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----- Original Message ----- From: <[log in to unmask]> Subject: Re: audit commission report > Why are so many people so dispairing about A&E and still doing the > job? The waiting times in A&E are appalling - we all know that and > there is a good opportunity at the moment when we finally have a > target that relates to us - the 4 hour target. This focuses attention > and should be helpful. However it is not just about resources- how > you use them also matters- I want senior staff everytime now. Some > systems work better than others - local department management IS > important and we should try and learn from the good departments. Good > relations with the hospital management team is vital and I know I am > very fortunate in having a supportive management team and importantly > one who recognises that we are the first part of a patient journey so > what happens further down the line matters to us. We are having an > exciting challenging time at the moment thinking about new working > practices/ systems. The Audit Commission report adds to my power to > encourage system change and so I am happy to have it. I quite agree Katherine, I just didn't put it as eloquently as you have! I welcome this report and also welcome the DoH proposals that "accompanied" it. I'm just a little concerned that government thinks that most of our problems can be solved by managment "trickery"; while I believe some serious spending will be required to get the NHS back into good shape, although I do take your point about the impact of improved management (with a small m). But there are encouraging signs, the recent national increase in beds being a watershed in NHS history. I too view the future of our specialty with a little more optimism now, and hopefully the knock-on effect will be to keep some of our disillusioned colleagues from early retirement and to attract high-quality fresh new recruits into an exciting specialty. Adrian Fogarty