February 20th was BBC Health Day and PM asked what you thought about the National Health Service.

Your say

We currently have a shortage of doctors and dentists working in the NHS. A large proportion of GPs are within five years of retirement age.

How is the government going to replace retiring doctors and dentists when students are experiencing such debt problems - as witnessed on tonight's PM programme? If students are in hardship on an average degree course, which only lasts three years, how are medical and dental students expected to finance their five year degree courses?

If we want sufficient quality staff for the NHS in the future, we need to scrap tuition fees and reintroduce the student grant.
Linda Dunlop, Wigan

There is no indication of cost of the ten items that the BBC NHS day invited us to vote for. The UK public are emotional about the NHS, and the choice of votes without costings is also irrational.
Geoffrey Harrison PhD, UK

The NHS coverage is disappointing. Once again you all fail to address the basic problem - why were so few doctors trained over the last 20 years?

It takes seven years - so the blame lies squarely on the 18 years of Conservative rule, but you are all apparently terrified of saying this.
Bernard Keeffe, London

Having come back to live in this country, I find the NHS quite frightening, particularly having experienced France and Belgium.

Last year I waited a year for physiotherapy and I have friends and relatives working in the NHS. All say much of the problem is the managers.

Management should be medical staff who no longer wish to practice full time, but who understand what is required. Management get all the perks, not the medical staff, but don't do an adequate job.

There is no point in throwing money at the problem. The NHS must be dismantled and a new service built on continental lines. Patients there have a better deal, know how much their treatment and drugs cost and, overall, do not pay a great deal more than we do - certainly much less than paying and having private health insurance on top.

Preventive medicine has a much higher priority and people spend less time in hospital, partly because the required tests and procedures are properly scheduled.

Staff here need better pay and less government and NHS management interference.

It must be understood that, even if the entire GDP of this country was put into health care, not everyone would be satisfied. However we waste far more than other countries and, although we have some of the best doctors and nurses in the world, we cannot retain them.

People who praise the NHS do so because of the staff and because they have experienced nothing else.
Philippa Madgwick, Ruthin

I work for a mental health charity. One of the biggest problems within the NHS, particularly in the field of mental health, is "short-termism."

I understand it is also a problem in other areas, e.g. physiotherapy. People are "treated" using the cheapest method, which may, indeed, help for a while.
But because treatments do not get to the root of the problem, or treat effectively, people become ill again and thus consume health services (and other services and benefits) for much longer, sometimes for decades.

Short-term and cheap treatment are not necessarily the best way forward.
Name supplied

Exactly 12 months ago my husband was diagnosed with renal failure - a condition which was both unexpected and unwanted for a very fit and healthy man of 35.

Naturally we, our daughter and families were both fearful and distressed by this news. In October of this year he began haemodialysis.

This wrench to our lives was made more than tolerable thanks to the highly-skilled and dedicated team at the St James's renal unit. He has received the very best, and speediest, in medical care and attention - including biopsies, medication, monthly clinic visits, hospital stays, a dietician and now thrice-weekly dialysis session.

In addition to this he has received the help and support of all staff, from transplant surgeons to the domestic staff; the highlight being a one and-a-half hour Saturday morning "chat" with a consultant.

And I have to say that the odd bit of dust on the floor is less than a minor concern, when he is being treated with the latest technology and medical advances - and all for "free."

I feel there is a real danger that we as a nation could lose sight of the fact that we have a wonderfully "free" service, which is available to all, regardless of age, gender, ethnicity etc.

It is staffed by dedicated people, who should be praised and rewarded for the work they do. If the NHS is continually berated and staff condemned, this may well result in any or all of the following occurring:

Low staff morale and staff leaving, which would be compounded by low recruitment.

A spiralling lack of confidence in the NHS and the increase in private health care. (look at the media-induced panic surrounding MMR).

The belief that private is best - simply because it does not get the same negative press coverage.

Just because it is free does not mean it is bad, wrong or an easy target.

How to address this?
Funding, pay awards obviously.
To support the NHS not to continually look for the negative press.

