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Do you work for the NHS? Can you give specific examples of new policies or initiatives that have not been good value for money?

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I am a Secondary School teacher and Carer of a loved one who has Borderline Personality Disorder.A local Consultant Psychotherapist/ Psychiatrist recomended the use of Dialogical Behavioral Therapy 18 months ago. This is not currantly available on the N.H.S.and after a long campaign it seems our local P.C.T. cannot afford to buy in from the private sector. (E.g. The Retreat, York.)We live in limbo; awaiting treatment with periodic repeating 'outbursts' of behaviour from the patient costing the tax payer thousands in police atention and repeated hospital admissions.
Jasper Gordon, Clitheroe, Lancs

I took early retirement from a London Teaching Hospital, as I got so frustrated by the fact inspite of large investements in the NHS, I was unable to provide the same caring best possible service to my patients to my satisfaction as well as the patients, because of arbitary obstacles created by straight vision, market orientated uncaring & some dishonest managers trying to satisfy their political masters rather than our real masters, the patients.

Massive constant untested changes occuring one after the other was confusing and I did not feel that we were managed by a group of professionals. Inspite of having layers and layers of management I as a consultant had to undertake a considerable amount of management in order to keep my service afloat. This time was spent at the cost of my patient time. I had the feeling I was working in a completely disjointed organisation. Perhaps politicians, who are basicaly untrustworthy with selfish motives should keep their fingers off the NHS.
Don B Wijetunge, London, UK

In view of the fact that any comments submitted may be published I don't wish to provide too many details - I have seen appaling levels of management incompetence, ineptitude and psychological bullying in relation to the operation of primary health care GP services. If it is typical of the national situation the prognosis is not good and politicians on a five-year election cycle will nevr resolve the root causes
David, UK

I am GP and disagree with the insinuation that we have all had a huge, undeserved pay rise.

We were given a lot of targets to meet, and have worked extremely hard to improve the care given to our patients. In order to meet these targets, we have employed extra staff, both clinical and non clinical which has swallowed up all our pay rise. Not everything that we do can be measured, but the government's obsession with targets has turned us into bean counters. It was assumed that GPs and hospital doctors were lazy slackers who were not giving their full time and attention to the NHS. It now turns out that we were all working a lot harder than we were given credit for, so now it's our fault that there is a huge £££ crisis.

Why did Panorama not mention the huge sums of money being paid to private providers such as Netcare who get paid 11% more than the equivalent NHS provider for doing simple, straighforward operations, no need to train expensive doctors, and no need to treat their mistakes? How much has the computer system cost-connecting for health? How much have management consutlants and marketing managers cost? what about NHS direct and Walk-in Centres? They are complete wastes of money. Patient choice and choose and book? All patients want is to know that their local hospital is clean and safe. The amount of £££ thrown at unnecessary gimmicks is scary.
Caroline, London

Good program, which pinpointed the problems with the NHS very well. Namely huge pay rises, with little expected in return, given by a naiive government, who thinks the way to 'solve' the NHS 'problem' is to throw money at it. Combined with 100,000 extra staff. It's a national disgrace that those responsible for spending our money should be so profligate.

But, would have been good to include a few output metrics as well. Did the 10% extra staff result in 10% higher output for example ? Did the 20% increase in GP's pay result in a 20% rise in GP appointments dealt with ? etc etc. You really need to do a good examination of good productivity metrics (rather than my simplistic examples) by experts in this respect (not the DoH) to establish whether all the extra billions were well spent or not.

But I suspect it has not been.

I work in a major multinational private sector company. We employ over 20,000 people in the UK. Over the past few years we have reduced our workforce by 25%, increased output by 20% and increased levels of customer satisfaction significantly. But of course we are driven by a profit motive and the need to survive in a competitive world - this drives our efficiency. The NHS has none of these beneficial pressures and hence as more and more money is thrown at it, it becomes more and more inefficient.

The real losers are we the taxpayers who have to fund this bottomless pit and the patients who are not getting the service they deserve nor value for money.
Sarah, Leamington, UK

Thank you for producing a programme which, for once, points the finger of blame exactly where the vast majority of problems with the NHS originate. The Ministers and Department of Health.

I spent over 30 years working in the NHS and retired early from my Directors post, 2 years ago (four years after the death of my wife) because I was no longer prepared to work within the political environement NHS staff are forced to endure. The constantly changing and ill considered political whims and 'initiatives' foisted upon hospitals by our political 'masters' and blindly followed by their civil service minions, make efficient and professional management virtually impossible.

