I *really* miss my people right now. Perhaps I feel it more keenly because my whanau  are a lot further away – the expat way of life. Perhaps it is because I am quite an emotionally charged person. Perhaps it is…nope I don’t know the answer why but I do know that I wish I could go home and give Mum and Dad a hug, and the rest of them.

The greatest asset in my life are people – here, there, everywhere (yes, that’s pithy). I am good at expressing that in person, but no so good at keeping in touch when those people aren’t physically in my day-to-day life. As I emailed my aunts and uncles this week, I realised it’s been months (if not a year) since I last did this. I want to be much better at this because these people really matter to me, even though I don’t turn thought into action that often.

My great-uncle Malcolm died earlier this year – he was a true storyteller, with a mischievous smile (like his brother, my Grandad) and I loved him dearly. I’m not sure I told him how much he meant to me but I hope he knew it anyway – I think he did.

I know I am the same with friends – particularly those still in, or back in, NZ. I know I invariably take months to reply to your wonderful emails but know that they sit like treasure in my inbox until I deal with them. I miss you all and 5 years of London-life has not changed that, although it’s less wrenching now than in the first year.

My people have shaped and moulded me, made me a better person (or I like to think so) and they continue to – even from afar.

“The test of love is not when we are together. It comes when we are not together and realize that despite the distance, love is still there.”

I write this for the same reason I wrote yesterday’s post…more for me to write than for you to read. I want to be there for my family right now and I can’t physically.

It has been a long time since I wrote a proper post. Several times I have considered writing one of those “This is my last post” posts but I know, inevitably, I will be seized by the urge to write again several days later. Thing is, having lived vicariously through others as I got more and more unwell, I took life by the horns [pondering 1 - where did life get horns from] in February this year when I returned to work. It’s been go, go, go ever since. [pondering 2 - how is is that it seems that time speeds up as we get older?]

I committed (or limited myself) to three objectives this year – working hard at the place of employment following their tremendous support through three rounds of surgery; giving my all at the (hospitals) Trust as a governor; and helping the NZ Labour party get expats voting. It’s been swings and roundabouts but all three have consumed my attention in 2011.

There’s much to share on the latter two – our cultural shift and organisational change campaign at the Trust, for one, is the most exciting thing I have ever worked on. I spend a day a week or thereabouts (in hours) on work for this role, by choice entirely – many governors would not. There have been a lot of opportunities and I am finally learning to ration my time and activities, although only because my diary in October and November has forced me into learning to say no. The work excites and challenges me – we are, with every step, improving the experience of patients and staff. We are beginning to understand what great care looks like. I am surrounded by passionate, caring, engaged governors, patients, managers and clinicians who want things to be better. I am learning more about myself, more about what I want to do/be, more about the things that drive me. I could not ask for more.

I ended up as a governor because, at the very core of it, I got sick and that made me angry, sad, frustrated, exhausted and sore (so sore). It’s that bigger picture – God is good – story. [pondering 3 - how do we learn to see the good in the bad when it's end-of-life stuff?] My life this Nov/Dec is a dramatically different picture to Nov/Dec 2010. The change, how far I’ve come, makes me tear up. I have life back and I love it. [pondering 4 - how do I learn to keep hold of this feeling?]

Dear Ocado,

I’ve been a long-time and loyal customer of Ocado but I’m starting to wonder if it might be time to move to Waitrose Delivery. In the last 6 months we’ve had a few too many broken/squashed goods and far too many late deliveries without notice.

The cake, however, has been taken with our delivery this week (not literally).

I was rung last night to confirm delivery would be 2-3 hours late (thank you for the phone call – that was very helpful) and did I want to defer it to this morning? While this wasn’t ideal, it did mean not having to wait up for a post 11pm delivery so we went for that option. I shouldn’t have been surprised, but I am, that there’s been no delivery and no phone call this morning.

It is well known that when smaller companies that do well at customer services expand, their service quality tends to decrease while their customer base increases. There are, however, firms that buck this trend. It’s time to put a marker in the sand and get back to the service quality that you became famous for.

We were relying on the goods that were due to be delivered and it was a large order (82 items). I should have ordered for earlier this week but I thought I could still rely on you to deliver what you said you would, when you said you would do it. I’m worried that when it comes to Christmas deliveries, when the weather gets added to the equation, you won’t be able to deliver and my family and I will be stuck again.