Be prepared as visitors to help the staff care for your relative, not simply disown responsibility as they are in a hospital bed.
Talk it up not down!

I do not want to see the fate of the state education system visited upon the NHS.
Anna Levick, Wakefield

Why don't the BBC ever have someone representing the direct taxpayer on your programmes?

You have pensioners - don't pay tax, students - don't pay tax, single parents with children - don't pay tax.

All these groups take more resources and don't pay tax, so, when you ask "Would you mind paying more tax?", the answer will be obviously no - they don't pay tax!

You asked the wrong questions as usual today about the NHS, they should have been:

1. Should we get all the waste out of the NHS? E.g. leaving heating on full blast next to open windows, paying for staff who are incompetent.

2. Should we get managers into the NHS who can actually manage? No one seems to be able to see the big picture, maybe because it is too big and needs breaking up.

3. Is the amount of tax you earn and used for the NHS good value for money? It is not free, hard working taxpayers pay about two days per week in tax and National Insurance, largely for the NHS and the welfare state.

4. Should those from abroad, who have never paid into the system, be able to come here and have operations using our resources - is it really our NHS, or are we paying for ever Tom, Dick and Harry's treatment?

5. Should there be processes and procedures in the NHS instead of staff wondering around aimlessly?

6. Should those who want to pay for private care as part of their salary and are also forced to pay for the NHS taxation have to in addition pay extra tax because the private care is seen as a perk?

7. Are the billions of pounds for which the NHS is currently being sued, for incompetence and mistakes, due to lack of processes and procedures resulting in lost resources for the NHS?

8. Are you fed up with the fact the incompetence and waste is not taken out of the system before the government starts asking for more of your hard-earned money? The incompetence will never get any better with a bottomless pit funding it!
Lynn Fellows, Birmingham

Napoleon was right - we are a nation of shopkeepers. Asked their top priority for an ailing Health Service, the great British public chose free care for the elderly - more of the same, but a bit cheaper! How depressing.
Alan Winters, East Sussex.

Four weeks ago, I had a hysterectomy at the Lister hospital, Stevenage - recently featured on a hit list of under-achieving health trusts in the UK (North Herts NHS Trust).

I had been on a waiting list for 12 months. When I was first placed on that list, the waiting time was given as 9-12 months. During the course of the waiting period, that time was increased to 12-18 months.

When first placed on the list, I had made a special request to be considered for surgery during a major school holiday period, such as Christmas or Easter, so that my younger son would have the support of his older brother whilst on vacation from university (I am a single parent).

My own work, as a college lecturer, would also be less dramatically affected if I "went in" during a holiday break.

I was given a bed exactly 12 months after going on the list, in the final week of my older son's vacation. I was very pleased.

Whilst in hospital - for five days - the quality of care I received was superb. At every level, I was given support; nothing was too much trouble. The consultant was happy to answer all my questions, as he had done, during overcrowded outpatient sessions, when I had first met him, and was visible on the ward until after 6.30 some evenings.

The anaesthetist talked me through a range of alternatives for treatment during and after the operation, the day before

Nurses were efficient, fun and committed to our well-being; the ward was spotlessly clean; food was good, with plenty of choice.

The single, negative criticism that I would make is in relation to the emptying of sanitary waste containers in the loos, a task contracted out to external operatives and not carried out often enough.

The otherwise clean loos were defaced by these overflowing bins - not the responsibility of the health professionals.

My experience of this often-maligned institution was wonderful. I came home full of hope and sure that I couldn't have done better anywhere.
Jill Harrison

My wife recently spent two weeks in our local general hospital, where she underwent surgery.

While the medical care from the surgical team was excellent, the nursing care was very poor and even dangerous, due to the obvious understaffing on the ward.

Nurses were rushing from one patient to another and were clearly under stress. At times, it could be up to an hour before my wife received attention when she asked for something (e.g. pain relief). Often, staff would say they would "be there in a minute," only to disappear and not come back again.

Not for the first time (my wife has had several hospital stays in the last six years), we, her family, felt we needed to keep someone with her to make sure she got what she needed. However, on her ward, the management has banned morning visiting, so that for 20 hours per day, in pain and feeling nauseous, patients struggle on their own to get help.