I enjoyed a successful career in the NHS and have always considered that all of the many achievements I was recognised for throughout my career, were only achieved despite the system and certainly not as part of it. I made those feelings abundantly clear in our local press when I resigned.

I have no regrets about my decision to leave, other than sympathy for those many thousands of NHS professionals, whatever their roles, still struggling to provide high quality care and services for patients within a system that will never have a coherent and integrated direction as long as it is a political football controlled from the very top by 'sound bite' policy.

The only hope, albeit naive, is for all the political parties to come together and prove their oft quoted support for the NHS, by producing a properly considered and realistically funded long term, coherent strategy, not influenced by political expediency and ego.
John Wane, Scarborough, North Yorkshire.

As a nursing student I feel that although your programme highlighted many of the current problems it unfairly grouped the nursing"agenda for change"pay and conditions changes into the same catogory as 20%increases for members of the medical proffession.Agenda for change has left many nurses worse off, or banded into lower bands in one trust compared to someone doing the same job at same level in another.Nurses are still underpaid and under valued and for it to be implied that agenda for change has made big pay improvements for nurses like the medical awards is unjust and unfair.Also has no body picked up on the fact that this Government has infact paid for more nurse training, but because of job freezes in overspent trusts there are many many newly qualified nurses who are forced to work in there local supermarket because of a lack of jobs.How absurd is that !!
Anon, Northwest,UK

I have worked in the NHS for 22 years and I have seen an enormous increase in paperwork which seems so time consuming and unnecessary.Also the wastage is still very high..and thanks to the NHS Procurement everyday items are far more expensive than the local shops.

For instance, my unit uses a printer for baby photos but the cartridges are about £20 each.I can get them at home on line for about £6 but my line Manager told me they have to use the approved makes in order to maintain warranty... I also work in a neighbouring hospital which has made all staff have new uniforms at enormous expense,at a time when they are badly in the red.

The Government needs to let those that work in the NHS run it..not keep setting target after target which is unattainable and unrealistic.After all today's Politicians will be tomorrow's yesterday-men but the dammage caused will be a very long lasting legacy.
Anon, Portsmouth,UK

I watched with great interest the programme on the NHS this evening (Sun 26th March 2006). I did not disagree with any of the points presented and as a consultant surgeon I echo the sentiments of Mr Skipper.

In 2005 I was awarded the first NHS Innovation Award for Service Delivery for introducing changes at my hospital that: a) increased the number of patients that could be seen
b) reduced the patient waiting time, and
c) provided a better working environment for the NHS staff; but these improvements in quality used only existing resources and so was not associated with any additional cost to the NHS.

I have been surprised that the improvements that were demonstrated and which have been sustained have not generated any interest from the Department of Health.

The following year I was awarded a further national innovation award for how we improved healthcare delivery using innovative information technology. Once again there has been no interest from the Department of Health.

The problem is not a lack of resources; nor a lack of innovation; nor a lack of recognition of proven innovation; but a failing of the Department of Health to learn without making avoidable and expensive mistakes.The NHS can no longer afford the pain of learning by trial and error.
Mr Simon Dodds, FRCS. Consultant Surgeon, Sutton Coldfield, UK

I have worked at out local hospital for 17 years in the laboratory, a part of hospitals which are thought of as 'backroom boys'. The pay reforms have made a huge difference to us as we have always been very much underpaid, escpecially those of us who are not qualified technicians but perform an extremely important role in the smooth & efficient running of the laboratory.

I think it is totally ridiculous that hopitals are fined then money deducted from the next years budgets for overspending. This 'business' is demand led obviously. Once a laboratory has reached its budget do we say 'sorry but we can't do any more analysis because we've got no money left'. Apparently our lab has to save 2 million in the next years budget, how the hell can that be possible when our work load goes up all the time due to advances in technology and longevity. I'd be interested to know if this £100,000 salary for GP's is for a fulltime week in the surgery. None of the GP's at mine or anyone elses I know actually works there fulltime.Most do 2.5 or 3 days a week.

As for hospitals trying to save money or stop wasting money perhaps if they actually spoke to the people working there they could get a better idea of what needs to be done. In our hospital the junior doctors on the wards waste a huge amount of money every year by daily repeating blood tests on patients which really aren't required. Before they leave on a friday request forms are made out for the saturday & sunday for bloods to be taken, and there's only a locum doctor on for the weekend who isn't going to be looking at the results anyway.The next time most of these patients results are looked at will be monday after that day's bloods have been taken !!

