Alice

My 2 comments yesterday were confrontational and unhelpful, and I hope you will accept my apology for them.

I'm sure we are both as concerned as each other that such a huge level of expenditure has not produced an NHS with which there is much satisfaction, let alone pride. It's my belief that the crux of our problem is that there is an orthodoxy that encourages inefficient resource allocation. It's not malign or negligent - it's the inevitable result of people doing their jobs, to the best of their ability, in accordance with what they have been led to believe is expected of them.

My experience is that the leanest, most efficient and most successful organisations are those that insist on strict financial control strongly focused on the budgetary/planning process. This is where intellectual disciplines work out how to produce the maximum value at minimum cost - BEFORE anything has actually started to happen. Is this what happens in the public sector?

Simon Stephenson, Windermere, UK

Alice :
here in California, if a patient wants convenient after-hours care they go to Doctor -staffed , free-standing, "Walk-ins" . They are usually seen and treated within 30 minutes and pay with Master-Card or Visa .
Does the UK have similar easy access and conveniently located market driven facilities ? If not, why not ?
When socialism is replaced by capitalism , change for the better happens miraculously fast. Try it.

wilfred knight, orange county, california usa

Have you noticed that the American National Health Service is not an embarrassment for George Bush?

That is because they don't have one, and he doesn't run it.

It's probably incomprehensible to "we run your life" New Labour, but there is considerable merit in not trying to do things you are not trained to do, and no merit at all in attempting the long-proven impossible.

For the UK Government to run a National Health Service makes about as much sense as for the UK Government to run the Football Association. Leave the FA to coaches and owners and leave health care to Doctors and Hospitals.

jon livesey, Sunnyvale, CA/US

Labour sold us the idea of a national health service to be funded by national insurance. Unfortunately, like many other aspects of commercial activity, labour politicians don't understand the insurance provision market - and yes! it is a market. We pay the governement for health care and I can get a better service from private health insurance.

It's long past time that the NHS was billed as free at point of delivery or free anything else. Its a paid for service. Anyone who doesn't believe that, examine the percentage of wages that is classed as NI, and then add on the employers contribution to NI to get the REAL cost to the individual.

Run it like insurance and run it with professionals, not a "public service" run by incompetent civil servants and politicians who only think in terms of tax, tax and more tax.

KR, Stockport,

GPs are available to their patients for about 40 out of a possible 168 hours a week (ie less than a quarter of the time). Now it seems that you can usually see A doctor within 48 hours (to meet the targets) but not the doctor of your choice. Sadly, this situation is unlikely to change.

If the government invested the colossal sums of money they are now throwing at management consultants and at IT companies in the NHS, then we might see some real improvements.

As for PPP and PFI, well, don't get me started.

Elaine STewart, Dunfermline, UK

I worked for the Health Service for 32 years. I was the third generation in my family to work in hospital services. It became apparent to me a long long time ago that the diminishing intervals between re-organisations would lead to the current mess.

The hospital service at least should be hived off into an arms length set up to keep out political interference.

Provision should be charged for but reimbursed for those of limited means. The provider must not know who is footing the bill. If you do that market forces of themselves will sort out the best service with the most efficiency.

Customers will also be able to tailor their provision to suit themselves and have the opportunity to pay more for better service if they wish.

newt, Rochford,

Dear Alice i am a newley qualified staff nurse and have worked for the NHS for 4 years as an health care assistant, if like u say the NHS is well funded then how come after 3 years training have i been unable to find a job as a staff nurse.
Thank u
Joy Travis

Joy Travis, Sheffield, south yorkshire

"There has, generally, been a public consensus supporting all of this. " (NHS reorganisation).

What planet is Alice Miles on? Maybe she is reporting on the Scottish NHS? The Government's handling of out-of-hours services for GP patients was condemned as "shambolic" by an all-party committee of MPs in March 2007.

It reported that the best interests of patients had not been served by the new system, the public purse had suffered and Saturday morning surgeries had been abandoned.

Katherine Murphy, a spokesman for The Patients Association, said : "It is still really difficult to get to see a GP out of hours. At least before, people could see a GP on a Saturday morning.

