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Tuesday, 29 May, 2001, 11:00 GMT 12:00 UK
Can all NHS patients be treated equally?
The NHS has been plagued by the need to provide across the board services ever since its inception over 50 years ago.
Labour have pledged £450 million for cancer treatment and an extra 400,000 hip, knee, hernia and cataract operations by 2005.
The Liberal Democrats are committed to improving existing National Service Frameworks on neurological illnesses, prosthetic limbs, hepatitis C and HIV and Aids.
The Conservatives meanwhile have promised to match Labour's spending plans by establishing an "Exceptional Medicines Fund", a trust with money determined by the Health Secretary, to pay for new or expensive treatments.
Do you feel that hospital treatment has improved under the Labour government? Are separate illnesses treated differently under the NHS?
Labour's initiative to reduce hospital waiting lists is cynical manipulation of the figures. In order to be put on a hospital waiting list, patients have to be referred by their GP to attend an outpatient clinic where their need for an operation will be assessed. Only after attending this clinic can patients be put on the official waiting list. Labour has instructed doctors to reduce the number of clinics held thereby reducing the numbers able to get on waiting lists for operations. There is now a separate waiting list to attend the clinic - this is known as the waiting list for the waiting list. No one knows about this because Labour is so effective at media manipulation and doctors are too overworked, and too poorly represented, to communicate the facts
When we had SRN and SEN the NHS was better. One looked after the care and the other the medical needs. Now nurses need a degree. Why can't ministers understand that young people have different types of abilities? Some can pass exams at degree level whilst others can pass exams at Vocational level but both can care for patients. How about returning to the old system and giving young people a chance to use the abilities they have effectively?
The NHS is in a no-win situation. Collectively, we expect too much of our politicians, and sadly the response of the two main parties seems to be to behave like second-hand car salesmen Arthur Daley ilk. We all want a first class service, but equally many of us don't want to pay any more tax. More money is being spent on the NHS but I fear money may not be the answer. Our expectations are considerable for health care, and impossible to fulfil, especially if we, the patients, have poor incentives to look after our health. So the big question is how do we provide better incentives for the population to take better care of itself. Solve this and pressure on the NHS would be much less.
Alan Carruth, Canterbury
Using the private sector will inflate wages and fuel more clinician absenteeism from NHS facilities. By allowing the private sector to 'cherry pick' the routine work, the NHS will be tasked with the more difficult and lengthy cases making NHS waiting lists even more difficult to meet. The clinicians, and not the private sector managers or the politicians should prioritise who is clinically the most in need. Privately insured patients tend to be younger and richer than NHS patients and so it will eventually turn out to be a vote-loser for Labour. It is not an ideological stumbling block to state that all healthcare should be prioritised on the basis of clinical need and not on ability to pay, but on the bedrock of a universally available public healthcare system.
The NHS is not supposed to be a job creation scheme - it is supposed to provide care to ill and injured people. Part of the problem is that many of the NHS employees and their unions from the Consultants down are not just resistant to change but resistant to even discussing it. Even Tony Blair has admitted as much in the past couple of years. I don't think any party has the answers and the fiddling of waiting list statistics isn't the answer either.
Andrew Gale, Birmingham, UK
Most consultant surgeons work at least 60 hours per week for the NHS, but their contract is for 35 hours only. So, they do not get a single penny for 30 hours overtime. Stopping them from doing private practice (in their own time), is going to make many of them leave the NHS or even the UK. Labour will try and hit doctors hard, but the medical profession is fed up with lies and bullying from the government, who want to shift the blame for the NHS's failings on the one group who have kept it going. Expect Labour's popularity to fall in the next term as inexperienced Spanish doctors are shipped in to fill the vacancies.
The NHS is far too complex and important for a single political party to be able to manage alone. It is sheer arrogance on their parts to think they ever could. The Conservatives ran the NHS into the ground and I think they will again given the chance. Labour, on the other hand, make out that they are improving the NHS but who can say if they really are? I'm sure the Liberal Democrats will be equally at a loss if the tiger's tail is ever passed to them.