Phlebotomist were introduced to weekend working to help reduce the junior doctors hours. Unfortunately they just fill out lots of forms before they go home and the lab has had to have more staff working weekends to cover it & the phlebotomist take all the grief from the patients because they're being stuck with a needle every day. What a huge waste of time & money.

Speak to people who actually work in the hospitals & I don't mean senior management I'm sure they would get a lot more sense out of them.
Dawn Perry, Exeter, Devon

We have just witnessed the best and the wordt of the NHS. My husband has recently undergone open heart surgery for the repair of two heart valves. The cardiac surgeon and all of the NHS staff involved were exeptional in their dedication and skills, However, my complaint lies with GP services who should have picked up on his problems years before his heart reached such a dangerous condition.

GPs are the gatekeepers of our care and my experience of them has been lacking in the extreme. The problem with their underperformance is that there is no proper independent policing of their performance and productivity, until this changes patients are at risk. The NHS complaints procedure deters relatives and patients from complaining for fear of retribution.

GP's are past their sell-by date. We need to instigate a better system of patient care through central GP centres and return the surplus back into the mainstream NHS, where they will find out how real work feels.
Lynn Wood, Lancashire, England

Patricia Hewitt was recorded as saying: "Every patient survey that we do says patients ... rate their own GPs, their hospitals, their accident and emergency as better than it used to be, getting better still". Perhaps this is true of DoH surveys. Other surveys paint a different picture. Though when Trusts find that struggling to balance local budgets in an uncertain environment diverts time, energy, and attention from providing services to patients, perhaps we should not be surprised.
John Hunt, London Borough of Hounslow

I work for the NHS in a large hospital. I can't understand why we have to have separate 'pots of money'. Surely if there is a deficit overall, we should be looking at pooling all the rescources and getting rid of the debt to allow us to start with a clean slate. Why build a £60m extension when we haven't the money to pay for staff and equipment. Other parts of the hospital are facing staff shortages and redundancies are being made. Also, why do we keep making these redundancies, closing down wards then realising they have to be re-opened using expensive agency staff.
Anon, Southampton UK

Excellent, but terrifying programme. The programme didn't even touch Mental Health. My daugher, a trainee clinical psychologist in London sent me the following on Friday ....'the office here is falling to bits. The heating has been broken for a week and a half now and we have one fan heater between the whole team. Its not our turn with it today.... the windows in the trainees' office don't fit the frames so there is literally a 1 inch gap around the top of it, letting in a howling gale. The lift has broken so if any patients are old and frail, they are screwed since the psychology department is on the 3rd floor. And the printer has broken in our office. You've gotta love the NHS!!! Is there every going to be enough money?
Lynwis, London

As a student nurse, I am shocked and disheartened to hear that Agenda For Change is an area of blame for NHS over spend. Nurses are paid less than teachers, policeman & fireman, etc. We go into this job because we want to help people, but unfortunately this is used against us to keep our pay down. We are constantly being reminded of how much everything costs, so we make sure we dont waste equipment and supplies. I would like to know how much money is spent on purchasing of supplies and how these costs could be reduced with some proper purchasing negotiation. The improvement in patient satisfaction that Ms Hewitt mentioned on tonights Panorama will be short lived once there are no nurses or doctors to treat them. Perhaps the Government thinks we will work for nothing. I for one wont, as much as I love my new career. I need to earn a living too.
Anon, North East Essex England

I am a staff nurse and until 1 year ago, I worked at the University Hospital of North Staffordshire. I never thought I would see the day that nurses were made redundant, but the issue I really struggle with is this.

A few years ago, while there was a shortage of nurses, as many were leaving due to poor pay and conditions, the government decided to bring nurses from the phillipines to England to fill the gaps in staffing levels. After 6 months assessment,quite correctly, these nurses were on the same wage as the rest of us. Unfortunately, there were some fundamental flaws in this scheme.

In the Phillipines, healthcare and education has to be paid for as far as I am aware. As soon as they were on a full wage in this country, a high percentage of these nurses brought their husbands over and started families! We then have to pay them maternity pay, plus pay agency staff to cover their shifts on the ward. It is hardly rocket science to see that we are paying double! And will also be paying for education and healthcare. There also appears to have been an oversight where the contracts are concerned as they forgot to make them temporary! We have hundreds of student nurses qualifying in this country, and they are being told there are no jobs for them, despite the thousands it has cost to train them! And to add insult to injury, nurses who have devoted years to this NHS are being made redundant! I cannot believe that anybody in any position of authority has any idea that this is going on, it is an absolute disgrace and waste of money!
jane mills, stoke on trent UK

In mental health care the implementation of 'Crisis Teams' were compulsorily forced on NHS trusts nationwide. In my experience as a mental health nurse working in acute psychiatry, they have not proved value for money - in reality they are large teams of highly paid staff working with very few patients for the minimum amount of time.

