BBC NEWS | Talking Point | NHS: How to spend the extra money?

Nurses are calling for part of the extra investment in the NHS to be spent on pay rises, at their conference this week in Harrogate.

According to a recent survey, a shortage of nurses remains one of the main patients' concerns.

But managers of the NHS suggest that this would be unaffordable as pay rises may eat up a large part of the £40 billion investment announced by the Chancellor last week.

The NHS Confederation which represents health service managers says money is needed for new hospitals and state-of-the-art equipment.

How would you spend the extra money which has been promised to the NHS? Should nurses be a top priority in any extra funding or are there other areas you feel are more needy?

This debate is now closed. Read a selection of your comments below.

Your reaction

The National Health Service should concentrate exclusively on properly educating the population on health matters and providing a monitoring service to detect problems early and advise on actions to correct them

John Brownlee, England

The NHS should be split into two distinct parts - the National Health Service and the National Sickness Service. What we all currently have is a National Sickness Service, which is groaning under the weight - sometimes the very real weight - of a population that has made itself sick through smoking, drinking, overeating and lounging about rather than taking a little light exercise. The National Health Service should concentrate exclusively on properly educating the population on health matters and providing a monitoring service to detect problems early and advise on actions to correct them. The National Sickness Service could be slimmed down as the population becomes healthier, fitter and wealthier - fewer days off sick for a start.
John Brownlee, England

I think it would be a good idea for the money to be given back to the government in the form of Employer National Insurance contributions. And even better, if the nurses get a pay rise they could pay a portion of the extra money back to the government as well.
Borat , Peterbrough, UK

For too long the NHS has relied on the goodwill of its staff to keep it working. I work as a staff nurse in the community and regularly work through my lunch break and after I should have finished to meet the needs of those I visit. In my workplace there has been an open advert for two years for staff, why? Because successive governments and the public want something for nothing. Nurses I work with, who have 20 years experience, are paid a newly qualified D grade, to keep pay costs down. The time of vocational nurses living their lives in nursing homes is over. If the public wants quality staff looking after their needs, and if the NHS is to continue to attract high calibre applicants in the future , they will have to pay for what they want. Why should I continue to work extra hours for nothing, the NHS is not a charity. I am NOT an angel, God does not pay my mortgage.
Karen Lyon, England

I am an NHS manager myself and would prefer more money to the targeted towards front-line staff

Martyn, UK

I am an NHS manager myself and would prefer more money to the targeted towards front-line staff. However, I read with amusement comments that are made to the effect of scrapping bureaucrats - obviously made by persons who know little about healthcare. The NHS is the biggest employer in Europe and has the lowest level of administration of any healthcare system in the world. Do people seriously want their doctors and nurses to take on all the planning and administrative functions of such a huge organisation as well as treating patients?
Martyn, UK

The choice for nurses and doctors is whether to push for more money and keep the same understaffed working conditions, or accept a more modest rise and recruit extra staff. This is a finite amount of money that must be used for the best purpose. And before we see a torrent of mail proclaiming how underpaid nurses are - I am a nurse. But I'd rather have a 3% pay rise and less pressure at work than a 10% pay rise and the pressure I have now.
Liam, UK

Nurses, beds, doctors, medicines but not suits

P, UK

Nurses, beds, doctors, medicines but not suits. I also think they should draw the line at some of the treatments they are providing. Infertility for one, and some forms of cosmetic surgery that are more triggered by vanity than medical need.
P, UK

I am a hospital physicist, and think it is insulting to other healthcare professionals to call nurses 'the glue that holds the NHS together' - it'd also collapse without technicians, cleaners, porters, physicists, radiographers and pathologists (to name a few) but because they aren't high profile these groups miss out on the pay rises given to doctors and nurses. A government-funded system will almost inevitably pay less than a corporately-owned one; I don't mind that, as long it's enough to live on. The real issue is that NHS staff are undervalued - we are highly-trained, highly-regulated, and do a very important job. Can't the government trust us (and fund us) to get on with it, rather than pestering us with continual restructuring?
Heather Williams, UK

I'd start by spending some money on some good quality research into what the money should be spent on. I get the feeling that at the moment the government are just making it up as they go along.
Adam, UK