We felt the visiting ban was for the convenience of the staff, who did not want relatives pestering them for things the patients needed. This was a very worrying situation for us all and we dread her getting ill again and having to go back to hospital.

Two nursing friends of ours, who have worked at this hospital, both left, because, they say, they cannot nurse people properly, due to the understaffing.

During a previous stay, one bank nurse admitted to us that the situation at the hospital was dangerous. The management, of course, deny this and seek to play down any problems as exceptions - but we, and they, know this is not true.

There seem to be two causes of the understaffing: There is not enough funding to employ enough nurses.

Where funds are available, they cannot find people willing to do the work, due to the stress of the job and the low pay.

I have no easy answer to all this, other than increasing nurses' pay to attract more into the profession. Until then, the NHS will continue to fail us.
Simon George

Last week my son suffered terrible injuries, from which he subsequently died, in the Intensive Care Unit of St. Thomas's Hospital in London.

On behalf of all of the family who were at St Thomas's hospital, I can only express our deepest thanks for the extraordinary care and skill that all the medical staff, at all levels, showed to him, and to us.

It is truly sad that such dedicated and skilled staff so often seem to be denigrated in the media for the inevitable few mistakes, or for organisational and resource deficiencies that are outside their control, rather than being recognised for their professionalism and humanity.
Ken Robinson, Southampton

I am planning a class action and group suit against the NHS for compromising my health with amalgam fillings, causing me unnecessary pain and distress.

I have experienced private and NHS medicine and will say that, in my honest opinion, it is a second class service and designed, I feel, to maintain the wealth of the pharmaceutical industries and give practice to medical persons, who then, when sufficiently experienced, will go onto private medicine.

For the price of ten cigarettes one can subscribe to private medicine.
Mark Anthony Henderson

In December last year, I needed to visit my local A&E department following a motorcycle accident (I was not at fault)

After the immediate contact with the tarmac, I waited 30 minutes for my bike to be collected, then walked to the local police station to report the accident. Then I caught a train home, walking from the station. From home I called a taxi to take me to hospital.

Whilst unpleasant, none of this was really too serious. Apart from the shock, I had a very painful wrist (which I thought might be fractured) and various cuts and bruises to my shoulder, forearm, thigh and knee.

I arrived at the hospital at about 6pm. By now (two hours after the accident), I was feeling very low. Waiting at the un-staffed desk for ten minutes, I checked in at the desk, and was advised to sit and wait for the triage nurse, who "wouldn't be long."

40 minutes later, I was called into the triage nurse who took some details and after tersely dismissing my suggestion that my wrist might be broken (well they are the experts), told me to take a seat.

"How long" I enquired. "We're very busy tonight, about two hours". OK, so I knew I was in for a wait.

Upon arrival, I had noticed two old ladies in the waiting area. One had been continually enquiring about ambulance transport home. She was continually told that the staff couldn't say when transport would arrive, but it would be soon. "Take a seat".

The first time I heard this was ten minutes after I arrived. After leaving the triage nurse, the old lady was still being told the same. Four times in the next hour, the same reply was repeated. The same reply came four times in the following 50 minutes. These two old ladies had been there for well over 2 hours, just waiting for a lift home.

At this point, I couldn't take any more. I enquired of them their situation, and telephoned a taxi for them (enquiring about the cost first and making sure that they could pay). They were old, two sisters in their 90s. One had suffered a "bit of a turn" at a birthday party in a local community hall.

What incensed me was the lame attitude of the medical staff - totally non-committal and actually rather unhelpful.

I was somewhat ashamed that I hadn't acted earlier, but here we were in the midst of Blair's latest caring, sharing NHS miracle and the people paid to care seemed they couldn't care less.

After the taxi arrived and I had seen them on their way, I enquired as to when I might be seen by a doctor. The response was amazing. I was ushered straight in. A couple of X-rays later and I was in the clear.

Two things I'd like to point out:

The doctor didn't offer to dress any of my cuts (or even clean them).