I work in a day hospital which was almost closed down due to the implementation of the crisis teams - we have a focus on prevention and therapeutic ways of working,as well as managing acute situations and preventing inpatient admissions. I love my work, but I fear that 'prevention' is no longer a priority in the current NHS climate of mental healthcare. The reality of my work as a mental health nurse is that I have to deal with issues such as suicide and self-harm on a daily basis, and have been verbally and physically threatened on occasion. But I am still eager to do the best for my patients. The

recent payrises were well overdue, and barely recompense us for the daily traumas that mental health nurses encounter as part of our everyday work.
heather , brighton, england

One has to ask why the senior managers at the DOH did not ask the doctors how much work they were doing before forcing the new contract upon them. The answer is they had been brainwashed at the Health Services Institute into believing that the doctors were all doing too much private practice. How wrong they were.
Robert Doran, Hereford

Patricia Hewitt must be on a different planet to me; she must also have private health care. I have been informed that, I will have to wait 12 to 18 months for a hearing test.
gordon jones, Taunton, UK

Government & NHS management have consistently under estimated,to a significant degree,the sheer volume of work historically performed 'pro bono publico' by primary & secondary care staff.

In our PCT, management have decided to withdraw local GPs from out-of-hours service provision Mon-Fri until Nov. & completely thereafter. OOH care will be provided by nurse specialists who,if unsure of what they are dealing with,can 'refer on' to A&E, thereby guaranteeing increase in their activity (which is then paid for by GPs & not the PCT). This is a false economy - nurses cheaper than GPs but no guarantees that they will keep the same no. of people out of hospital.
Hugh Delargy, Market Harborough , Leics.

I am an overseas doctor from India. Recently government has passed a law which prevents overseas doctors applying for training posts in NHS. While I entirely agree that local graduates should be given preference, the way this has been done is scandalous and has had no consideration to the existing overseas doctors. All of feel as being abused by the GMC.

They are still conducting the PLAB exams with no justification otherthan to bring in more revenue to GMC. The exam fees is a huge some £600 with the total cost until an overseas graduate gets a job averaging nearly£2000. I would be more than happy to discuss the same more in detail if you wish so.

Overseas doctors have contributed a lot to NHS in the recent decades and we expect to be treated with some dignity and consideration. Our community has been outraged by the home office decision and we plan to stage a peaceful protest in the near future!
venkat, northumberland. UK

I am a small cog in a very big wheel and feel that my collegues and I are being expected to give a good service, which we do, but at what cost, redundancy at the expense of customer care. Being expected to deliver that care by working longer hours, under staffed, rare meal breaks,abusive patients. I am in fact off with stress as are a few staff. For what so somebody can say that goals are being met etc. It is all so political and undermining. I used to love my job.
Lyn Carpenter, Southampton, Hants

I work in Primary Care with GPs whose sole motivation is money but who are quick to hide behind the facade of 'patient care'.The GMS contract is one where 'points make prizes' and it is simply a tick box exercise.For example mentioning a smoking cessation service to patients means a record of smoking cessation for the GMS contract- is this good care?In my PCT GPs are being paid extra to conduct medication reviews in nursing homes - this defies belief when conducting these reviews should be basic care. Yes, management costs are high and I know of PCT managers who are wasting NHS resources but so are many GPs.

It would also be interesting to see the total bill for compensation claims to the NHS. The public needs to start taking some responsibility for the current situation and stop assuming NHS resources are neverending, for instance the inappropriate out of hours visits for simple conditions that can be self-treated.
Anon, England

Thank goodness you have done this. Health managers are talking about a 'policy jacuzzi' and this is frightening.

The biggest waste of money is just about to come, though. This is giving the 'commissioning budget' to the private sector. This will allow huge multinational companies to command the primary care purchasing budget for secondary care, through the combination of Practice Based Commissioning and allowing large private companies to take over General Practices. Do they know what they are doing? Do they not realise that this is the way to allow global multi-national companies to drain money out of the NHS? It is insane. There is already a money war between primary and secondary care. This will make it so much worse. The situation is seriously unstable. Big multinationals are queueing up to buy up practices and take over vacant ones, so that they can get their hands on this money and decide how to spend it.