I’ve been drafting this for so long, we’ve finally got an answer. Driver’s explanation last night (that there were road delays) contradicts this morning’s explanation (that the goods never arrived at the depot) but nevermind that. Our order is being cancelled, we’ve received a voucher for next order (which covers the inconvenience of a cancelled order but not of our now having to go out to get the goods manually between now and this evening). This next order may be the last if it doesn’t arrive on time and with the products we ordered not squashed or broken.

I’m really disappointed because you were so excellent. This isn’t the service I signed up for and certainly doesn’t even begin to touch the “complete satisfaction” you claim to offer.

Fiona

P.S Incredibly outraged that you deem it ok to call my order refund a “goodwill” gesture. The goods were never received and you know it. Trying so hard to fight back the anger now.

This afternoon I spent some time with one of the brilliant nurses in the CCU in the UCLH tower. I went to discuss the ‘Prevention and Management of Pain’ benchmarking exercise with the staff lead but will save that for next time. While I was there, she kindly took me around her area of work and explained some of the key aspects of their work and the challenges ahead.

The CCU, with a full 35 beds, is one of the largest units of its type in the country and provides care for around 2,500 patients a year. Critical care is a incredibly specialised area of work, where staff are trained to react quickly to problems as they arise and use state-of-the-art equipment to look after the very ill. This unit have a lot to be proud of as national intensive care audits have shown the survival rates to be some of the highest in the country.

Our CCU incorporates an adult intensive care, high dependency care, the Post-Anaesthesia Care Unit, a critical care outreach team and the critical care follow-up clinic. Critical care deals with a wide range of problems but typically patients have problems with one or more of their organ systems (e.g. lungs or heart).

The work and care being put into the patients is tremendous (thank God for the NHS) but the hard part for me was seeing loved ones gathered round the very sick as I passed the bays and isolation rooms. I can’t begin to imagine the heartache and awfulness of seeing someone you care about so very unwell. I am thankful for the work of the chaplaincy team and psychologists to support families and friends through these times.

As I understand it, no matter how many parts of the NHS become privatised, critical care units will almost certainly remain in the public domain because of the high cost of care. While private companies/hospitals will happily take on the simpler cases (easy money), any serious problems that arise with the patient will then lead to necessary transport out to a hospital with an A&E, critical care unit or similar.

I am reminded of a something a fellow hospital governor, and much more prolific blogger than myself, said in a post about specifically choosing NHS services over anything else. By always supporting and choosing your local NHS hospital services, those elements of the hospital that make a surplus (Richard explains that well in his post) help to support those crucial services the hospital provides that don’t, typically A&Es, CCUs, and similar difficult and complex areas of care. As Richard puts it “Literally, if you have you hip operation paid by the NHS at a private hospital, there will not be the money to treat sick kids.”

Fiona McKenzie was a newly elected governor in September 2010. Joan Bell, governor and UCLH news editor, talks to her on her achievements.

Congratulations on being our youngest elected governor!  What made you decide to stand for governor?

My experience of UCLH has been, on the whole, a great one. However, there have been instances with plenty of room for improvement. I stood, like so many others, because I wanted to help work towards creating a better patient experience. With NHS reform and budget cuts, billed by many as the greatest challenge for the NHS since it’s inception, this seemed like an excellent time to stand as I love a challenge. Finally, it looked possible, as a role, to fit around my full-time employment and I wanted to contribute and be part of effecting change.

How long have a been a member of the Trust?

I joined the Trust in November 2009 as it was becoming clear I was going to have a fairly lengthy relationship with UCLH at that point and it made sense to get a better idea of the bigger picture. I remember joking with friends that I had joined the hospital’s “loyalty programme”, having received a membership form along with my nth appointment letter.

You’ve been governor for just a few months and have already got involved in many areas of where you can make improvements for patients.  Tell me what you’ve done so far.

I am liaising with clinicians and external partners on ensuring patients with learning disabilities, one of the vulnerable groups of patients, are provided with the same high standard of care as others. I am working with Ros Waring, in the Membership Office, to recruit and engage more members. I have joined a committee which deals with quality and strategic priorities alongside patient safety and a group of Governors who focus on improving the full patient experience. I am taking part in a hospital walkabout looking particularly at non-clinical practical issues including cleanliness, food and facilities. Later this year, I will be helping with the ‘environment’ and ‘prevention & management of pain’ audits of Nursing and Midwifery practice, which help promote sharing of best practice across the Trust.

