1600 Thursday April 29 2010 Well here goes. If anyone actually reads this blog I will be very much surprised, but it gives me a chance to articulate my own personal frustrations and satisfactions of working in the modern NHS. Inevitably the frustrations will mostly stem from management, and the satisfactions from patients, with colleagues evenly split. (and some of them should be). Feel free to comment, though all comments will be moderated according to 2 rules, 1. I will moderate, edit, or refuse any and all comments in accordance with my own views on what is appropriate and proper. There will be no appeal. 2. In the event of any disagreement refer to rule 1. Every day out there things happen in our health service that should get more publicity, but don’t. There are a number of reasons for this, including apathy, resignation, practicality and others, but I think one of the major ones is fear. Many of us remain silent because we fear what our employers will do if we stick our heads above the parapet and criticise or express adverse views. Such fear is not unjustified. “In British public life loyalty and service to power can sometimes count for more to insiders than any tricky questions of wider reputation. Disloyalty, on the other hand, means a terrible casting out.” Chilcot enquiry. Any such incidents and views can be sent to me and, if I think it merits I will publish it on this web site and will assure the contributor of complete anonymity if that is his wish. Naturally abuse, libel or breaches of patient confidentiality will not be entertained. We all of us have every right to freely express our thoughts and we are protected and supported by various authorities. Article 10, Freedom of Expression of the Human Rights Act 1998, which is a qualified right, states everyone has the right of freedom of expression. This right shall include freedom to hold opinions and to receive and impart information and ideas without interference by public authority and regardless of frontiers. This guarantees the right to pass information to other people and to receive information that other people want to give to you. It also guarantees the right to hold and express opinions and ideas. It is unlawful for a public authority to act in a way which is incompatible with a "Convention Right". Article 8 of the Human Rights act 1998 1. Everyone has the right to respect for his private and family life, his home and his correspondence. 2. There shall be no interference by a public authority with the exercise of this right except such as is in accordance with the law and is necessary in a democratic society in the interests of national security, public safety or the economic well-being of the country, for the prevention of disorder or crime, for the protection of health or morals, or for the protection of the rights and freedoms of others. Paragraph 330 of the Terms and Conditions of Service for Hospital Medical and Dental Staff  "A practitioner shall be free, without prior consent of the employing authority, to publish books, articles, etc, and to deliver any lecture or speak, whether on matters arising out of his or her hospital service or not."3   And Finally Doctor’s are often labelled as “challenging”, for having sufficient independence of thought to challenge politically driven diktats which on occasion are unhelpful, or even compromise care. As Shaw said “all change is achieved by the actions of the unreasonable man” There is difference between leadership and management. Good leadership does not entail a headlong rush to implement whichever initiative comes down the line uncritically and regardless of the implications for patient care. Prof David Oliver BMJ 338;1153-1218 16 May 2009 page 1160