This policy, and others like it, will hand the NHS to the private sector before the next election. This is coming in 'under the radar' and the public have no idea that this is happening. Most health professionals are also unaware. by the time the next election comes, the NHS will no longer exist, except as a kitemark. The public did not consent to this at the last election.
Dr E D Barrett, Nottinghamshire

Yes the NHS is in a mess a big mess.I have worked in the NHS for passed 7yrs and have seen a lot of mistakes in the way public money is wasted.No other business could run like the NHS because it would not have the money handed to them on a plate. The public would be horrified if they new how much public money is wasted. We get through managers and cheif excutives like nobodies buisness, with big pay outs to chief excutives. Some staff we employ are rubbish and do not understand the job they were employed for.

The agenda for change the Goverment introduced for the NHS,managers cannot understand. The Goverment need to relise the NHS is not a bottomless pit to pour money in. The only way to sort this mess out is to privatise it.
Mr Thomas, Birmingham West Midlands

I am a psychiatric nurse working with the elderly with mental health problems. I have suffered a triple whammy as a result of government reforms and Trust cuts. In November last year I was appointed to the post of Clinical Systems Trainer at our Trust headqurters, training clinical staff to use software aimed at establishing a paperless record as part of the National Framework for IT. After a weekend of celebration I was told that the Agenda For Change review had just come in for the new job and the actual rate of pay would now be £4,000 less than that advertised.

As I was already to be taking a £3,000 pay cut to do the job I declined to accept. Two months later I commenced work as Clinical Systems Trainer on secondment from my regular place of work, in the hope that the Agenda For Change issues could be sorted out in my favour. After one month of intensive preparation I was ready to start training only to find that in a cost saving exercise the entire department was to be w iped out.

I have now returned to my original place of work but there is a strong likelihood we are told that this unit will be closed in the forseeable future. Not because there is no clinical need but purely for cost saving purposes. This situation is true for the unit that my wife works in too...
Andy Godden, Coleford, Gloucestershire

I am very disappointed with the programme, which has been a great missed opportunity to inform the public as to the real reasons the figures are not adding up. The sole explanation for the financial problems given in the programme was the increase in doctor's pay, also other staff under A4C.

The now considerable use of the private sector has been an enormous drain on public resources, in terms of, among others, the PFI initiatives, and the Independent Care Treatment Centres. The latter are paid for specific amount of procedures regardless of uptake, the remainder of money can be pocketed by the company, which is incidentally compensated if it does not recieve the contract next time around. The NHS is left with the complex cases, trauma, etc, and also to clean up the mistakes left by these private companies.

I, and I am sure many thousands of my colleagues, am very disappointed that the BBC does not have the balls to clarify the bigger picture, to tell the whole story. We are very close at this stage to not having an NHS.The public deserves to know what is happening.
Rosie Faulkner, South Godstone

Poor policies? Easy! Scrapping of house officer programmes for newly qualified doctors.

Training nurses as "cheap labour" to do operations when there is a shortage of nurses for the wards. Meanwhile, junior surgeons miss out on vital training experience yet will be expected later in their careers to be experts.

Mass redundancies coupled with the expectation of an improved service to a population that's aging and will require MORE carers, not less.

Denying work permits to doctors from Asia who have a proven good track record in this country and have proof that they can speak good English, while doctors from the EU can come and work here without speaking a word of English and often call themselves "consultant" when only 3 years out of medical school.

Shame on New Labour and its interminable "quick fix" solutions. They seek only to demean the honourable medical and nursing professions, and demoralise a well-intentioned workforce even further. Don't be surprised when all the doctors emigrate. I may be one of them.
Dave Tragen, Nottingham

I have just watched your programme on the NHS reforms and the impact they are having on the service across the country. I am a senior nurse who has 26 years of NHS experience, in which time I have seen many changes to the service. I am in no way adverse to change and in some respects acknowledge that some modification to efficiency and spending is required. I am, however greatly dismayed to think that one of the ways to meet the shortfall in funding for 25% of NHS Trusts is a reduction in staff.

I have recently recieved an 'At Risk' letter from the Trust that I work for after being a loyal employee for 22 years. I cannot recall the numbers of additional hours I have given to the Trust that have been purely given through my own good will. I strongly believe that the patient comes first and my duty is to the patient, hence, my commitment to their care beyond that which is expected. I am not alone, the majority of health care workers spend additional time at work to ensure continuous care for their patients.