A whole new system for governing the NHS needs to be established in my opinion, to stop it from being the political football it's always been.
PFI (Private Finance Initiative) locks us in to paying for hospital services which may, during the duration of a PFI contract, become obsolete (as TB sanatoria did). It fragments hospital teams by introducing non-NHS profit orientated employers. It costs much more than if funded using traditional government methods. Edinburgh Royal Infirmary being just one example. It reduces patient resources as shareholder profit takes precedence over all other issues.
This matter unites consultants, other doctors and unions in their opposition. Why is it being expanded in the face of both concern from health professionals and numerous examples that its introduction is a structurally damaging operation which appears only to pave the way for full privatisation.
Labour's NHS plan is appalling just like everything about the party. If Labour think that they can fool people into thinking that waiting lists are down then they are insane. The real picture is that you have to wait twice as long to get an appointment in the first place!! But as usual the short sighted people of this country are fed inaccurate statistics by the Labour supporting BBC and have not got the brain power to work it out for themselves. Putting a few 'Walk in' centres on a few street corners is not helping anyone apart from un-educated girls who get pregnant and need the morning after pill!
Darren Ward, Peterborough
5 years ago I had a lump in my breast and after 5 weeks and still no sign of a hospital appointment I opted to go private. I never did get an appointment . This year I had a similar problem and was seen at a one-stop breast clinic within 2 weeks of seeing my GP, had all the tests etc.
To me that's an improvement in the NHS.
I understand that most NHS employees will probably vote for Labour. Is any further comment necessary ?
In 1992 I had a Hernia operation, from seeing my GP to having the operation took 3 months. 3 months ago I saw my GP about one on the other side, but I have not even been seen by anyone yet!
Surely this proves that things are not any better?
We have just contacted our local GP to try to make an appointment for our son to see the GP about a long-standing condition. The school is closed on Friday for a teacher-training day so we tried to make the appointment for that day. However, the receptionist could not make the one because there is a government rule preventing appointments being made more than 2 days in advance!
No wonder businesses and other organisations are complaining about bureaucracy under this government.
I think people are wrong to expect the Labour government to repair 18 years of neglect and cuts under the Conservatives. I remember visiting my father in hospital in '96 and having to walk past numerous closed wards to find him. It reminds me of the South African black voters who when Nelson Mandela won power thought they were all going to get new houses and cars overnight. The NHS staff are doing a wonderful job and need all the support they can get but of course it's going to take time.
Andy Law, Warrington
The NHS will not improve until we make sure the consultants work for it alone. They have a vested interest in having long waiting lists - this drives patients to seek private treatment, lining the pockets of the consultants. Unfortunately a large number of consultants have always been opposed to the NHS and would be delighted to see it replaced by private medicine. Aneurin Bevan had to "stuff their mouths with gold" in order to get them to work for the NHS when he set it up.
Having worked and studied within the NHS I am staggered by the level of ignorance displayed by some people writing here. Too many are saying: "The NHS will never improve because the organisation itself is at fault". Look how much of the health care budget in the USA is spent on admin. Its about 25 per cent, compared to here were it is 3-4 per cent.
I think the NHS, in common with other public services in this country has suffered from long years of under-investment. Unfortunately we have realised too late that our infrastructure is terminally ill. The Labour party is facing a gargantuan task - they have made a difference but it is only the tip of the iceberg. As uncomfortable as it is to admit, my family's experience is that money talks. At least now the Government is encouraging everyone to think about their education and emphasising the need to be self-reliant wherever possible (witness the new stakeholder pensions) perhaps we can reduce the current levels of burden placed on the NHS and other state institutions that we have traditionally assumed would always be there, gratis, to prop us up. Time to do what we can for ourselves, I think!
We are an overpopulated country with scarce resources and an aging population. The NHS was never intended to be used in this way. A radical rethink needs to be done. What do we as a population want the NHS to be? How much money are we prepared to spend on it? Are we allowed to opt out and pay less NI in order to fund private Healthcare if we wish to?
