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Last Updated: Friday, 2 June 2006, 16:25 GMT 17:25 UK
Manager's view
Spiralling debts and job cuts are plaguing the NHS in England, bringing a new focus to how it operates in the 21st century.

Health workers in a variety of sectors - plus the BBC's Home Editor, Mark Easton - offer their views on what is wrong with the National Health Service and prescribe their own remedies.

Jon Restell, chief executive, Managers in Partnership, gives his assessment.

DIAGNOSIS

Jon Restell

There are many, many good things to say about the NHS to both staff and the people we serve and care for.

The extra money has been put to work - we are doing much more, better - just look at huge cuts in waiting lists and what people say in surveys - and we have many more staff with better pay and training than we did five years ago.

So why are where we are, with hospital after hospital announcing proposals to cut posts and nurses nearly rioting?

The situation varies from place to place but the NHS is being asked to change fast, perhaps too fast.

Some organisations are being asked to tackle historic deficits by the end of this financial year and all organisations are affected by changes to the way money moves around the system.

This means the people who run local health services have to make some hard decisions.

Job cuts - although often exaggerated - have badly knocked staff confidence in change.

PROGNOSIS

Calling a halt to change is not the answer.

We need some organisational stability in some parts of the NHS, but overall we have to keep changing because the world around us keeps changing.

Public expectations will never stop rising - for example, an aging population will want healthcare delivered in a new way, everyone wants flexible, convenient services - medical and technology is advancing faster than anyone can predict and any health service needs to be more productive.

Change is not the problem; how we change, and how quickly, is.

We must rebuild staff confidence urgently.

Only well-motivated managers and staff will deliver services for patients in a new way.

The government needs to be clearer about where it is going and to address concerns about how different elements of reform might work against each other and about the risks of moving so quickly.

Most of all, we must keep in mind what the NHS already achieves every day for patients and service users and not run down the whole of the service when we campaign around specific problems.



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