People keep saying that more wards/beds should be opened for use. In a hospital I used to work for, wards were being closed down for the simple fact that there weren't enough staff to keep them open. By providing decent working conditions for the medics, then maybe more people can be brought into the NHS. Then the wasted capacity that exists at the moment can be used. As for the calls for high-tech equipment - again, you need the staff to operate the equipment, as well as provide the care before and after treatment. Having an expensive new machine that's sat doing nothing because there's no-one to run it is a waste of money, yes?
Paul Williams, UK

With a free health service people will gladly become dependent upon it. People are no longer encouraged to take care of themselves. More money should be spent on the education of the individual on how to take care of themselves. The de-medicalisation of things like ageing will also reduce strain on the NHS. Also schools could teach the youth of today in preventative measures rather than telling them that if they ever can't handle real life they can go see a doctor.
Peter Hill, United Kingdom

No amount of extra tax can fix public services

Alex Keenleyside, England

No amount of extra tax can fix public services. Public service unions will always demand higher pay and lower working hours and at the stiff of extra cash will pounce. The only solution is to tax ourselves less and trust the market to provide us with our requirements
Alex Keenleyside, England

No pay rises. Let's spend the money on beds and cheaper prescriptions.
Volker, England (ex Germany)

Yes, I totally agree. The money should go to the nurses and doctors who work in the NHS. Often hospitals appear to be built for the sake of the management staff i.e. new offices, new desks etc while wards and A&E departments suffer acutely from lack of staff. It's nurses and doctors who administer treatments, surgery and save lives, not managers or boards debating policy.
Wendy, U.K.

I have to say that I get rather fed up with the constant denigration of NHS managers. I was one, I wasn't that well paid and worked hard. It would certainly cost more per hour for a medic to do the job of a middle manager! The NHS is the biggest employer in the country: how on earth can it function without people to recruit staff, pay staff, deal with building and facilities, deal with complaints, make sure staff and the public know what's happening in their service, and all the other non-clinical tasks that simply must be done in a workforce of that size.
Anne Keane, UK

I believe that a restructuring of the entire NHS and its priorities is needed

David, UK

I believe that the nurses do deserve a pay-rise especially if we want to avoid losing all the older, highly experienced nurses. However, before this is done, I believe that a restructuring of the entire NHS and its priorities is needed. No business could have been created over 50 years ago and still be working within the same basic structure; it would simply not be viable or cost effective. There are many complex issues to be sorted within the NHS, and I feel that we are only just scrapping the top of the iceberg.
David, UK

Nurses pay has risen by more than inflation consistently for more than 2 decades. The fact that their first response to more money is to try to grab it for themselves rather than see it spent on more staff and improved equipment shows that all their claims to be altruistic and concerned with patient care are just lies and they are just in the job for what they can get.
Bernard, UK

This is good news for all those who may wish to make a negligence claim against the NHS - the payouts will be increased.
John Thomas, UK

The nurses do need a large pay rise but it shouldn't come out of this funding. This extra money will now just disappear with hardly anything going into the primary health care. Naturally, government spin will make sure it is not reported this way.
Simon, UK

Open a children's hospital in London, because once it's open it will receive loads of corporate funding and charity and it will end up being sell funded.
Jacqui, Australia

In order to attract more doctors and nurses we need to pay them proper, satisfying wages

Michael Peel, Netherlands

There is an old expression: "Pay peanuts get monkeys." Not to suggest that any health professionals are monkeys but, clearly, in order to attract more doctors and nurses we need to pay proper, satisfying wages to those who are going to spend years in training and who undergo all the many rigours of being a health professional. To do or think otherwise is both patently stupid and deeply offensive.
Michael Peel, Netherlands

Hospital beds.
Bryan, UK

I would like to see more money spent of giving pay rises to the nurses that provide direct patient care. I am an E grade nurse on a very busy paediatric ward. A snapshot of my day: management of up to 34 children and their parents; management of the nursing team, administrator, provider of nursing care, counsellor to children and parents, diplomat (i.e. conflict resolution), advisor on a wide range of health matters, pharmacist (nurses are also responsible for administration of the correct drug and correct dose of the drug, which means we have to double check any medicine prescribed by a doctor), dinner lady (we have no health care assistants on our ward to dish out dinners and bring to the children), domestic (some of the cleaning responsibilities falls on nurses, children's entertainer, machine (because I often go for a whole shift without a break due to staff shortages).. I could go on and on, and all for some measly pay packet at the month. Who in their right mind would do this job?
Esther, UK