It's not just cancer patients that are having a raw deal. It's everyone who has the misfortune to be channelled via an emergency department! How many of our MPs who make rash statements about the health service actually use the NHS? If you are elected as an MP - and certainly the Prime Minister - it should be compulsory to use the services they claim to know so much about!
Avirl, Exeter, Devon
The cheapest and most efficient way to run the NHS is not to have one.
My family has recently had two brushes with cancer. In both cases the NHS has been astonishingly fast in dealing with them. I thought the wait would be much longer. All I can comment on is my own experience, I believe the system is working.
As someone who regularly uses the NHS, all I can say is that the provision for my treatment has improved. I am not saying it is brilliant, or that it works 100% right all the time (a two hour wait in the pharmacy for example) but it's a hell of a lot better than before.
Jason, Manchester, UK
As an outsider looking in, the comments mirror almost exactly the discussion, which is taking place in this country.
That is, growing waiting lists, insufficient trained medical specialists, insufficient nursing staff, lack of resources and in general a lack of political will to address the wider question.
In short, no. Labour have showed how useless they really are not only on health, but on every other single issue.
As someone who has worked in the NHS, I have nothing but respect for those continuing to do battle with low funding and negative press. I do personally think the private sector is greatly responsible for this, for although it brings in money, it also takes skilled people away from vital NHS work.
If the Liberal Democrats are serious about achieving that which they have set out in their manifesto then I would gladly pay a penny in the pound more on income tax.
James of London mentions that Tony Blair had a run-in with an ordinary voter yesterday. The lady in question was interviewed on Radio 4 after the event and admitted that not only did she not vote in 1997, she had no plans to vote this time either. So she is an ordinary non-voter, and really has no right to demand satisfaction from an elected representative.
Alan Saunders, Staines, Middlesex
The lady who confronted Mr Blair is entitled to her view but she was unfair. The consultant at the hospital expressed surprise and strongly felt her husband was receiving good care and that her comments were hurtful. Perhaps if the lady had given the prime minister a chance to explain then she might have changed her views.
The hospital in Birmingham who were treating this lady's partner have been quite upset by her comments and have no hesitation in defending that her partner's care. Regarding the state of the hospital, it is due to move into a brand new building shortly, none of which will ever reach the front page. Don't let an extra few pounds in your pocket from Mr Hague change that, or you will get what you pay for and that won't be very much.
Tony Blair is all talk. It's about time he got his priorities right, and stopped wasting taxpayers money. I was pleased that the woman gave him a good dressing down about the cancer care. He would sooner spend money on the Millennium Dome than look after the health of the people. Come on Mr Blair, don't talk - do some thing.
Mrs Burton, Leicestershire UK
It is not very profound when a chain-smoker, knowing the underlying future effects of smoking, blames the government for slow in treating smoking related cancer. The government had time and again raised taxes on cigarettes, year on year, the number of smokers seems to grow.
I am a Tory voter, I believe the NHS is no better or worse under Labour as it was under the Tory government, the difference is Labour are now in government. They are clearly spending a huge amount of money but there seems to be little improvement, so where is the money going?
Of course, the NHS was just peachy under Thatcher, wasn't it?
After beating skin cancer four years ago recently I began to exhibit worrying symptoms of a recurrence. Concerned I tried to make an immediate appointment to see a doctor at the specialist unit in London. The operator I spoke to told me the first appointment he could offer me was on August 28, 200. I pointed out that I had a history of cancer and that if this was indeed a recurrence then I was likely to be dead or terminally ill by then. In desperation I contacted hospitals in Switzerland and Germany. In both countries I was given immediate appointments and chose one in Switzerland. People who say we should be grateful for what we get here have obviously never been in a situation where they were at the mercy of a service and politicians that could not care less.
Jan Julicher, Maidenhead, UK
Sharon Storer obviously had a point to make but typically when offered a private meeting with the PM she refused. Some people seem to think they can abuse politicians with impunity.
