Page last updated at 15:23 GMT, Thursday, 3 September 2009 16:23 UK

Painful cuts or necessary remedy?

Doctors performing in surgery

The government says it's dismissed advice to cut the NHS workforce in England by 10% over the next five years.

The plans to close 137,000 clinical and admin posts were proposed by McKinsey and Company to save £20bn by 2014. But the Department of Health said many services needed more staff, not fewer.

People who have worked on the frontline of the NHS or the medical profession have written to the BBC to tell of their experiences. Below is a selection of some of the e-mails we've received.

YOUR COMMENTS

e-mail sent in by reader

Nurses are currently working at low levels and are becoming more and more stressed. This in turn causes huge amounts of sickness.

I believe that the government should be looking at improving the lives of our staff who are desperate to deliver quality patient care and stop spending money on consultancy firms who are putting our patients at risk with the outrageous suggestions
Anonymous, Stevenage Hertfordshire

e-mail sent in by reader

As an interim project manager who goes into NHS organisations to manage projects aimed at increasing efficiency/productivity it is quite clear that the McKinsey report was mostly a waste of money.

Cutting clinical jobs is just a method of rationing, which would cause waiting lists to increase, and patients would suffer and sometimes die while waiting.

The only solution is for bottom up clinically driven efficiencies.

Doctors and nurses can and do find more efficient ways of working, lengths of stay are decreasing, inpatients become day cases, day cases become outpatients and outpatients get treated in community community settings, each step leads to a reduction in resources required.

What is needed is robust methods to implement and spread these good practises across the nation.

In a static world these efficiencies would lead to job cuts, but with new technological developments and an aging population, it just means staff will be redeployed and more patients will be treated for conditions that were previously incurable or could only be partially treated.
Dave Perton, Coventry

e-mail sent in by reader

I have been working for the NHS for the past three months.

Coming from the private sector there was one thing I noticed which stood out - the distinct levels of over-staffing and low efficiency in the administration and clerical side of the operations. There is also a distinct lack of managerial clout.

Basically the employees rule the roost and the management are too scared of political correctness or employee backlash to do anything about it. It's ridiculous.

I fully agree with the proposals to cut staff and make those left more productive.
Sam, Taunton

e-mail sent in by reader

As a military nurse seconded to the NHS, I spent shift after shift with nurses who sat behind the desk and said nearly everything was not their job. How hard is it for them to empty a bin, take a drug chart to the pharmacy, perform blood sampling and ECGs?

All these jobs are done day-in, day-out by military staff who, on occasion, have to look after more than 36 patients between two trained staff.

It makes me mad that NHS nurses complain they are overworked and underpaid then have the cheek to sit and do virtually nothing all shift.
"A", Surrey

e-mail sent in by reader

I work as an Allied Health Professional Recruitment Consultant providing locum staff.

From speaking with managers and staff alike it is a general consensus that locum staff provide a more efficient service to patients. A lot of the permanent members of staff that have used their sick pay entitlement because they have "swine flu" have wasted time and money.

Locum staff do not call in sick as they wont get paid, they are flexible in regards to length of contracts, hourly wage and a lot of the managers I work with say they could not do without locums and want more but do not have the funds.

A better balance between locum and permanent members of staff would provide a more efficient service and having a larger pool of locums to use means that in busier periods and in serious cases locums can come and go.
Lee, Ipswich

e-mail sent in by reader

There are too many managers running around at the behest of political masters trying to tackle "breeches" of clinically irrelevant targets.

Get rid of the superfluous management posts and remove governmental interference - let clinicians and other professionals actually work as professionals rather than harassed technicians and more efficiency would be possible.

Reinvest the funds from management staff into ward clerks, medical records staff, secretaries, porters and other forgotten workers, as these are the people who really make a hospital work well.

At the moment, these people are demoralised and poorly paid and would have better career prospects stacking shelves in a supermarket. Goodwill needs to be returned to the NHS.
"Hospital doctor", Cardiff

e-mail sent in by reader

I work at an SHA [in the Midlands] and they absolutely waste money hand over fist. I would say that 90% of the staff could be got rid off as they are totally a waste of time and money.

Directors and Assistant Directors on massive salaries do nothing to earn getting paid that amount of money.

These people work from home most of the time. They attend meetings in London travelling by first class rail when they could have a teleconference instead.

They employ temporary administrative staff and pay them twice as much as the permanent staff.

This type of SHA should be closed down with the money saved going into the Hospital Trusts so that REAL people can benefit.
"Karen", Notts

e-mail sent in by reader

As a community practitioner working under enormous constraints, it is infuriating to learn yet again that the NHS is paying management consultants thousands if not millions of pounds to come up with these ridiculous suggestions, which would most certainly compromise patient/client, care even further.

The NHS is in a poor state with ineffective managers and never enough frontline staff to deliver the service that we trained to do!
Anonymous

e-mail sent in by reader

My wife is a surgeon in training, and the cuts are already affecting her training.

Where as she used to work a 56 hour week, she is now restricted to a 48 hour week. You would think this would be good, but many Trust's are not employing additional doctors to cover the gaps.

This means that trainees like my wife, rather than spending time in theatre learning how to become good surgeons, are just spending their time on wards providing basic service provision.

In the short term this will not affect patient care, but in the longer term, the latest crop of trainees will not be as skilled as previous consultants, and that is when patient care will suffer.
Duncan, West Yorkshire

e-mail sent in by reader

I am a nurse and will be leaving my current trust in a few weeks.

I established a service and after running this (alone) for three years had to go through the humiliating process of re-applying for the job, which i didn't get.

If this is the way that the NHS treat their staff then they needn't worry about making job cuts as staff will be leaving in their droves.
Anonymous



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