Over the holidays, NHS managers will need to stay on the ball to keep their organisations running smoothly

The sickness level among emergency department staff at King's is one of the lowest in the trust at 2.8 per cent. This does not square with received wisdom about sickness absence being related to stress.

The department handles three to five shootings and stabbings a week. It also receives regular casualties from multiple road accidents and other incidents. For several years it has also been the receiving centre for heart attack and stroke victims from much of south east London and parts of Kent. Meanwhile, especially around Christmas, it becomes the receptacle for addiction problems, family breakdown, mental breakdown, club fights and elderly people living alone - a microcosm of the troubled elements of our society.

The low sickness level, is I think, a measure of morale and team spirit. This has been tested recently by some unfair remarks about crisis mental health services but remains strong. It will be tested again in the next couple of weeks for the reasons above.

Meanwhile, we won't have the slack of previous years as we use time, space and committed staff over the holiday period to address the 18-week target. I suspect other acute trusts will be in a similar position - if not, please give me whatever advice you think I need.

Over Christmas, our management will need to be nimble and contingent so that our people are properly supported.

And, since it's that time of year, I thought why not a poem? The trouble is once you start you can think of content for dozens of verses. The few scenarios mentioned below are of course entirely fictional. Oh, and for those who don't remember young Mr Grace, he was the store owner from Are You Being Served who would somewhat insincerely tell the staff 'You've all done very well' before falling into the arms of a young, blonde assistant.

A Chief Officer's Christmas

Xmas time for the chief exec,

do you head for the hills

or stay on the deck

of a ship that gets through

the rest of the year

with challenges dealt with,

nothing to fear.

You might even think

of doing on-call

to help you keep

your eye on the ball.

If only it stayed

as quiet as you hoped

at all other times

you'd have probably coped.

But how do you handle

the strange events

that this time of year

always seems to present?

The family brawls that

at Christmas we see,

promptly restart

in casualty.

Besides this breakdown

in family life

we see other signs

of seasonal strife.

It helps to remind you

that what we're about

is being available

when others are out.

If only the critics

would give it a thought

as they make themselves comfy

and sip on their port.

It's the time of year, too,

when unusual cases

turn up in majors

to fill up the spaces.

'You shouldn't have put

that thing in your ear,

Of course something that size

does not belong there!'

Some things are simply

too bad to report

but painful enough

to leave you distraught.

It's not just in Cas,

where work must go on,

the 18-week target

will stop for no-one.

So give it two days

Then: 'Can you come in to help with a list?

'Sorry to ask you

Please say you're not p*****d.

We need the performance

to stay in the race

so wait til New Year

to get off your face.'

Our friends in Whitehall

have already gone.

You can tell their last day

because that's the one

With last-minute e-mails

round about four,

to give you an action list,

budget cut, more.

So please have this done

by the end of the day

and please don't call back

we've all gone away!

Not long after that

the chair marches in

with an excessively

seasonal grin.

He wants to thank those

who are rostered to work

so let's tour the trust

he's not one to shirk.

He'll praise many colleagues

for running the place

trying not to sound

like young Mr Grace.

But let's not forget

it's the season of cheer.

You'd think the word 'party'

was invented round here.

Scenes where the workforce

loses its care

and fuelled by the sauce

rediscovers its dare.

For some this means giving

the boss a hard time.

For a few it's the risk

of extra-marital crime.

But happily more

in the thought than the deed.

New Year fallout

is what you don't need.

Instead you uncover

the skills of your staff,

musicians, actors -

you don't know the half.

Raconteurs all

with a story or two,

knowing enough

to embarrass you!

All in good fun

and mostly no harm.

All targets met

no cause for alarm.