On the way out, I took a wrong turn and passed an area with about ten staff standing around drinking coffee and laughing and joking,

Can this be right? I know that it's not necessarily a reflection of all medical staff, but where is the integrity?
N A Holmes

It was good to hear of the extra mile a surgeon went to in assuring that a patient was progressing well after their operation.

My daughter underwent a major operation in the autumn of 2000 to straighten her spine, with two rods being inserted. (This would also prevent her scoliosis getting worse).

It was carried out in an NHS hospital in central London, the surgeon was more interested in the lovely straight line of stitching and the way it was healing, than the fact that she continued to suffer a great deal of pain.

Nearly 18 months later, she is still on a cocktail of drugs, including morphine. Having had to move to Nottingham, the new hospital, to which she was referred, took ages to arrange a scan, and could not arrange an appointment to get the scan results for another three months. She has now had that appointment postponed for another month!

As her husband is studying for his masters degree, she has to continue working (in great pain). As a speech and language Therapist in a Nottingham hospital, she has sometimes been unable to work because of the pain, therefore having a knock-on effect on other NHS patients awaiting treatment from her.

Needless to say the minister of health's office has not bothered to acknowledge my letter of complaint.

My mother-in-law, at the age of 95, has just had an operation for a broken hip and broken arm, and she cannot use her other arm.

The medical care has been OK but there is no nursing/care staff to help her eat the meals taken to her, so, yesterday, she had no breakfast or lunch until my wife visited in the afternoon and told the staff what had happened!
Alan D Dunningham

At the start of January 2001, my husband was an apparently fit and healthy 46 year-old. After a normal, active family weekend, on Monday 29th January he travelled down from our home in Yorkshire to Redhill, Surrey, where as an accountant he was working on a financial system for a bank.

We spoke daily during that week, he said that he had a bad cough and cold. On the Thursday morning his landlady rang me to say that she had called an ambulance, because when John tried to walk downstairs he had had difficulty moving his arm and leg. He arrived at hospital at around 9:30 a.m. I called the hospital immediately - he had been taken to the Accident & Emergency Department at the East Surrey and Redhill Hospital.

Despite the obvious severity of his symptoms, he was not seen by a doctor until midday; he was finally sent for a brain scan at 2.30 p.m. At this point I was told that he seemed to have a virus. At 4.00 p.m. I was finally allowed to speak to him over the telephone - he spoke clearly but sounded very ill.

That was the last time I heard John speak - he had had a stroke following a split in the left hand artery leading to his brain. I drove down overnight and was rushed into the hospital at 7 a.m. the following morning. I had not been at all prepared for what I found - John was completely paralysed down his left hand side and had lost all power of speech. His condition worsened over the next three days because by now his brain was swelling and pressing against his skull.

He was finally declared out of danger on the following Monday and spent the following five months in various hospitals in recovery and rehabilitation. These were very variable: in some the care was excellent, elsewhere sadly lacking, especially for someone who could not speak to his carers.

Now he can walk slowly but with difficulty, he has lost all use of his left arm (for a violinist this in itself is devastating), he is in almost constant pain with muscle cramp and spasm, and, although he can understand spoken language, he cannot speak himself.

Because he has damage to his short-term memory he cannot count or understand numbers or read.

There are techniques for dispersing clots and / or bypassing them. I know now that John's symptoms were classic ones, especially for a younger stroke victim. I am convinced that if the cause of his illness had been recognised and treated early enough, he could have made a much better recovery. As it is, our family has been devastated. In economic terms, John will never work again and will be dependent upon disability and incapacity benefits.

It seems to us that the lack of resources at the front line of the NHS leads to huge problems elsewhere. It is a very short-sighted attitude both in personal and national terms.
Lesley Gould

I was delighted to hear, on the PM programme, letters illustrating the good that can be found in the NHS. May I contribute another example:

My wife died in our local community hospital, after she had been fighting cancer for almost eight years. Her final decline was mercifully rapid - she was in that hospital for only seven weeks.

During those seven weeks, the care and sympathetic attention that she received was as perfect as anyone could wish for. And her family (especially myself, her husband for nearly forty-four years) received the same support and sympathy.

