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Last Updated: Friday, 11 May 2007, 08:48 GMT 09:48 UK
Blair and the NHS: Viewpoints
Medical form
The NHS has received unprecedented sums of money
Tony Blair is to step down after 10 years as prime minister.

From the very start of his premiership he made the NHS a priority and has pumped record amounts of money into the health service ever since.

But what has he really achieved? Staff and patients give their views.

Barbara Clark, Herceptin campaigner

Joyce Robins, co-director of Patient Concern

Dr Michael Dixon, Devon GP and chairman of NHS Alliance

Alan McIrvine, vascular surgeon

Nick Stolls, Norfolk dentist

Dr Mark Reynolds, weekend and night-time GP

Mike Smith, A&E nurse practitioner from Surrey

Breast cancer patient who fought NHS over the Herceptin drug

Barbara Clark
Barbara Clark fought for Herceptin

"I can understand why the National Institute for Health and Clinical Excellence (NICE) was set up.

"Doctors are bombarded with information and marketing from drug companies and the NHS cannot afford everything.

"But I think it has gone too far. NICE is now a cost-saving exercise, rather that a body which looks to use the best treatments.

"I am not saying they should be scrapped, just reformed. Too many drugs are being restricted.

"And this is going on when there is so much waste elsewhere. Many millions of pounds are lost through missed appointments and the managment of NHS finances leaves a lot to be desired.

"I think the health system is better now than when Tony Blair came to power, but it is just that it should be so much better.

"We pay taxes all our lives thinking the NHS will be there when we need it, but all too often it is not now and that is wrong."

Co-director of Patient Concern

"I feel sorry for Tony Blair. He has seen all this money go in and yet patients are not seeing the benefit.

"People are on the streets campaigning about hospital closures. Doctors' morale is low. Yes, waiting lists have come down, but all this extra money has been wasted.

"We, like many others, were urging him to put more money in. He did, but it has not been managed properly. Look at the GPs contract, they ran rings round the government, ministers just did not know what doctors did.

"I think they should have had much tighter control on the spending.

"The thing is you ask patients what they think of care and they say it is good. But if you dig deeper they are basically just happy to get out alive.

"They are not asked about their care, whether they were consulted on the type of treatment they could have.

"However, the government has got it right on doctor regulation.

"Following the Harold Shipman case, it was clear we needed to reform the way patients are safeguarded. There are now much better checks and balances in place."

Chairman of the NHS Alliance and a GP from Devon

"There has been some very good things. The extra finance has safeguarded the NHS for the future and waiting lists have come down.

"But I think the government could have done more to get clinicians onside, after all we are the ones spending the money. Some of the targets have been pretty blunt.

"From a personal point of view, my job is much better. I am better paid and I no longer do out-of-hours care as GPs were allowed to opt out under the new contract.

I think patients are getting a better service
Dr Michael Dixon, of the NHS Alliance

"Saying that, my working day now is quite intense. I work from 8am to 7.30pm and my performance is monitored closely.

"I think patients are getting a better service. They maybe don't get the continuity of care they use to with their GP by their bedside at 2am.

"But at my practice we have a same day service, staffed by a doctor, two nurses and a paramedic, so patients can see someone straight away.

"We also run diabetes, heart disease, asthma and stop smoking clinics. It is a much more integrated and extensive service than before."

Vascular surgeon from London

"Waiting lists have come down, but that does not tell the whole story. GPs are being put under pressure not to refer patients so they don't add to the waiting list.

"Targets have focused minds, but have taken away from clinical decision-making.

"In A&E, doctors are concerned with seeing that patient within four hours whether that means sending them to another ward undiagnosed or getting them out of the hospital. That is not in the best interests of the patient.

"For consultants, we have got more money, but we are not any happier. Surgeons like working, they want to operate on people, we are not motivated by money.

"The new contract we got in 2003 started paying us for the work we were doing, but this has led to a clocking in and out culture as managers are monitoring what we do. It is Orwellian.

"There has also been an obsession with the private sector. We have PFI hospitals saddled with huge amounts to pay in rent, while fats cats get even fatter.

"It has not been all bad however. Some of the waiting times were too long and some of these hospitals would not have been built without the private money. It is just that it should have been better."

Dentist from Norfolk

Nick Stolls, dentist
The new dental contract has proved unpopular with dentists

"There were problems with dentistry when Blair came to power. Dentists complained about the treadmill of having to see as many patients as possible, without being able to spend proper time with their patients.

"Meanwhile, the public complained they could not get access to a dentist because the lists were full.

"He tried to do something about it with the new contract last year, but it just has not worked.

"Morale is at rock bottom because we are so tightly controlled and have lost our relationship with our patients.

"The new contract has done away with registration and dentists are given a set amount of money to treat patients.

"If that runs out, especially with the finance problems there are at the moment, we don't get anymore and have to start turning patients away.

"That's what happened with my practice earlier this year. I think we will see more dentists leaving the NHS in the future."

Medical director of GP night and weekend service On Call Care

"When the new GP contract started in 2004, doctors were able to give up their out-of-hours care.

"A lot has been made of this. The system that is working now is good in the sense that there is no point GPs working through the night and then running surgeries during the day.

"However, the problem is that out-of-hours care provided by organisations like mine is cut to the bone.

"There are so little resources given to it. For example, take your AA membership - that is probably 100 a year. Out-of-hours care costs less than 10 a year per person. It is pretty good value for money.

"There are also problems with NHS Direct. They are referring too many people as urgent cases and not dealing with enough themselves.

"It is clogging up A&E departments and wasting doctors' time."

A&E nurse practitioner from Surrey

"Nurses like myself have been given the opportunity to take on much more responsibility.

"I think that has been good for morale and good for the NHS, because we can free doctors up to see the more serious patients.

"I can take blood tests, order x-rays and can prescribe. It means I will see patients with simple fractures, cuts and bruises.

"But there have also been problems. The four-hour A&E target has obviously had an impact, but it does lead to patients being pushed through into other wards just to make targets.

"There has also been an issue with out-of-hours care after GPs gave up responsibility. It has meant we have seen more people coming to A&E and this has stretched already limited resources."

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