The report says nine million patients receive out-of-hours care in England every year. But the percentage of providers who met targets on answering calls or making visits was "extremely low". Only 15 per cent of services provided "urgent face-to-face consultations at home within 2 hours".

m paul, London, England

I see people with good degrees in biology desparately trying to get into medical school and failing. Meanwhile teaching has to offer part ownership of key-worker housing to attract applicants.

Whilst I would accept that the minimum acceptable doctor is more intelligent than the minimum acceptable teacher, it is not clear to me that we should channel our best young people into medicine. A doctor who passed but came in the lowest 10% of the class will normally prescribe exactly the same lotion as a doctor who came in the top 10%. A teacher in the best 10% of the year group will give a much better lesson than a qualified teacher in the bottom 10%. Then in the nature of things, a weak doctor can call in help if he meets a problem beyond his abilities, but a weak teacher cannot do this.

Some people who are going into medicine should be encouraged to take up teaching.

Malcolm McLean, Bradford, UK

I am a recently retired doctor from Hong Kong and I have spent 6 years working in the NHS in the late seventies. I still have contacts with colleagues in the NHS and apart from the massive rise in the pay and lucrative private work, the uniform complaint I hear is the low morale, administrative meddling and poor access and standard of care. So labour has managed to pour billions down the drain and little to show for.

The ill concieved GP contract even makes GPs feel embarrassed for doing less for more money and where is the continuity of care that made the British GP system the envy of the world?

Dr. Samuel Lin, Hong Kong,

Nasty snide remarks about doctors taking on extra money. The truth is that the government got the consultant contract wrong. They thought the doctors were lying when they told them how many extra hours they were working. Now individual consultants are working fewer hours than previously because their contracts have been limited to 40 hours. The extra unpaid work has been taken up by many new consultant appointments. I left the NHS 4 years ago. The 6 sessions that I was officially supposed to work for the health service have been replaced by 18 sessions of consultant time.

Since more than half of British medical graduates are female, and many have family committments, the old model of consultants working 24/7 for the health service will no longer wash. Sure, the consultant pay bill has gone up and productivity has fallen, but consultants will be less likely to collapse with a coronary within a year of retirement and less likely to suicide at the height of their powers.

Dr T Hamblin, Bournemouth, UK

In listing improvements in NHS provision under this government, Alice Miles appears to have forgotten about dental treatment which used to be free under the NHS. New Labour has done nothing to arrest the gradual privatisation of this service which began in the 1980s. On the contrary, the latest contract drawn up by the government for dentists still practising in the NHS seems to have accelerated the process. I cannot be alone in having had to see a dentist much more frequently than consult a doctor and in having been unable to find another NHS dental practice when the dentist with whom I had been registered for over 20 years retired and the practice to which he had belonged went private. This is now beginning to cost me serious money and is much resented as it represents another of Tony Blair's failed promises.

Martin Litchfield, Wimborne ,

Taxes have risen "A LITTLE"!! Are you living in a different country from me?!

Catriona, WGC, UK

I am working as a GP. There has been a huge amount of political spin and half truths used against GPs recently. The new contract effectively removed the out of hours commitment from us, and we also lost the money we were previously paid for doing it.
Out of hours provision is currently under fire because the money we were paid is insufficient to pay for a good service. We were doing it on the cheap but no-one believed us. They do now.
Our pay has increased because we put alot of work nto achieving targets. To do this we have had to take on more staff and invest our own time and money into the service. Our pay is currently being clawed back as we have "overachieved" but our expenses and staff bills are going up year on year. We are expecting a 5-10% pay cut for last year (06-07) as a result.

Again this year, our baseline payments from the government have been frozen. This has been described as a pay freeze, in fact it is a pay cut as our staff salary bills continue to rise.

JP

j poland, Bristol,

I work for the NHS in Canterbury as a Personal Medical Secretary. I see first hand how money is wasted and germs are spread. It doesn't need rocket science. We get whizz kid managers brought in from 'god knows where' for 6 months - they make sweeping changes and then leave. The next one comes in and changes the sweeping changes..........you get the picture ? As for germs. I just had a cleaner come into my office with a filthy cloth, wipe the top of the cupboard, the window and underneath my chair!!!! I wouldn't like to think where the cloth has been previously !!!
Moral is very low amongst all sectors here and I am guessing the rest of the NHS.

