It was an early start. Marjorie was nearly late. Her train down from the Lakes was delayed. By the time she arrived all the senior management team were there, plus the chairman. He would be briefing the non-execs over lunch, in time for the Board meeting at 5pm.

Already, jackets were off. The Chief Executive looked disapprovingly at Marjorie, made a deliberate show of looking at his watch and turned to the finance director; 'David why don't you put us in the picture...'

The FD was an interim. Time served, retired, pile of a pension and now with a consultancy, doing the rounds 'sorting out' for the Regulator. The Trust's regular FD had gone with a stress related illness; paid off.

The news was bleak. David, a tall, rake-thin man peered through his gold rims and listed a series of 'measures'; moving clinics, amalgamating lists, stretching payables, increasing car-park charges. Re-grading nurses, down filling. He went on for nearly an hour.

"Turning to staffing levels... the workforce constitutes 73% of the budget. Overspend on agency nursing is out of control. Immediate action is required."

The executives around the table avoided eye contact with each other. They knew that.

"The Trust has a high level of 'churning', particularly turnover of nursing staff. The national average might be about 8%, here, nearer 12%. The Trust could take advantage of that. Vacancies at any one time might be around 150. By leaving the vacant posts open the Trust will not have to declare redundancies, the workforce will not be 'reduced' and it will give the finances a breather. We might get closer to an interim balance... it will, of course put pressure on the front-line..." his voice tailed off.

All eyes turned to Marjorie. Marjorie Newman, director of nursing.

The chairman broke the silence.

"David, you've given us a lot to think about. Let's take a short break, clear our heads and come back in 15 minutes... talk it all through."

As the room cleared Marjorie spoke quietly to the Chairman.

"I can't go along with this, it can't. The wards are near breaking now. Most of the time we don't even get close to the NICE guidelines. If the CQC turn-up they'll crucify us... and as for down-grading... "

Sir Brian looked directly at Marjorie; "It is just for a few months, I promise. Once we are back on track things will be different. We have to get these people off our backs. All the time they are here we are in the spotlight... special measures and goodness knows what... we'll have the devil of a job to recruit anyone, never mind nurses."

Marjorie felt sick. She turned away walked across the corridor to her room. On her desk the pictures: the cottage, in the Lakes, she and James had been redecorating over the weekend; the grandchildren, their cheeky grins jumped out of the silver frame.

On the bookcase a black and white picture of a slim version of Marjorie, one side her Mum, the other Dad; the day she became a nurse. Her Dad bought her silver buckle. Her grandmother, a retired nurse, passed on her treasured, Condal pendant watch... for luck.

Marjorie had been a nurse for over 30 years; held every senior post. Now the pinnacle, a member of the Board. Registered with the NMC her duty was clear; accountability, safe practice. This wasn't safe but neither was the future of the Trust she had given her last 8 years to.  Just two to go.

The chief executive walked through the doorway and closed the door behind him; "We can't do this unless you support us Marjorie and I can't stay if I can't turn the Trust around. They're threatening to put someone else in. Brian says he'll step down as chair; he is in line for a NED job in the city and doesn't want a problem on his CV. I know what you are thinking but it's not permanent... we can manage. Marjorie... we are depending on you... there is nowhere to turn for help.  We have to sort this out ourselves."

He turned and quietly closed the door behind him.

Marjorie was two years away from her pension. She and James had planned to sell up and move to the Lakes. A great place for the grandkids, the boat, the fresh air.

Her door swept opened. Neil, the IT director; "We are starting..."

Marjorie picked up her papers and headed for the boardroom....

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