I cannot believe that by reducing the workforce further that patients will benefit. I am saddened that my career has come to this at this stage. The NHS will loose many experienced ,skilled staff who have until now tried to maintain high standards of care for patients within limited resources.
Anon

I am a Clinical Midwifery Manager at the local NHS Trust. Nationally, Maternity Services have been tasked with targeting at risk groups. These include teenage pregnancies, pregnant substance abusers, domestic violence amongst others. No funding is forthcoming to address this extra work and, as throughout the NHS, much of the work is done from goodwill and during the hours contracted for 'normal' care. This means that we are short on the wards and in the community whilst midwives try to address some of these target groups.

The department in which I work has, until this year, always come in on budget and that has been managed by prudent (some would say over-enthusiastic) financial management by the Head of Midwifery (my direct line manager). Now, in order to help reduce the deficit at the Trust, we have had to cut services to a ludicrous degree. We no longer supply nappies, sanitary towels or infant formula and, to replace an obsolete breast pump, an essential piece of equipment, I am required to complete a business plan! My first recourse was to charitable funds - for an essential piece of equipment that would cost £1,000 (for a recon of course)!

Morale is low, sickness levels are high and we are at the point of desperation. Whilst I am still passionate about my profession I really cannot take much more of the political environment in which I find myself. Your programme tonight was the first honest and fair account of the situation that I have seen but I doubt that any good will come of it.
Di Sandland, Barnstaple, Devon, England

Having just watched your Panorama program on the NHS, and being reliant on the NHS for life long treatment of chronic pancreatitis, I cannot see where Blair's millions have gone to. I went to my local hospital outpatients department last week and the Doctor I saw failed not only to find a blood pressure monitor that worked, but already knew that she wouldn't find one in the department without an audible air leak. Surely basic equipment such as a working blood pressure monitor on an outpatient's ward is the very least that patients can expect.
Matthew Bridle, Glasgow , Scotland

This evening's programme angers me. The take home message that the NHS is in deficit due to the pay rise given to doctors is absolutely absurd. The consultant surgeon stated he worked 60 hours per week and got paid for 30, now he gets paid for 40 but still works 60. He is not alone, this is a usual occurrence. Money is lost in the NHS when patients operations are cancelled due to bad planning. An example of this is when 3 surgeons, 2 scrub nurses, 2 anaesthetists, 1 anaesthetic assistant are all ready to perform an operation but 1 recovery nurse has to leave early with no cover organised, therefore the operation is cancelled. This is how money is lost in the NHS.
Cleopatra Darwish, London, Uk

I work as a health visitor in London. The recent reforms taking place in Agenda for Change seem to be creating more higher paid staff to do more "management" work and less qualified staff on the ground. We are already short staffed and are only able to deliver a skeleton service to our clients. The Health Service is top heavy with expensive management at the expense of the staff delivering the service. Moral is at rock bottom.
Anon

Last summer I tried to get an appointment with my GP and had to wait ten days to see him. Last week I again needed to see him and phoned - the next available appointment was eleven days away. What improvement here, Mrs Hewitt? Even if you are prepared to see a different doctor, you still end up waiting four or five days.
Maggie, South London

I have had several different types of admission to my local hospital over the last fourteen months. I can honestly say that at no time have I been kept waiting on a waiting list for any more then three months. I think that the policies that have been implemented locally by the government have been exceptionally good ones, and my care and that of my family have been very good.

Over the last couple of years I have had to see in the region of ten different consultants for one thing or another, and I can only praise the NHS for their good standards of care.

The only thing that I would complain of is the management side of things. I feel that there is far to much management and not enough workers. The managers are taking a large bulk of the money from the hospitals, and this leaves the short fall for the nursing staff.
Frances Williams, margate, Kent

As a third year student nurse I feel uneasy about job availability when I qualify. this was initiated on my first day of term in January when my head of year announced to the class that our trust was the only one in the area taking on newly qualified staff due to heavy defecits. This has led to increased competition for jobs. Why then do the government invest around 20k to train nurses with no guarentee of a job at the end of their training? Now I am faced with the prospect of moving to Australia, where not only are there lots of nursing vacancies but they offer better opportunities for newly qualified nurses by offering a 12 month transition programme, which gives newly qualified nurses more support at such crucial time. Yes, the quality of care has improved under the labour government with the introduction of clinical governance, however, it could be said there are too many policies which can be confusing, and also these new policies and their implementation cost money and time. The NHS government needs to simplify its current policies, reduce the amount of cheifs and increase the number of indians instead of making them redundant because it is these indians who are at the forefront of care provision after all.
Sarah Marsh, Huddersfield, uk