My Girlfriend is a nurse in an NHS hospital. The understaffing in all areas makes her work dangerous. This is putting staff under immense pressure.
Speaking as someone who works in the NHS I'm sick of hearing people moaning about it. They always seem to be the same people who happily pocketed Tory Tax Cuts throughout the 80's and 90's while the NHS got 20 years of chronic under-investment. These people are getting exactly what they did(not)pay for!
Phil Tidy, Lancaster, UK
Blair's enthusiasm for public-private partnerships in medical treatment is insane. By paying profits to stockholders in the private companies, it will raise the cost of providing care. Salaries are higher in the private sector, so doctors and nurses will be lured away from the NHS. Also, can you imagine the bureaucracy involved in sorting out bills from the private companies to the NHS? I can - I have experienced both the US private/public system and the NHS and I prefer the NHS. Why not simply invest more in the NHS?
I think Labour have done an excellent job in improving the NHS over the last four years. Of course these situations not going to be remedied overnight.
Having private insurance through work, I have used consultants for some minors issues without waiting. That's my good fortune but as a high rate taxpayer, I am also fully committed to an NHS that is free at the point of delivery because that is the mark of a civilised society. I am in favour of 45 per cent higher tax band to fund improvements in our nation's health and education systems.
The NHS has improved under Labour, but there is still along way to go. I am confident that it will continue to improve if Labour serves a second term. They simply could not increase spending on it, as soon as they came to power, because they had to sort out the massive deficit they had inherited from the Tories. Would the Conservatives really be any better at sorting the health service out?
I know quite a lot of NHS staff - they are seeing increased investment and salaries for the first time in 25 years. They have hope for the first time in years. This country is so cynical. People expect that Blair would be able to somehow wave a magic wand and everything would be OK. This government is very serious about the NHS and is slowly gaining the respect of the NHS staff. Keep at it and don't let the doomsayers get you down!
The problem with people in this country is they want an efficient health service yet they don't want to pay for it. We now live in a society with an ageing population. That irate woman outside the hospital had a point, but she was rude and abrasive to a man who does not have the power of God. Doesn't she realise what a mess the NHS was in four years ago? If people can give the Tories 18 years to get it right then they can give Labour four more and quit whining.
Jason Kewley, Camberley, Surrey
I am a British Nurse working over in the USA. I have been shocked by the insurance-led system here, that almost always puts profit before patient care.
The NHS is far from perfect but it provides healthcare that would otherwise be unaffordable to the majority, and overall the general quality and availability of healthcare is far superior in Britain. Encourage the NHS to grow and continue its unappreciated work.
Amazingly British people pay £55 per month per towards the NHS and expect the same level of service as the Germans who pay £600 per month including insurance.
Most people are probably basing their opinions on what they have seen on the television, but we should be wary of this. In my opinion Labour have done as much for the NHS as they have for the railways. I agree with the comment about spending too much on spin. If the ecomony is making so much money and is healthy, why are Labour not spending it on those promises they made in 1997? A healthy economy should lead to healthy people...
My father was on a 12 month waiting list for a heart by-pass operation. There are many more waiting for this operation. Imagine the stress and anguish that they and their families go through hoping they will live long enough to receive the life saving operation. "24 hours to save the NHS" - Tony Blair should be thoroughly ashamed of himself. They raised billions from the sale of mobile phone licences. Why couldn't they have spent some of it on reducing waiting lists instead of manipulating the figures? Please, please someone do something about the NHS.
Glen, Stockton, England
More people are living longer, a smaller percentage of an ever-aging population are expected to fund more and more expenditure. It's not the fault of either government - things are not the same as in the golden years of the NHS. Of course the costs are spiralling. Of course lists get longer. The money has to be moved from somewhere - or do we all want to pay 90% tax? Labour or Tory - both struggle. But under Labour, we'll be forced to wait. They want everyone to use the NHS and for private healthcare to be abolished. Under the Tories, we can choose - pay for the NHS and private health care, and use either. There is room for both NHS and private. I pay for both - I haven't opted out. So stop telling me I have to go NHS. I've paid for you to go NHS, why can't I pay for me to go private?