What do you find most satisfying in being a governor?

I look at what some of the long-standing members of the Governing Body have achieved and it’s tremendously exciting to see how much change they have effected. The most satisfying thing is being able to be part of that change now and in the future.

What influence do you feel young people would have in being governor at the Trust and would you encourage other younger members to stand?”

I would love to see more younger people standing in the Governing Body elections this year. It provides an excellent opportunity to play a part in shaping a community – it’s challenging, exciting and ever-changing and there is plenty of room for being actively involved in the work. While I have taken on quite a few positions, you can make the role suit and fit with your interests and time commitments. Many of the meetings happen outside 9-5, so it can fit around work commitments. Alongside this, many employers have specific HR policies providing extra leave for Governor responsibilities as part of their corporate social responsibility programmes. For me, the experience will help my career and, very selfishly, it’s a brilliant role to put on my CV. I think more representation from younger people would contribute a fresh perspective to the Governing Body and could also provide those younger people with skills and experience useful later on in life.

It’s a bit of a funny term, though, this ‘Foundation Trust’ business, and I have to admit I had very little idea of what it meant so to help readers, members and anyone else unsure – here’s the low down on Foundation Trust status, from someone on the inside.

Back in the day, before 2004, UCLH was a simple NHS hospital trust, providing health care commissioned by primary care trusts with the help of strategic health authorities. Foundation trusts were announced in 2002 by the Health Secretary as a new step forward for highly efficient hospital trusts. UCLH fitted into this category and was one of the first hospital trusts to jump through the hoops required to gain more managerial and financial freedom as part of Foundation Trust status.

The stated purpose of a foundation trust is to devolve decision-making from a centralised NHS to local communities in an effort to be more responsive to their needs and wishes – which is where Governors come in. Local people, patients (& carers in our case), and staff can become members and governors and hold the Trust to account. It’s all very laudable…

Experiences seem to vary widely – while some Trusts place a lot in the hands of their Governors, other Governors feel less able to contribute and achieve improvements, at least according to research done (which I have a hard copy of but can’t find online). I am particularly excited to be on the Governing Body at UCLH because of the changes already put into effect by earlier Governors, some of whom retire this year. This bodes well for what I can work towards. We have a membership base of over 6000 and most elections are hotly contested. Governors get involved in a wide variety of activities aside from the most basic statutory requirements of the role (we’ll get onto that next time) and I’ll be blogging about many of these and other causes I’m working towards as part of it all. Such fun!

My new local hospital trust – St George’s Hospital Trust – are going through the steps of becoming a Foundation Trust and have recently released a lovely little 3 minute video about it.

Any questions yet? Do please ask and comment below.

It’s a funny old life I lead. Are you settled? Then I’ll begin…

In 2009 & 2010 I spent a lot of time visiting University College (of London) Hospital near where I lived. My most frequent visits were to the basement where they keep the physiotherapists and the gynaecology/endometriosis team. I don’t know what this says about these two departments but the staff were, on the whole, a fantastic bunch. A few problems plagued me though – administrative issues, last-minute cancellations of appointments I’d moved hell-and-earth to be at, lost blood test results requiring a redo, that kind of thing.

In September 2009, on receiving my umpteenth appointment letter which included the appropriate form, I signed up as a member of “the Trust” with very little idea of what that meant. I fairly quickly received a newsletter, which told me all sorts of wonderful things about the hospital and the wide variety of activities going on there.

Fast forward to April/May 2010 and my relationship with UCLH was becoming fairly cemented. With the prospect of at least one, and possibly two, rounds of surgery I felt like I had a vested interest in the success of the hospital. I don’t know if they have a word for someone who likes to stand for office but I think, if they do, it could be used for me. A flyer advertising the Trust Governing Body elections came out with the Spring 2010 newsletter and was immediately pinned to the noticeboard by my desk at work.

