Having worked in community nursing (school nursing) for the last 20 years i have seen many managment and structual changes. There are now many more layers of managment - although we have a modren matron, 2 child protection managers, looked after children senior nurse. continence specialist nurse etc., all of whom are seen as professional advisors as well as managers, not one of them comes from a school nurse background. There is no real professional advisors, but plenty of managers to jump on you when you can't fit whole time working case loads in your part time hours.
Just too many chiefs and not enough indians! Too many meetings about meetings. Too many people covering their own backs to care about the patients or staff on the ground.

Name Withheld by request, leicestershire, uk

The NHS used to be run on good will and professionalism. Managers and business people obsessed with the ideology of market forces, have been unable to see that for frontline staff, doing a good job and helping people was its own reward. They judged us by their own standards, thought medical staff must have some scam or fiddle on the go, and simply didnt believe that consultants worked overtime for no pay, or came in at the weekends to reassess their own patients when they were not on call, or that the GPs' out of hours work was so onerous. So they interfered and now they realise that no one was lying or dossing & they are now having to pay the price. There is an emphasis on only what can be measured, by people who have no understanding of the job: I am GP and my skills lie in developing a trusting relationship with my patients: without that no management plan will work. how can that be measured? You have to trust us as professionals.

sarah, york, york

I work in the NHS and have done for over 30 years in total, since I started in the early 1970's I have seen a vast increase in the number of administrators, our local PCT's have because of government joined together so we have 1 PCT instead of 7, yet we have lost hardly any jobs. These days the NHS is "top heavy", the nurses are at the bottom of the pile struggling under targets and peperwork.
Training for nurses doesn't equip them to give basic nursing care, and when they do qualify there is no gaurantee of jobs. Support staff are often under valued and over worked. PCT's often cut nursing numbers to the bare minimum so staff are under pressure, leading to increased sickness levels and poor quality care for the patients.
Pay wise the agenda for change was implemented but when staff were put on high grades they found their jobs at risk or were re-assessed to a lower grade. The current rise being the last insult.
Patients need to be put first not paperwork.

Diane Jewkes, Chesterfield,

The NHS has a hierarchical structure which, like an army, has ludicrous yet visionary generals in armchairs back at base, gallant but ineffective leadership on the ground and struggling troops 'going over the top'.
We need:
1. No more new targets or initiatives for at least 3 years
2. Consultants to be required to do some of their work in the community and not in their hallowed hospital sanctuaries
3. A simple IT system that actually works

linda caine, norwich, united kingdom

I left the NHS last week after working in it for nearly 8 years as a physiotherapist. It's like a weight has been lifted from my shoulders. The difference in private healthcare is that I purely do clinical work. Granted, private healthcare has it's own pit falls, but so far so good.
It's distressing to admit all this as I truely loved my work in the NHS. The training was excellent but the pay and the organisational set up was diabolical. My biggest gripe is that there is too much deadwood in the system such as too many management layers and support staff that can not be sacked despite poor performance. I remember when all our reception staff were off 'on the sick' for a variety of dubious reasons, we employed temporary staff. They cut our waiting list in half. Did we work harder? No, they actually sent out the letters to patients. Obviously it went up when our surly staff returned. My advice: pay staff properly and ditch the non-performers.

Peter, London, UK

The recent MTAS and Modernising Medical Careers debacle is the perfect example of government interference gone wrong. No doubt the designers of these systems felt they had a legitimate agenda but through repeated failure to listen to the junior doctors (who warned of problems and suggested not scrapping the reform but slowing it down to allow more careful implementation), an enormous mount of goodwill was stripped from the people doing front-line work, much of which is done above and beyond the call of duty. When I see the gloomy and anxious faces of my peers walking round the wards these days, I know what they're thinking: What's the point? I'm unlikely to be involved in the NHS for much longer.

Jeremy Newman, Beverley, East Yorkshire