More important is what the money should not be spent on - that is producing league tables and endless statistics for ever-changing government's latest thoughts. We must realise that it will take years - (not a single parliament) announcements of money will not have an immediate effect. We need more beds, more staff (lots of pressures are due to the demand on beds) and to spend on the latest therapies. The most expensive and valuable commodity in the NHS? - as with all organisations the staff, pay increases / improved conditions are needed to recruit & retain the best.
Mike, England

I find it slightly amazing that as soon as more money is provided, we have to start asking where to spend it. Why wasn't this thought out before taxes were raised? It's insane to raise taxes and then find out that you don't have plans already prepared for the use of the money. It proves beyond a shadow of doubt that this Government is simply throwing taxpayer money at a problem it hasn't even bothered to analyse.
Jon Livesey, USA

A better paid nurse will be a happier nurse

Steven Hill, USA

A better paid nurse will be a happier nurse. Them being happier at work will show. We, the users of hospitals, will reap benefits from having a happier nursing staff.
Steven Hill, USA / UK

I read Alan Milburn's ideas about NHS devolution in The Times, which sound excellent. However I have zero confidence that any will be implemented within the rest of this parliament. In my view the NHS will never deliver without devolution and 100% locally elected management accountable to the local community.
Tony, UK

Ironic, isn't it? We give ?40 billion of our money to a group of people who have proved that they are world class in wasting resources and we then have polls to suggest new ways they can waste even more. It's simple really - NHS - National (it's belongs to the nation) Health (the money should be spent on people's health) Service (try providing one for a change)
Dennis, Lancashire, UK

Not one extra penny should be spent on administrative things, like office furniture, travel, bureaucrats and the like.
Les Jacobs, England

For heaven's sake, do not spend it unnecessarily on management consultants, accountants and lawyers. Spend it on infrastructure and medical facilities, more nurses and doctors from third world countries .They are dedicated and provide value for money.
Vijay K Vijayaratnam, United Kingdom

I note with interest the calls for greater health awareness and particularly that people should be encouraged to stop smoking. Sorry to disappoint you all, but if revenue from tobacco duty dried up, we'd have a lot more than a penny on National Insurance contributions to contend with. Smokers cost the NHS a fraction of what they contribute to the Treasury.
Dan, UK

Nurses have done extremely well under Labour, whether its pay or working conditions

R. Langton, Britain

Nurses have done extremely well under Labour, whether its pay or working conditions. Yet all the government get in return is criticism and veiled threats of industrial action. Whether Unison likes it or not, this government was democratically elected with a mandate of PFI and more private involvement where necessary. It should be allowed to get on with improving the NHS with the full support of all parties within it. As Tony Blair said if it fails he must carry the can. Everybody, public or private, would like more pay, but as a taxpayer I would warn Nurses the government has not got a bottomless pit.
R. Langton, Britain

Now I know why all the nurses' eyes lit up when the budget was announced. They saw more cash for themselves. I was under the impression it was for better health care. More fool me.
MAUREEN, UK

I think I would first look into why the NHS underspent its budget by ?700m last year.
Tom, UK

I think most non-NHS professionals acknowledge, is that this is not extra money. The NHS has not been appropriately funded to provide services expected by the public, yet has struggled to provide them, incurring huge overspends and regular vacancy freezes and training bans to try and recoup some of the cost. A GP made it clear to me that the NHS can no longer say that it has overspent by this much, rather, that it is under funded to provide services by that amount.
Helen, UK

Government initiatives to persuade people to look after their own health before having to see a GP would help. A wide range of public information films regarding healthy eating, exercise etc. on TV will spread the message as widely and quickly as possible. There should also be initiatives to prevent GPs and A&E services time being wasted. I used to work in a hospital and there were literally hundreds of occasions where "patients" would demand an emergency ambulance and A&E treatment for such "ailments" as a headache or a splinter. More funding, generally, for A&E and emergency ambulances (the only emergency service not to have its own direct funding) wouldn't go amiss either.
John G, London, UK

