New Surgeon at Ashvale A&E. Joanna Neil
She hesitated, allowing time for the audience to settle.
‘I have to say, though, I entirely agree with Becky’s sentiments on the subject of staff reductions. You cannot remove key personnel and expect things to go on as normal. The doctors and nurses who work here are the lynchpins of this organisation. They are the ones who keep the system going, and reducing numbers will only result in stressed, overworked staff members. The end result will be to bring down morale even further than it has fallen already.’
Sam shook his head. ‘The alternative will be to close units down altogether. Is that what you want to see? These debts will not simply fade away. It may be an unpalatable fact, but savings have to be made somehow.’
‘And how did those debts come about?’ Ruby’s grey eyes challenged him. ‘I’ll remind you, shall I? It was because of the finance deals entered into by the trust board to ensure that the building of the brand new Heritage Hospital could go ahead…the state-of-the-art, be all and end all of hospitals.’
‘Yes, that’s true.’ His tone was appeasing, smoothing over the arguments she’d made as though all was perfectly in order. ‘It was a costly venture, I grant you, but many, many lives will be saved because of its existence and because of the up-to-the-minute, high-tech equipment it enjoys.’
‘And what of the lives of the people who come here to the Ashvale Hospital, expecting first-rate treatment?’ She was warming to her subject, more than ready to tackle him head on. ‘How are they going to fare when we’re short of doctors and nurses simply because of the measures you’re about to take?’
He didn’t answer straight away. Instead, he was thoughtful for a moment or two, taking his time in contrast to her quick-fire opposition. ‘All right, let’s look at that,’ he said. ‘I can understand perfectly well why you’re concerned. But let’s take an instance, shall we?’ He paused once more, thinking things through. ‘Suppose a child is brought here by ambulance, suffering from a severe, life-threatening asthma attack. How many people do you suppose would be involved in his care?’
She thought about that. ‘The paramedics, a triage nurse, maybe the senior house officer and a paediatric nurse. There would be a consultant on call to oversee the situation.’
‘And between them you expect they would be able to resolve the child’s difficulties? They are all essential to the child’s well-being?’
‘I believe so, yes. Provided that they were able to access him quickly enough and give the right treatment, he should stand a good chance of recovery. That’s our job; that’s what we’re here for, after all. But if there is a breakdown in the chain of personnel brought about by staff shortages, or because people are too busy dealing with other life-threatening emergencies, I can see how things could go drastically wrong.’
He nodded. ‘You’re right, of course. Having qualified people in place to deal with events as they occur is essential, and no one wants to see staff stretched to the limit, least of all me. But in our hypothetical situation, all the staff and equipment in the world might not have saved the boy…because without the necessary savings to the department, the A&E unit here would have been closed down, and the child would have been transported instead to the Heritage…a journey of a further fifteen miles or so. Given the time taken for that journey, the strong possibility is that he would not have survived.’
There was a combined intake of breath amongst the doctors and nurses in the room as his point sliced home.
Ruby frowned. That was not good. He couldn’t be allowed to persuade his audience to submit to his plans by laying out a worst-case scenario as if it were the accepted outcome.
She sent him a direct, lancing stare. ‘Do you really think that argument is going to sway me, or anyone here? You’re planning to cut the tree off at the roots and afterwards you’ll inspect it every now and again to see if it somehow managed to survive.’ She shook her head. ‘There are other ways to make savings, which don’t involve shrinking your prime resource. For instance, you could take a closer look at some of the maintenance and repair contracts that are up for renewal with private companies. You could look to reducing payments for supplies by checking that only essential items are ordered.’
He smiled. It lit up his features, softening his expression and enhancing the perfect angles of his face, and just for an instant, it took her breath away. He was incredibly good-looking, she acknowledged. She hadn’t expected to have the rug pulled out from under her in quite that way, and it was a low blow, throwing her out of synch, her nervous system responding with a keen fluttering of sensation, a soft ripple of excitement running along her nerve endings.
‘So you want me to cut down on the number of pens I order,’ he said, with a soft edge of mockery. ‘Well, that’s a start, I suppose. And we could talk to the contractors about maintenance and ask them to forego checking the equipment once in a while. I’m not sure how well that would sit with nurses trying to programme a faulty infusion meter, though. It could turn out to be a false economy.’
His answer riled her. ‘If you have your way, there might not be a nurse to administer the infusion in the first place,’ she retorted, throwing him a cool glance. ‘You know as well as I do that commenting on pens and infusion meters is just a cheap jibe. With perseverance, good intent and a willingness to examine all possibilities, we can make this work. There are savings to be made, but we have to choose our targets carefully. I don’t believe that units have to be closed, or that staff have to be let go.’
Becky interrupted with an excited babble of baby talk just then, and Ruby glanced down to see that she was shaking her teething rattle with sudden vigour. The tension in the room dissipated as rapidly as it had risen.
‘The baby obviously agrees with you,’ Sam said, his mouth curving. ‘She seems to be a staunch supporter.’
Ruby laughed. ‘I’m sure if she was able to speak, she would remind us that people are our greatest asset. We have to work together to make this happen the way we want.’
He nodded and then agreed to take comments from other people in the room. Ruby sat down and tended to Becky, all the while lending an ear to the proceedings. The discussion ebbed and flowed for some time, until eventually the chairman called an end to the meeting.
‘We’ve covered a lot of ground today,’ he said. ‘Clearly, there has to be a lot more work done before we can decide on our ultimate course, and we welcome suggestions for different strategies from anyone who cares to make them. I suggest we meet again in a few weeks to finalise matters.’
The meeting broke up, and Ruby chatted with James and Olivia for a while, before getting to her feet and preparing to leave the room.
‘Dr Martyn…do you have a moment?’
Ruby paused, turning at the sound of Sam Boyd’s voice. ‘Of course.’ She nodded to James and Olivia, and they continued on their way, leaving her free to talk to her new boss.
He studied her thoughtfully for a moment or two. ‘I didn’t realise, at first, that you’re one of the members of my team.’
‘Would that have made any difference to our exchange of opinions a while back?’
He shook his head. ‘I think you know that it wouldn’t. I recognised your name when you introduced yourself. You’re my specialist registrar, aren’t you?’
She nodded. ‘So you’ve been looking through the personnel files. Perhaps I should give you full marks for staying on the ball.’
He made a mock wince. ‘I can see that you believe in being forthright at all times. You’re not going to easily accept any changes that I decide to put in place, are you?’
Her expression softened. ‘Ah, now there you have it,’ she said. ‘You see, I do have the interests of the A&E department at heart, and I can promise you that as long as I’m working there I’ll do what I can to support my colleagues and steer things in the right direction.’
‘As long as you’re working there?’ He looked