It turned out patients had a voice at the lofty senior-management levels of this hospital (it’s all part of being a Foundation Trust, but we’ll learn about that in a later blog post) and they were looking for more people to join them. I had plenty of time to think about it and they were looking for two new regional patient governors, which was the area I now fitted into having moved out of Bloomsbury…

I stood for election, couldn’t see any harm in it and it seemed like a way to put to good use my already numerous hours at the hospital. I had ideas to help make the experience better for patients and I wanted to be part of that change. I wrote for my election statement (the only way of communicating with any potential voters):

I am standing for election because I am passionate about high quality patient care and ensuring members feel part of the governance structure. I have many years experience in Local and National Government liaison and understand the problem of facing increased cost pressures whilst maintaining a strong and successful service delivery. I know I could bring fresh interest and a young voice to the role.

In particular, I am passionate about:

• Representing the concerns of younger and older patients
• Strengthening partnerships with health charities who can help upon diagnosis
• Identifying situations that contribute to patients’ unease and working to provide more support at these times
• Ensuring cost-saving means effective financing of the trust and not lowering the standard of patient care

I firmly believe the Governing Body are crucial to the life of this high-performinghospital. They help the trust to improve quality of service by:

• Appointing or removing the Chairman and non-executive directors of the Board
• Considering annual accounts, auditors’ report and annual report
• Providing direction and focus for the trust’s strategic plan
• Acting and responding as representatives

If elected as one of your Governors, I would commit to:

• Attending all meetings, committees, working groups and seminars
• Ensuring due consideration is made to appointments, annual accounts and strategic direction to ensure patient care is not compromised
• Being available for members to contact
• Making certain that members feel they and their concerns are adequately represented and heard

Remarkably, this, and a similar podcast I recorded for voters to listen to (no longer available, sadly), won it for me and I was more than a little shocked when I loaded the results on my phone to see my name in the list of newly elected Governors. I had not expected to win – I had stood against 9 other candidates, all of whom had far more experience. I had very little idea of what I had got myself in for, but had my usual healthy dose of enthusiasm and excitement for the prospect of a new challenge.

As of 1st September 2010, I was an elected member of the Governing Body of the UCLH NHS Foundation Trust, for a term of 3 years no less. What did this mean? What, exactly, was I supposed to do from here on in? Stay tuned for more Governor exploits…

[This is background -  largely here because me launching straight into posts about my work at the hospital without it was going to confuse many. Next up - what is this Foundation Trust malarky? Surely it's just a hospital with a fancy title...]

There have been other great steps – getting out of bed; walking to the window and back; climbing stairs; washing myself; leaving the house; going for a walk; attending a meeting; cooking Christmas dinner; cutting back on codeine; cutting out the codeine; cutting back on naps; attempting public transport; cutting out painkillers all together. It’s been 8 days since I last had painkillers and that is a wonderful, blissful, release. I feel like I’m getting my life back again.

I have only good things to say about my employers, the Church Commissioners, who have kept me gainfully employed and paid despite my last day in the office being in late-October 2010. My department, and particularly my line manager, have been wonderful, understanding and compassionate. It is a pleasure to return to them and while I’m sure the daily grind will wear me down occasionally, I have so much to be thankful for and much to owe them for. I understand there’s a long list of activity waiting for me – well bring it on, I say!

Unfortunately recovery stalled in it’s final week. We hope nothing is wrong but the symptoms I have had this week, including some more maddening pain, could be indication of something not healing correctly inside me. If I feel worse I am under instruction to head straight to A&E for more tests. Bah humbug!

I blame myself a little for not going to the doctor earlier in the week – I realise now that I am increasing sick of talking clinical to doctors and in some ways I’d rather let whatever is happening do it’s worst than deal with another slightly awkward conversation with a doctor, especially when “it can’t be that bad, surely”. Anyway it took a lot to convince me to make this morning’s urgent appointment, following three days of symptoms, and it shouldn’t have. More bah humbug!

What was supposed to be a back-to-work Monday post (you will eventually see how gleeful this post was/is to be) is now a back-to-tv Thursday post. I write because it will help to make me feel more like this is a minor blip in what has been an amazingly good (or slow but steady, as the specialist put it) recovery rather than the start of more problems. I am scared that it is the start of more problems but maybe admitting it, typing it, will help me to deal with it better. How very angsty of me. Oh goodness…

I am listening to Anna Nalick Breathe –  ”just breathe”…