I think the NHS is a sham and in desperate need of reform. I have lived in France and visit Germany regularly. We could learn a lot from the systems in Europe. For instance, a patient visits their GP and is seen at precisely the time of their appointment. There isn't a waiting room, because it is not required. A fee of around £10 is charged and is then repaid into the patient's bank account, commensurate with earnings. Consultants can be seen within a week. I have been waiting eight months! How about following the European example. The NHS doesn't work, never has worked, and never will work. CHANGE IT!!
Craig Nowell, Bristol, England
Britain still rates higher than a lot of other developed countries in health care provision. The World Health Organisation issued a report last year on the status of health systems for developed countries. Britain was 18th overall, with Germany 25th and the USA 38th. Yet still you all complain. If you Brits took two minutes to look beyond your own borders, then you might realise that your problems aren't as bad as you think.
The NHS under the Tories would not be any better if they had regained power. There are huge problems and even though this government has invested a lot, the real investment needed is beyond what people are willing to pay for. This government at least has tried to increase recruitment and increase wages. There are still a lot of good things going on in the service, it is not all bad, and at times we tend to only look at the negative and not the positive. Morale is not just about money but recognition of what we do, what we try to achieve. Let's be realistic in our assessment and expectations.
The NHS is run in an antiquated and inefficient way. We have the classic public sector bureaucracy and waste, complete with arrogant attitudes to patients (customers). Labour has definitely not improved the NHS. Their socialist origins won't allow them too. Spending massive amounts would not improve anything. Pumping more money in, as we did to ailing nationalised industries will only make matters worse. The Tories can make radical changes that we all need. I cannot afford the luxury of voting Labour. It is ordinary people who pay for government waste.
The NHS is a victim of its own success. If you have ever stayed in a hospital then you will know just how little the government care about patients. Not a lot. Labour have had four years to make changes but they say it will take longer. How much longer Mr Blair, another four years?
Why don't we congratulate the NHS? Yes it could do better but couldn't we all?
The NHS has definitely improved and the long term
ideas - electronic patient records, direct booking
etc are really good. As an NHS worker I also
see morale is much higher under Labour.
There will always be room to improve. Does anyone seriously believe the Tory solutions would be better? At the end of their period in office, how many extra doctors, nurses, hospitals etc. were being trained, built or re-recruited in comparison to Labour's efforts?
People need to understand that morale within the NHS is at a very low ebb. This is due to years of under-funding, but also many structural inefficiencies. I, like many doctors, am disillusioned with a service which I feel doesn't give the British public what it deserves. My cure is to create a private healthcare system taken out of political control, much like the US with certain safeguards. Only then will the real service improvements be seen.
John Smith, Surrey, UK
All parties are basically arranging deckchairs on the Titanic.
My eight-year-old daughter has been waiting for an appointment to see an ear, nose and throat doctor since September 2000. It finally arrived earlier this year, but was cancelled about a month before it was due.
They stated that they were changing the system, and the new appointment would be on or before the original appointment.
Does this not add to, or constitute, the manipulation of figures by the con artists the government to spin disinformation to the unsuspecting electorate, i.e. me?
I am shocked at some of the ignorance expressed. No government can "sort out" the NHS in four years. Consider this - it takes four years to train a nurse and eight years to properly train a doctor. The Labour government will need at least two terms to make significant improvements to the service. At that point we can quite rightly ask them to show us these improvements. The real question we should be asking is this - after 18 years of Conservative rule where are the doctors and nurses?
Yes, the NHS is better funded and with good ideas, thanks to the Government but now the NHS management needs to deliver, especially in improving the attitudes of its employees and the atmosphere they generate.
The NHS is in a complete mess. The problem is that this government doesn't understand the current NHS, nor does it have a vision for how to improve it within the existing budget. At least the Tories were prepared to take difficult and innovative decisions. Labour shies away from the real problems and looks to spin the truth.