I am an auxiliary nurse and due to cost cutting measures our ward is understaffed. This results in staff being stressed and patients not getting the best standard of care possible. I myself am looking for a job elsewhere as the stress of having so much work to do when i go in, work which would have normally been done had there been an auxiliary nurse on the previous shift is making me stressed and not look forward to going to work.
Anon, North East UK

I think the Panorama programme hit the nail on the head. I am an NHS consultant and looked forward to the new contract allowing us to demonstrate increased productivity. Instead I have received a pay rise (not as much as quoted in the programme) and am being asked to cut from 46 hours a week currently worked to 37.5. I cannot see how this would not affect the service provided.
David Laws,

What an unhelpful programme. I am a doctor. I feel undervalued and underpaid. Many professionals at my age are bringing in huge salaries. Unfortunately, all of these types of programmes complain about how much doctors' pay has risen. What they don't explain is the fact that we have always been paid poorly and expected to work long hours. Only in recent times have we seen our pay rise and our hours reduced. Most junior doctors work around 56 hour s a week with relatively little renumeration. Furthermore, have we not earned the right to decent working hours and decent pay?! If we are squeezed out of more money and expected to work even harder, there will be only one sure fire way to make the government understand how difficult life is for most doctors: STRIKE ACTION. The government places a clause in our contracts, stating that we are not allowed to strike: obviously required, when you (the government) know that you are treating a group of professionals like slaves.
! Dr J Johnson, LONDON

No mention of the huge increase in administration, far more than clinical staff. the majority of them spend their time in meetings achieving very little. I work in a dept with 18 staff we have 4 managers
angela rehschuh, glos

You have shown in graphic detail ,what those of us involved in this service have been saying all along. In the rural parts of the community where i live,there are only two doctors who cover the whole county at night. People in pain and in need of medical care wait hours before a doctor reaches them. It was obvious from the begining that the new pay awards and the GPs contracts will suck all the money put into the service. Is it time now that the unthinkable,what no political party is brave enough to say,should be said ;that the NHS should have part private insurance as it is in the European countries?
sabina ahmed, somerset.uk

I saw a consultant privately in order to jump the nhs waiting list when I saw the same consultant via the NHS for MRI results there was a marked change in attitude. A once attentive personable man became bored and dismissive. If it was financially viable I would go private just for the improvement in personality.
, Wolverhampton, West Midlands

I have worked for the NHS for the past 7 years. Pressure to keep waiting lists down means, for example, that sometimes I do not follow NICE guidelines regarding treatment type and length. However, it is not all the responsibility of the NHS. Many patients do not attend appointments or attend erratically leading to longer waiting lists and more internal pressures.
Anonymous - Psychologist , London

As a hospital consultant, I found the program gave a profoundly depressing and accurate picture. Surprised you didn't also mention the scandal of the 'Independent Treatment Centres' (ITCs). These have been set up to reduce waiting lists and give patients' choice. Primary care trusts have been obliged to pay the ITCs at an inflated rate regardless of whether any patients actually choose to use them. This is taking money out of the NHS to give to the private sector even in areas where the local hospital has achieved its waiting list targets. They cream off low risk proceedures and leave NHS hospitals to sort out the ITC's mistakes.
ros jones, slough

The programme on the looming NHS financial crisis was OK as far as it went. What I totally missed, however, was any comparison with our neighbouring countries in Europe, and how they have coped with aspects such as doctors' pay increases, tariffs, etc. I live nearer to London than some people in Scotland do, but the national health service here in the Netherlands does not seem to be in such a deep crisis. Why not?
Eric Dickens, Blaricum, Netherlands

The programme mentions the agenda for change pay rise for nurses. I would like to point out that many nurses have still not received this payment and are not likely to in the near future as trusts get further and further into debt. The individual trusts have been given the money, but have not passed it on to staff. Where is the interest that this money has earnt gone? Because it is certainly not going to be given to the staff! Wards are closing and medical staff are losing their jobs. So who is going to look after the public who are living longer, have higher expectations and whose population is ever growing?
Karen, UK

Contrary to the assertion that all areas of the NHS are getting increased funding in the next 12 months, General Practitioners are recieving no inflation or cost of living uplifts.This,combined with VAT registration and changes to dispensing regulations actually allows a substantial clawback to be taken.....and don't mention the theft surrounding superannuation payments!!!
Dr R J Moffatt, Framlingham, Suffolk

