I find it very difficult to make friends. I am a sad and lonely person and the demands of my job are so great that I often break down in tears. How can I toughen up?
'Shrinking Violet', Leeds.
Why don't you get out of yourself a bit more? Try visiting the House of Commons from time to time and talking to a few MPs. Join the Labour Party and ask to go on the Number 10 press release mailing list. Attend the Institute of Health Services Management conference and clap loudly whenever the secretary of state says something. If the prime minister attends, stand and cheer - you can even cry a little if you are overcome with emotion. Write complimentary letters about the New NHS to the Daily Telegraph. Pretty soon you will be noticed, and you might even be asked to sit on a national project team. Once this happens, people will want to meet you and be seen with you. Your problem will be solved. This is called notworking.
Do you know of any hospitals which have successfully managed to stop nurses pinning hand-written notices to newly built wards saying things like: 'Dr Smith's bleep not working 'til 1 May 1987?' I am about to commission a new hospital and I would love to crack this problem.
Yes, it is a common problem, isn't it? I know of only one successful anti-notice pilot, which is in Sedgefield. The director of estates printed new notice forms which had to be used for all scribbles, and then allowed the nurses to put up as many as they liked. The clever part was that they were pre-printed with a smiling picture of Tony Blair. It was an amazing success. Anything with the PM's picture on was read avidly by staff and patients, and they all cheered up no end. It seems like a simple solution, but there is a snag. All notices must be vetted by Alastair Campbell first.
Can you offer any advice on how I can get on with my community nurses? I really want to make a good impression and establish good relations. What is the key ?
'Tryer', Tower Hamlets.
What a refreshing change. You must earn the trust of your community nurses. The best way to do this is not to challenge their travel claims. There will be clear clinical justifications for going from Bethnal Green to Whitechapel via Great Yarmouth - don't impugn their motives. Second, it is a little-known fact that it can take up to three hours to administer an insulin injection and sometimes longer to change a dressing. That's why community nurses can only manage two or sometimes three calls in a shift. Third, don't be a clock-watcher: community nurses have to keep their knowledge base current, so you can be sure that when they finish their 2 to 10 shift at 4.30 they are filling in the rest of their time with their huge backlog of reading. Finally, don't forget that community nurses get lonely. That's why they prefer to work in teams of at least three or four, and sometimes pick up their kids from school for company.
After years of being a finance director for a major multi-national company, I have just been appointed to a similar post for an NHS trust. Can you explain the NHS capital accounting system, or tell me where I can find further information?
It's quite simple, really. First, work out how much you owe the government for donating your hospital buildings. Then divide this amount in half and add a percentage to your prices. When you get paid you don't get the percentage bit, but your purchasers pretend to give the money to the government, which then pretends it has received it and reduces tax rates as a result. The second element is that you must show a return on some things but not others. The level of return depends on whether your chair was appointed after 1 May 1997. If you don't achieve the return, you might be held accountable by the courts for your personal failure; this is called a capital charge. Finally, you must ensure that your costs are always the same as your purchaser's income. This is called an external financing limit. Hope this helps.