Karl Hamer, Leicester, UK
Fewer beds, higher occupancy rates, higher patient expectations! Our pay does not reflect the demands made upon us, or the time we spend constantly updating our knowledge and skills to cope with the rapid pace of change.
GPs are threatening to resign. Consultants are to take industrial action. "The NHS is safe under Labour"? What do you think highly trained expert consultant surgeons will do if they are made to choose between the NHS and private practices? The government gets their services at a fraction of the going rate, and should realise that waiting lists are created by lack of beds, nurses and theatres. Consultants already work 65 hours per week, but get paid for only 35.
As a nurse for 13 years I find some of these comments risible. The Conservatives attempted to run the NHS as a plc, and only massively increased management numbers and poor staff morale. As for the private sector, they should be forced to pay for the training costs of all their staff, which was paid by the NHS.
Jonathan, Wickford, UK
I was waiting to see a consultant for six months after tests, and then a further five months after physio. I've been told I may have to wait a further 12 months for an operation.
All NHS staff suffer under Labour and the Tories, but nurses and doctors get a better deal than most of the other staff as they have a higher profile in the public eye.
The NHS has definitely improved under Labour - waiting times are falling for both inpatients and day cases. However, consultants should either work for the NHS or the private sector, very few employers would allow their staff to work for an organisation with similar interests. The consultants want long waiting times because it feeds their private practice - this should be stopped.
The NHS is, in effect, dying. It simply can't and won't be able to cope. I have never understood the horror over the idea of privatising both much of the infrastructure. The NHS was always designed to provide healthcare, free at the point of delivery, until death. If it continues to do this what do we care if the hospital is owned by a private firm or the nurse employee by private employers. As long as I get the health care I require having paid my NI then so what?
Three broken promises:
I don't live in the UK now, but last year when we were there my son was having stomach pains, I took him to our old GP there who immediately phoned the hospital to tell them he had an expected appendix, when we arrived at the hospitals emergency we only had to wait 10 mins before he was seen by a doctor. Our treatment and tests were done immediately and they were all very helpful. We were covered on insurance but because my son was born in the UK we didn't have to pay a cent which I did find a bit puzzling. Here in Canada we are having problems with health care, long waiting list, people waiting 6 months to see specialists, 6 months for MRI and also I have two friends that were misdiagnosed one now has advance cancer, which she started seeing doctors a year ago last January and nobody diagnosed it in fact one doctor told her she was imagining it all. Another has been in and out of hospital since Christmas and they may have now found out what is wrong with her. People are living longer so there are more people depending on the service.
Angela Lewis, Calgary, Canada
The NHS was a complete shambles from the very start when we were told it would take a few years to bed down. Then we were told it was the envy of the world, whereas it terrifies them. Finally the Tories put a larger proportion of national income into the NHS than labour has done over the past four years. To those naive souls who think it will get better I say: dream on!
No, it's hopeless. The government keeps making undeliverable promises: an extra 7000 doctors first, and now another 10,000 doctors - where from? The NHS is full of consultant vacancies and there is a terrible nurse shortage. It's all pie in the sky.
In my opinion the NHS has got worse over the last four years both for patients and staff and no amount of money in the world is going to cure it. This is the fundamental problem with the concept of free health care for all. To my mind it is quite simple, those who can afford private health insurance or non-essential operations should pay. It is immoral for people to use valuable resources when they don't have to, thus depriving people who cannot pay for themselves. To all those who say they would pay more tax to fund the NHS I say put your money where your mouth is and pay for your own health care as much as possible, don't be a burden on the NHS.
From the point of view of someone who has experience of several European and both North American health services, my comment is that the British should stop deluding themselves that they have the best health service in the world. They may well have the cheapest and they get what they pay for. A third rate service raised to the level of second rate by the hard work and dedication of a large number, but by no means all, of the nurses, doctors and other staff.