Why no mention of the rising drugs budget? The Cornwall trust blamed pay rises and drugs budget increases for the need to cut 300 jobs. As drugs companies worldwide are ripping off health services with hikes in prices that are not justified, did you omit this because the Government is not to blame?
Paul Flynn, Newport Wales

I have worked in NHS for 25 years and as senior doctor feel that too many policy changes and politicians who come and go with new initiatives before the previous one's ink is dry is one of the major problems. We receive dozens of policies, initiatives and more so from Welsh assembly every day. None of these are proven to work before they are rolled out. When Patricia Hewitt on your programme shows her ignorance about NHS any person in and outside NHS can judge what politicians know about NHS before dishing out all these policies. Some of these are to keep the jobs in Whitehall and Government.
Dr Sandip Raha, Bridgend, Wales

Your programme failed to explore (or even mention) the added expense entailed in the referral of operations to private hospitals as part of the effort to reduce waiting list times.
Frank Niering, Buckfastleigh, Devon

I am really angry that your program and the newspapers are talking about the pay review "Agenda For Change" in a skewed way. I am a medical secretary and I am certainly not better of for the new payscale. My banding has been downgraded and I will lose my cost of living rise. Morale is horribly low at our local hospital. You only have to ask the staff and most people are contemplating moving on.
Victoria Holmes, Paignton, England

Enormous admininstrative costs have been incurred by reintroducing 'internal market' paperchasing; 'Payment by Results' and Practice-Based Commissioning' will swallow huge sums which could be better used to recruit, train, and dare I say it, pay the staff a decent wage, who actually TREAT patients rather than shuffle papers all day. The NHS is a people delivered service - the majority of increased costs are therefore in wages/staff numbers to improve service delivery and quality.
Dr Alan Woodall, Telford

I work as a Practice Manager and I still cannot understand why GP's are paid extra for quality. Surely quality is something that we should be able to take for granted. My GP's were earning 60k 3 years ago and now they expect to earn 110k. This year even more money is on offer.
Kerry Gold, Essex

Maybe hospitals, doctors etc should start checking who is eligible for free treatment. On a recent visit to the UK my baby son was admitted to hospital, I offered to pay when he was admitted and discharged. I was covered by Belgian social secuity E111 and Private insurance and nobody was interested - if it is that easy to gain free treatment no wonder the NHS is losing money!
Susan Heron, Brussels, Belgium

One important point that was lost is the vast increase in hospital managers that are active members of this labour party. These managers never said government stop we cant afford this they said oh this will help waiting lists and now they have egg on their face. There is also an important point with the gp wage increase that the incentive for people to work full time has dropped. many GPs work part time as they can still live on this increased wage.
Dr Jonathan Myers, London

Just watched your programme. Why no mention of dentists? Do you know that there is not one dentist within 15 miles of my home who is now accepting NHS patients? As a pensioner I face a minimum £40 surcharge and at least double the fees I paid previously - some costs have increased almost ten-fold. I am told that the Government believes that its new contracts for NHS dentistry will benefit dentists and patients. None of the dentists nor patients I know share this belief. Neither do the facts support it. Another tax to pay for Government bungling!
Sean Brady, Saffron Walden, England

When are politicians going to admit that there are far too many people coming into this country and receiving health care when they have not paid a penny into the Scheme? Surely this is basic economics? I worked till I was 60 but have to pay for dental treatment yet asylum seekers, illegal immigrants etc. get treatment for free - there is something wrong somewhere!!!!!
Gwen Lawrence, Dereham, norfolk

i work in mental health services in the south east of england and i've ten years experience of the nhs now. its true that patients say their experience's of the nhs are largely good, but clinicians are broadly exasperated by the pace of change. there are good managers trying to implement a vast programme of change, and at the front line it feels like there is no end to this. recruitment to the front line is frozen, retiring staff not replaced and prospects don't seem good. newly qualified staff are beginning to panic, as jobs are actually scare to find. morale across clinicians is low.
Anonymous, south east england

I work for the nhs i have done for nearly 20 years.Iv'e seen the nhs employ more managers than they need,they have made rearly great nurses up to managers and have taken them off wards that need them more.Recently a manager asked if she could employ nine new domestics and porters and she was denied .Accident and emergency asked for a new charge nurse a new manager and a new consultant they were all agreed to.I ask myself why ? when we have had mrsa and a vomiting bug that have closed wards we are lucky if our department gets hooverd sometimes the domestic only has time to empty our bins because she has to clean several other departments.I think that the nhs is being run in to ground ,so that we all have to pay for private health care.
Anon