever.

How many nurses does it take to change a bed ?

'Joker', Edinburgh Well this is an old chestnut and no mistake, and it's often presented as a joke. . . joke indeed! This is serious business. The answer is 12 and a healthcare assistant. The HCA makes up the bed, and the nurses form a professional support group to lobby management to release them from mundane tasks.

However, the making up of the bed also involves the porters who deliver the linen, the driver of the laundry lorry, 12 laundry assistants at the laundry and so on and so on.

What all this means is that the HCA is at the pinnacle of the caring pyramid. Why not train your HCAs to undertake minor surgical procedures, thereby releasing nurses to use their valuable time in more important patient care tasks. These might include identifying cross-infection risks in laundries and automating hospital corners. The only limit is your imagination.

Why not let Mel help solve your problem? E-mail her, in strictest confidence, at: Mdestrange@healthcare.emap.co.uk