The NHS is a massive organisation run by hundreds of thousands of human beings. So, my own experience may not count for much. But, on the few occasions in the last few years when I've either used the service personally or known a relative who needed treatment, it has been delivered quickly, courteously and with incredibly high levels of genuine service. On the Tory test set by Liam Fox - judge by your own experience - I'll be voting for Labour or the Lib Dems.
I was waiting to see a Consultant for six months after tests. Then awaiting a further five months to see Consultant after Physio. Been told the a possible further 12 months for an operation. before
We, the tax payers, pay nurses to train. During their training period they get a small salary. Compare this to medical students, who have to fund themselves for five years through loans, etc. Once qualified, both have qualifications that enable them to get a decent job in the public or private sectors. Yet we're considering forcing doctors to work for the NHS for a fixed period to 'repay' their training debt to the country. We should do the same for nurses. Once both have come to the end of this period they should feel free to move into the private sector or do something else.
Last autumn I had the experience of watching my aunt die of terminal cancer in an NHS hospital. I cannot fault the service she was given, the compassion and care with which she was treated were unsurpassable. It frustrates me tremendously that people seem to constantly devalue the very existence of the NHS. I will be the first to admit that there are still huge problems, but under Labour, more money has gone into the NHS, and small improvements are being seen.
Nadine Manji, London, UK
Ministers know very well that better health care seen in the USA and other European countries can be provided here as well but they dare not increase the taxes to pay for the high quality care. The patients are the electorate who do not like to pay higher taxes, and can vote the government out of office at the next general election.
The politicians refuse to tell the truth to our patients, i.e. the voters, but instead keep tightening the screw on the doctors who are expected to provide much more for much less. Therefore our NHS will never ever be as good as the health care seen in other countries.
You can throw all the money you like at the health service, but if you don't have dedicated bosses it will fail. It should be run like a private company. There are too many lazy and incompetent admin staff who know that because of the poor disciplinary procedures and performance reviews they have a very cosy job. In the private sector you've got to be on you toes all the time.
Robert Eastwood, Halifax, UK
My daughter has just had to wait for two years to see a specialist orthodontist and now she has been told that she is on the waiting list for treatment, which is at least 18 months long. But because by then she will be over 16 she won't be treated in the same hospital, so she now has to go and see another specialist after her 16th birthday, but we haven't been given a date yet 'because she is still under 16'.
This is bureaucracy gone mad.
At our local hospital a first time mother was told to leave with her baby after giving birth only six hours before. Her partner had a stand-up argument with hospital officials before they would relent and keep mother and baby in hospital for overnight observation. NHS now stands for Nominal Health Service.
Malcolm M, Scotland
I have worked for the NHS for 30 years. The managers are only providing crisis management, and there is lack of long-term planning based on good quality patient care. Too much paper and too little substance.
The NHS has certainly improved over the last four years. The investment is evident. What hasn't improved is the staff's attitude. They take the view that patients are there for the convenience of staff, not the other way around
Denise Cooper, Stanford le hope, Essex, UK
I think it is quite clear that the healthcare is Britain no longer up to the average in the rest of Western Europe. While there may be some issues about better organisation and less wastage, the fundamental point is that we are not spending enough money on healthcare.
I am deeply concerned at the current government's poor understanding of the issues. They seem to think that it is OK to throw money at the problem, and wrongly assume that simply recruiting more nurses and doctors will solve everything. What they fail to grasp is the fact that due to the initiatives they started more and more staff are walking out of the NHS.
No one I work with would have an operation on the NHS as we all have private cover. Why wait nine months to have an operation, when the same surgeon can book you in a week tomorrow? Of course Tony Blair would never dare chance his children's lives with the NHS, just like he wouldn't allow them to be educated in a state school.
Karen, Tony Blair does send his children to a state school. His wife went to a NHS hospital for child-birth. Before criticising him, get your facts right.
Selvy, London UK
Labour have confused the issue by having waiting lists for the waiting lists. Of course, this means that there are fewer people on the waiting list but more people are waiting than ever.
