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And with constant reports of the ever increasing pressure on hospitals, Duncan says that strain can be felt.

The role also calls for good relations with other hospitals. Duncan said: "Sometimes we have to deal with patients [from, or going to] other hospitals. It's not uncommon for patients to be at King's Mill or other hospitals in the region because we are a specialist centre."

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Jordan Cap Black And White

"We have more problems over the winter than the summer and one of our challenges has been increasing emergency admissions for frail older patients and things like that. Managing that has been one of the key challenges this winter."

But Duncan is not alone in the job. A team of senior managers and site matrons assist him, as well as clinicians and ward sisters. In total the Nottingham University Hospitals NHS Trust has around 1,700 beds to manage.

"Especially when things are very difficult if we are in a day when we are struggling to have enough bed capacity.

The Silver On Call begins work at around 7.30pm and spends the day meeting bosses from around the hospital, checking on availability of beds and watching the flow of emergency admissions a constant balance with people coming in for planned operations and treatment.

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to the next hours or tomorrow. That's one of the key parts of my role."

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"We're a very large organisation and we have a lot of different departments that do different things. Most of the time it works well and effectively and my role is to deal with things when they aren't going well."

The former bar manager at the old Manor pub in West Bridgford, added: "It first became a problem ten years ago its got worse and worse and I'm pain all the time now. It's not always tremendous pain but it's like having quite a severe earache all day every day tasks like peeling potatoes are harder to do.

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The Post will also be behind the scenes in the operations centre with Duncan Hanslow who takes on the role of Silver On Call and the responsibility for managing crises and understanding and reacting to every event.

"It can be a very challenging role," he said.

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Presiding over the vast operation of the Queen's Medical Centre for three or four days every month is Duncan Hanslow.

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"Mostly it's been treated with pain killers at various times but before Christmas I had an injection in my right thumb to see if it could improve movement but it didn't.

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And to be part of a the team where work has to travel at a furious pace to ensure patients' needs are being covered can be a real buzz.

We have a lot of pressure on the system. We will do and plan to do less elective surgery during the winter and we put more beds and staffing in. We do have plans that we can put in place to help mitigate the impact. But there's no doubt as a hospital we are under significant pressure and that pressure is also felt elsewhere in the country. We do everything we can with our resources to try and get our flow right."

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FOR most people the doctors and nurses who make their hospital stay as comfortable as possible are the only faces they see.

"I'm hoping the operation will get rid of the pain and I will be able to use my thumbs. I've been told it could be a bit weaker but the doctor said in 80 per cent of cases it's really successful and it's the best pain relief. I'm very hopeful."

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"At the moment it affects my two thumbs I've had problems with the bones in my feet but they seem to have settled down again now and I have an arthritic knee. It comes and goes there.

From the nerve, or operations, centre of the hospital Duncan follows several computer screens which constantly flicker with incoming and outgoing patients; trends are monitored and patients are moved between wards to ensure beds are free where they need to be.

But, behind the scenes, an army of hard working staff are fighting to keep operations running smoothly, ensure there are enough beds for everyone and that patients are discharged safely and quickly.

He said: "Over the last few years I've been in hospital a lot so I wouldn't say I was anxious but certainly there's a lot of anticipation. It would make a big difference to my life the little simple things like trying to button my cuffs is impossible. It's the finer stuff that I cant do."

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"It can be a fight," Duncan, who has worked at Nottingham University Hospitals NHS Trust for 11 years, said.

He added: "There is a buzz it's a job where we need to make decisions quickly in relation to what's going on in front of you and also have a forward look Adidas Hat With Stripes

The 62 year old from Chilwell will have a Trapeziectomy today in order to give him some pain relief and improve the workings of his right thumb. If the operation is successful medics will repeat it on his left.

Ian Slater whose operation we will be watching has struggled with arthritic joints for a decade and is now going under the knife in an op that he hopes will give him a new lease of life.

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"It's slightly different for me because I do it three days a month when the site matrons do it every day. It's about how you work as a team people are used to it being very busy and challenging but it's a pressured environment and a pressure situation. We have our good days as well sometimes flow is good and it's great when that happens. We have a steady demand and a steady flow.

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