An amount should be set aside for cleaning

Kathy Sadler, UK

An amount should be set aside for cleaning. All the operating theatres in the world won't help the queues if the wards are so dirty. And the wards I have seen recently are filthy!
Kathy Sadler, UK

We have to pay nurses and doctors more. Junior doctors work 60+ hours, nurses just as much. How can we expect numbers to increase when we don't pay for it? The job is extremely stressful, working with people who attack them. If you want x thousand more doctor and nurses, pay for them!
Vish, UK

Casualty should be number one - the faster and better people are treated the less likely they are to need expensive, lengthy, follow up treatment. Long term free care for the elderly is a noble but unaffordable goal (and no, Scotland can't afford it in the long run). Second should be the treatment of front line carers - nurses and GP's - how will Tony Blair get all the promised nurses if the ones that are there now wouldn't recommend it as a career?
Chris, UK

Sack the managers who do nothing but write reports, and employ more doctors and nurses. The money should go to medical staff and equipment, and not to business management graduates.
Robert Fawkes Jenkins, UK

I don't know how the money should be spent. Nor do politicians

Simon, UK

I'm not a health care professional. I don't know how the money should be spent. Nor do politicians. It's time they allowed spending priorities to be determined by those who do know what they're talking about i.e. the health care professionals, and kept out of it. They should have no more say in how the NHS spends its money than any other member of the public.
Simon, UK

Some of it should be invested into our old uniforms. Mine is in its 3rd year and is rather worn.
Samantha Rolfe, Shenfield, Essex

Ben Drake is correct. I dated a nurse from Yorkshire who made just about 19,000 pounds a year, working overtime nearly every week. He could get called in last minute to cover for someone who failed to show up, and he was given no sense of career direction or merit increase. The best people, he told me, were fortunate enough to go into private nursing. The result? The British tax-payer gets treated by those who are overworked, underpaid and underappreciated. Millions of Americans go without any health care at all; please appreciate what you have!
Jennifer Ethington, USA

Of course nurses deserve a pay rise. They've been underpaid for years and we all know it. How can we recruit the extra nurses needed unless they get a decent deal on pay and conditions?
Ben Drake, York, UK

As well as putting in extra cash the NHS is going to have to have a very long hard look at the services that it offers. For example should IVF be allowed on the NHS? This is not a life threatening operation & therefore should not be allowed. This view will not be popular but the NHS is going to have to be realistic.
Jason, Manchester, England

If all this extra tax does go on pay rises, Labour won't see another term!

James , UK

These things really get under my skin, now I wouldn't say I am on the breadline. However I am not rolling in it either. It disgusts me that people working in sectors that serve the public, trains, health etc feel that they can hold everyone to ransom whenever they feel like it just to get more money. If it transpires that all this extra tax does go on pay rises, Labour won't see another term!
James , UK

The money should go on free nicotine patches for smokers, free gym membership for those who don't pay or can't afford to pay health clubs' extortionate fees, free ongoing training for car drivers and teaching (not lecturing) kids about using alcohol wisely. Some people will say my ideas are barmy but smoking, obesity, car accidents and alcohol abuse cost the NHS millions each year. Prevention is surely better than cure and it could be money well spent.
Deb, Manchester, E

S.Dynan is absolutely right. We have abandoned rigorous thought and debate and luxuriate in precious touchy-feely nonsense, ignoring the harsh realities of life. We need to focus on keeping well and using our abilities to progress individually and collectively. The obsession with illness (which is what the NHS is about) is a destructive neurosis.
Michael S, UK

Surely the most important priority is the prevention of illness. The NHS is burdened with cases that are largely preventable and yet politicians rarely mention the role of the individual in their own health. The NHS should be a safety net for a small percentage of people who fall ill through no fault of their own. Instead it has become 'the health of the nation' - the more we spend on it, the healthier we will all be! This misguided idea is popular with politicians because so many people really do believe it. Britain is a world leader when it comes to the rates of heart disease, obesity, diabetes, certain cancers, and alcohol-related illness. Will extra spending on the NHS change this? The chancellor seems to treat health as a purely financial problem. How much money is needed - how can we raise it? This is fine to address the short-term problems in the NHS, but the real long-term issue is in giving people responsibility for their own health and in providing an environment that supports and encourages it.
S. Dynan, UK