My baby son was recently at Great Ormond Street for vital surgery. But the surgeon admitted that he wouldn't be able to do the surgery for months. As a last resort we were forced to go private to alleviate his appalling suffering.
The NHS is the same as it ever was, and Labour is lying to cover up their non-achievement.
Money is not the answer to the health service, better organisation and adequate resources are. Labour's only answer to the problem, as with everything, is always the same, and it doesn't work. At least the Tories are looking at the private sector for help and I'd personally like to opt out if possible.
No one promised that all the NHS problems would be solved overnight. The Tories spent 18 years pulling the health service to pieces. It's going to take much longer than four years to get back on track.
The NHS has got far worse under Labour. My retired (and previously fit) parents have been waiting a very long time for treatment. My father has prostate cancer, and is having to wait a very long time to see how far is has spread, and my mother has had to wait nearly 18 months for a kidney operation.
I am no devout Labour supporter, however the naivety of the general public who rate the Labour performance as 'very poor' or 'a disgusting waste of money' forget how many years the service has been run down.
Frankly, the only people in a position to genuinely know are those actually working in the NHS. I do, and along with the majority of my colleagues I am certain things have improved. Unfortunately you can't reverse 18 years of penny-pinching bureaucracy and damn fool "market-tested" initiatives overnight. God help the NHS if the Tories ever get back in again, because it will become a "sink" service for those too poor for private care.
Phil Tidy, Lancaster
At last. A sensible comment from someone who should know. I for one can't believe that anyone thinks the Tories would be better for the NHS than Labour. Can you get treatment for amnesia on the NHS?
The NHS is getting worse under Labour, but the key point is that it is deteriorating at an ever-decreasing rate. If Labour are returned they will probably reach a stage of improvement. Senior NHS staff I know have hope for the future of the NHS for the first time in a decade.
Labour inherited a dispirited NHS in a state of collapse after Tory tinkering using the "Free Market" approach, sadly Labour played safe and left things as they were. Will someone ever admit that we are not "customers" but patients?
The NHS is like one of those giant oil tankers which take ages to turn around. The real problem with the NHS lies in the fact that as a nation we have historically undermined the initial principles upon which it was founded and allowed this to be dissipated since its inception. When those with extra money 'queue jump' and indeed are still encouraged to do so, is it any wonder that for most of us it becomes a second-class service?
Alex Birchley, Birmingham
I could go on at length, but one question to all those who persist in treating the NHS as a sacred cow: if it is so wonderful, why does no other country in Western Europe have such a system?
I speak as a GP at the sharp end. I see no evidence at all of improvement in the service. Artificially massaged waiting list figures, triple-accounting to claim huge cash injections, cynical manipulation of numbers of nurses and doctors to make it look as if there are far more people than there actually are - these are the norms of the last few years.
Its not disputed that more money is going into the NHS, How wisely its being spent of course is a different matter. I liked the earlier suggestion that an independent NHS body should exist to oversee spending.
My Father has been receiving cancer treatment the last 18 months and I would say things have improved in that time.
The NHS is a disgrace. The system does not work from either a health or economic perspective. The quicker we become part of Europe and get a service to match that in France or Germany the better off we will all be, or maybe we could appoint the French minister of health to run our pathetic system.
Paul Clarke, Bedford UK
I have much experience of hospitals, some whilst the Tories where in power, and all I can say is yes there is still much to do, but compared to the Tories' time things are a lot better.
My wife works in the NHS. She and her colleagues are so "on the edge" that they are considering leaving the service. Some are exhausted by the constant demand for greater productivity. They are continually pressed to deliver more by managers who are at the mercy of politicians, who in turn appear to be driven by headlines. Priorities are driven by the need to meet targets as opposed to the real patient needs.
What sort of magic wand do you expect the government to wave? It takes at least four years to train a doctor, three for a nurse. Those that I've spoken to in the NHS are disappointed that things haven't happened quickly, but you can't change 18 years of one administration's work in four years of another.
Six pence of a litre of fuel wouldn't cover private health insurance for my family.
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