Jacqueline Batt, Canterbury, England

Does anyone truly appreciate how much extra money has been injected into the NHS bottomless pit? The extra funding, money that belongs to us as taxpayers, is almost unimaginable. Yet can anyone honestly say that NHS services are that much better? £92 billion is equivalent to over £1500 a year for every man, woman, and child in the UK. In addition, some 7 million people have private health cover, and many others pay for treatment privately out of their own pockets, increasing the £1500 average for those who do not have the ability to pay, or indeed choose to spend their money in other ways. My wife and I pay £950 each for private health insurance which seems good value when compared to the NHS average cost, even accepting that the NHS provides some services not usually covered by private schemes. Give people the financial means to control their healthcare as consumers and they will 'shop around' for quality and value for money like they do everyday for other goods and services.

J Norris, London,

If petrol were payed for by taxation - free at the point of delivery - and the government organised it's distribution I'm sure the cheapest way of getting petrol to drivers would be via a small number of gigantic service stations stuck on the edge of towns. The super stations would be modern, efficient and safe. You would always be able to find someone qualified to change a spark plug or wheel and more than that they would save the tax payer money. That money could be used on education. Never mind that every driver may have to spend a half day or more getting to and fro the station, never mind the extra congestion, never mind the queues on bank holidays. Never mind if new ones take 10 years to build. The good news is that everyone gets petrol with the same standard of service and no-one can jump the queues, unless of course you could afford to forgo the 'free' petrol and go to the local private garage. That's the NHS, no need for change, it works!

jason white, paris,

To be honest, the real reason that the public has lost complete faith in Labour over health is that they have managed to triple funding and delivered relatively little for it. Now we all know there is nothing a socialist is better at than spending someone else's money, after all it is the politics of financial envy that drives much of their doctrine, but come on, to take an extra 57 thousand million pounds a year and turn it into around 8 thousand million pounds of quantifiable benefit - that really does take some exceptionally bad mismanagement, indeed one could even say almost criminal negligence. I appreciate what our health service does but allowing a bunch of career politicians, none of whom has ever actually worked for a living and whose ideology is driven by university formed schoolchild socialism is really asking for total catastrophe - and indeed that is what we have. Socialism may be acceptable, but its wholesale abuse of the taxpayer is not

Bryan Reed, Totland, UK

"Everyone has had new contracts, with nurses taking on greater responsibilities, consultants taking on extra money and GPs devolving responsibility for out-of-hours services to others (while taking on extra money). There has, generally, been a public consensus supporting all of this. Taxes have risen a little to fund it."

What nonsense. There is not general public support for Doctors and consultants to be paid more and do less, far from it. Nor have taxes risen just a little.

The situation is scandalous, increases of £50 BILLION per annum, and we get some marginal improvements in waiting times?

Please stop wearing your labour tinted glasses if you want your column to be taken seriously.

Pete, Bristol, UK

Another Misleading Statistic. Death rates fell at the same rate, or slightly faster, between 1986 and 1996 as they did between 1996 and 2006, according to the Office of National Statistics. Spending more on the NHS seems to have no effect, in this respect. I understand that, generally, life expectancy is affected much more by levels of prosperity, the extent of relative poverty, lifestyles and public health measures than by medical intervention. This is not to say that we don't greatly benefit from such intervention, just that looking at death rates is looking in the wrong place.

Frank Upton, Solihull,

Alice and Jeremy James are right. Patricia Hewitt has never run anything and is in her own McKinsey stratosphere. Lets hope that Brown recognises that. Doctors/Nurses OK, politicians back off!
Same principle applies to teachers.

Gordon, Woking, UK

Is Alice Miles by any chance married to a doctor? Otherwise she might like to tell us of her recent experiences in getting an appointment with her GP or of getting out of hours care in an emergency. Following the changes in their contracts, my GPs have become more elusive than Rod Stewart.

h Jackson, Richmond, Surrey

As the third largest employer of people in the world, after, I gather, the Chinese army and the Indian railways, the centrally-controlled NHS is unmanageable; as an organisation funded solely out of taxation, it is unaffordable. Until politicians come to terms with this, things will continue as they are. It is a shibboleth that has long had its day.