I have become distressingly familiar with various hospitals that deal with cancer. Her condition was diagnosed when we were resident in Washington DC, so she was first treated in one of the most advanced cancer units in the USA. Later I became familiar with the Royal Marsden Hospital in London and with another specialist oncology unit in the UK.

I cannot criticise these specialist units which, building on her indomitable spirit, provided treatments that led to at least two near-miraculous recoveries. But the aspect that I shall always remember is the quiet and unassuming care that that she received at that local hospital, from the nurses and other hospital staff and from the local GPs, who supervised the final, purely palliative treatments. And, incidentally, from everybody else including social services workers and the receptionists at the GPs' surgery.

We read daily in the newspapers, anecdotal criticisms of the NHS. Perhaps those critics should be invited to North Wales to see the best side of the NHS.
R. A. Yates, Denbighshire

My mother has recently been informed by her local hospital that it will be 33 weeks before she can see an ophthalmology consultant. However the hospital will contact her at the end of 27 weeks to invite her to phone them to make an actual appointment at the end of the remaining 6 weeks. Is this a way of cooking the books to enhance one's efficiency and could it be that the honest hospitals are those about to be penalised?
Mo. Downing

The experience with the NHS that I should like to tell you about refers back to a period immediately before my mother's death four years ago.

She was in the local NHS hospital being treated for lung cancer, and we already knew that she was not going to survive for very long. She was 85.

A young Asian lady doctor told my mother that she was able to come home and that this would be a very good idea for her, all that was needed was for me to give up my job to look after her.

At the time, both my husband and I were both in full-time jobs and, with two children to support, and my employer - although very good about giving time off - would not have countenanced my taking leave of absence for an indefinite period.

Although in actual fact my mother died less than two months later.

I spoke to the Macmillan nurse who was looking after my mother's case and she said that this kind of attitude was extremely common and, although it caused my mother considerable distress, that I should try and forget about it.

Unfortunately this is easier said than done. I don't know if it was simply unthinking cruelty or the difference in cultural background that assumed either that there would be someone at home to look after her, or that it would be easy for me to give up work.

Either way, at a time in both her life and my own, when we both needed support, the superb work of the nursing staff was sullied by the attitude of this doctor.
Val Downes

I am a 67 year-old housewife. I have had chronic back pain for nearly 14 years - scoliosis with degeneration of discs causing pressure on the sciatic nerve.

I also have osteo- and rheumatoid arthritis. I am in constant pain - walking is difficult and standing even worse. I am a blue badge holder and dependent on my car as I am unable to use public transport.

On 15th April 2001, I had a slight stroke. I was referred by my GP to a rheumatologist.

13th August 2001. Saw the rheumatologist, who referred me to a vascular specialist as he was unable to locate a pulse in my right foot, with the promise that I would see the vascular consultant and be back with him (the rheumatologist) by Christmas.

When December came, with no appointments forthcoming, after several phone calls I was told that the appointment with the vascular consultant would be at the end of January 2002, with a return to the rheumatologist at the end of February.

As I was no longer able to drive due to loss of feeling in my right foot and anxious to regain mobility, instead of being housebound, I asked how soon I could get a vascular consultant appointment if I paid to go private - 2 days!

I went private and had that appointment. He said I should have an MRI scan to diagnose the trouble and he would arrange it - on the NHS.

February 2002. No news, so I rang the MRI unit - they had received no referral. I rang the vascular secretary, who had not written yet to either my GP or the Rheumatologist, recommending an MRI scan.

Resulting from several requests she faxed the rheumatologist, who has now referred me to the MRI unit. I have phoned the MRI, who advise that there is a 40 week wait.

At present they are booking April 2001 referrals! I asked what the wait would be if one went private - 3 days, using same scanner at the same hospital.

So it looks as if it will be 2003 before I even get a diagnosis - having taken the best part of two years. And then, how long before getting any treatment? By that time I'll be 70 so will probably be told I'm too old! It's a good job I have a sense of humour.

I know that there are thousands worse than I, but nevertheless the frustration and psychological effect are difficult to cope with at times.
Pamela Miles (Mrs)

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