IAN GIRVAN, Dunkerton, Bath, Somerset, England.

People don't want to keep local hospitals open because they are 'much loved', but because they seem, rightly or wrongly, to be better for patients. Patients are ill, often elderly, and more likely to be poor than random chance would predict. They find it difficult and expensive to travel, and so do their visitors. They suspect that a larger hospital or GP surgery will be less interested in them individually and more likely to lose their records or forget about their appointment. They suspect that larger hospitals will suffer from too much administration and cost. They suspect that the closure of older local hospitals is dictated by the requirement to feed to PFI beast. These are rational, not emotional concerns.

Frank Upton, Solihull,

I'm in my mid-20s and can not remember a time when people have not complained about education and health.

Come to think of it, same goes for whoever is prime minister, the weather, any form of media, the housing market, immigration... uhm - it may be quicker if I list what people don't complain about.

I haven't heard much on the unemployment front recently, and most people I know like Waitrose.

Mark, Woking, UK

Hear, hear! I am sick (pardon the pun) of seeing and hearing criticism of the NHS on every news bulletin, current affairs programme, in the press, etc. To the outsider, it must look as if this country is completely populated by seriously ill people who are unable to receive medical treatment. Let's lay off the NHS.

Peggy, Kent,

Perhaps he could get rid of Patricia Hewett and then hire someone from outside government who actually knows how to run an organisation. John Birt need not apply.

Jeremy James, St Maurice de Lignon, France

I don't know in what rarified lair Alice Miles lives. The general public consensus is not what she says. Retired some time ago I hear my old friends lament the days when things were somewhat different; nowadays their personal doctor seems to want to distance himself/herself being available only a limited number of week-days and a limited number of daylight hours; his/her interest in them is as a terchnical, academic exercise rather than 'to comfort always'.

Dr J Findlater, carnforth,

We are the only developed nation that has nationalised and centralised our health service and in sixty years of constant tinkering and endless reorganisation have turned it from "the envy of the world" into a political football. No other government spends so much time and political capital on health at the expense of so many other equally important endeavours, especially education. But of course no party would go into an election promising to return health into a sensible, rational arrangement which serves many other countries so well. We are stuck with a huge, inefficient, bureaucratic nationalised industry that the public will never wish to change.

Stewart Ware, London,

Here's something for you to consider, Alice. I can't prove it but I'd bet my house that I'm right.

Put the entire NHS out for tender. Insist that the quoting organisations guarantee that no provision will be poorer than under current arrangements, and put in place huge penalties to ensure that this is adhered to. Make it quite clear that any evidence of collusion between bid-makers will result in permanent disqualification from the bidding process.

I'd be very surprised, for what is currently costing £92 billion under public administration, if the highest tender was greater than £70 billion, and I would expect the best offer not to exceed £60 billion. You just have to accept, whatever you WANT to believe, that if you are seeking a way to maximise the cost of providing a service, you don't have to look much further than to incorporate it into the public sector.

Simon Stephenson, Windermere, UK

It is not a solution for Gordon Brown to leave the health service alone. The provision of NHS dental treatment is being killed off by serious underfunding and an absurd new contract unilaterally imposed by an inept department, and the state of the nation's dental health is deteriorating fast. This needs correcting. If the GP's are being overpaid this seems to be an obvious place to recover some of the money required. Sounds like a pay freeze for GP's is needed.
While he is at it he could abolish PCT's. Yes, I know they serve to give Government a useful scapegoat. But is it worth the cost? We all know they have little real freedom.

Ian Ainsworth, Newcastle upon Tyne,

The closure of community hospitals is a cause of great local concern: these provide a popular facility - often financially assisted by local support groups - they remove pressure on acute hospitals - excellent for aftercare and eliminationl of bed-blocking - but there is an administrative funding crisis: the money does not follow the patient who is placed in a community hospital - hence much of the financial problems facing community hospitals - and a failure to evaluate community hospitals true merits. Why does the Minister resist the recommendation of the Audit Commission to correct this failure of accounting?

Peter York, Tonbridge, Kent