As people who work in the NHS you are under more pressure than ever to deliver on the government's promises. We asked for your views on what is expected of you.

Your views

To enable the NHS to continue to be the comprehensive free service it is today, we need to become responsible for our own health.

As a health professional, I continually see patients who smoke, drink excess alcohol, overeat, eat unhealthy food, or take no exercise, and yet demand medicine and treatment for their self-inflicted illnesses instead of changing their unhealthy lifestyles.

Isn't it time we insisted people did their bit first?
Carol Lincoln, Leicester

I am a GP working in Reading. One week ago, in the evening, there were more than 20 patients waiting for admission to our local hospital, of which seven or eight were being admitted by GPs.

The bed manager could not find beds for them. During the evening two more were added.

Most of the seven were over 80. One had possible cardiac pain. One was so ill that her GP was not sure she would survive overnight. One of the two added had a thrombosis in her leg, which could have caused an embolus and perhaps death.

The hospital was unwilling to declare itself closed and neighbouring hospitals also had no beds. The chief executive appeared to have no contingency plan. During the course of the evening, as GPs, we put pressure on the hospital.

We told three patients that they could not be admitted; this included a lady who lived alone and was unable to move out of her chair.

The other patients were eventually admitted. Three of them we just sent to A&E. It will probably never be known whether the delay actually affected the outcome of their disease.

I had written to the chief executive a year earlier about a similar situation, but this was the worst that I have seen. We were helpless to give the patients the care that they needed.

People could have died - a child could have become motherless and a husband wifeless; adult children could have lost their parents. This experience was a profound embarrassment to all concerned and seriously demotivating.

No individual is to blame for this particular situation; it is just a symptom of where we are at.
Dr S G E Brown, Reading

A strange irony - the NHS under scrutiny, failing in many respects due to lack of investment, low morale and poor management and yet seeking 10,000 new doctors (according to the BMA). Students claiming that they are being forced into poverty and often having to quit degrees after two or three years of study due to extreme financial debt!

A student who is fortunate enough to be sponsored through university by his or her employer can live the life of Reilly. He/She has adequate funds to purchase books, avoids the need to take on part-time employment, in an effort to supplement his income, and perhaps eases the financial burden on his/her parents, and is able to devote all his/her time to studying in order to achieve the best possible results.

Consider a medical student, a young person who has wanted nothing else for the last three or four years of their school life but to become a paediatric surgeon.
This student has excelled at school, leaving with five A-level passes at grade A and has so far achieved excellence in his first year exams at Birmingham University. He has chosen to live in student accommodation, as the environment is far more conducive to study, with easy access to the library and the medical school facilities. His prospects are excellent and he is certain to graduate after five or six years of study.

The sixth year gives him an "intercolated" degree, thus improving his net worth to the medical profession. What are his employment prospects once he has graduated? If he remains in the UK, his only prospect is to work within the NHS. Eventually, after many years, he may be able to establish a private practice, or move wholly into private health care. However, the one certainty is that he will work in the NHS and the NHS, by their own admission want him.

We, his parents, already pay our burden to the health service through taxation and National Insurance contributions. His mother is employed within the health service at a GPs' surgery as a medical secretary.

I would like to know why we, like all other parents of medical students, have the huge burden of sponsoring our own children through university when, after five or six years, the NHS gain a competent doctor - surely they are the employer and they should be picking-up the bill now?

Or is it fair that a few parents should be paying a very heavy subsidy for the benefit of the majority in this once great nation?
Stuart J Barry, Kidderminster

As a practice nurse, working in GP surgeries and clinics, I find that patients frequently fail to turn up for their appointments. This then wastes doctors' and nurses' time and, more importantly, appointments are unused.

Other patients then ask why they cannot be seen sooner. If you are a patient, please remember you have an appointment or otherwise cancel it. Thank you.
Sylvia Caten, Sussex,

As a former manager and doctor in the NHS hospital system, I would like to note that, in general, if you set specific targets for managers on which their jobs depend, then they will do whatever they can to meet them, at the expense of other priorities.

For instance, if the first priority is short waiting times for surgery, then the answer is to cut down on consultant clinic appointments, which in turn cuts down on the number of patients selected and scheduled for surgery, which shortens your operation waiting times.

This, obviously, may not be in the best interest of the patient. I, personally, would prefer to see a consultant sooner to determine whether my painful hip was due to cancer or not, and then wait for surgery, rather than have to wait and worry overlong for the initial consultation and then have a speedy operation. In this regard, I was interested in the government's recent statement that NHS managers found to be fiddling their waiting time figures were guilty of "gross professional conduct" (I believe the phrase was) and would be sacked.

Can we be assured that the same fate will come to government ministers and other government officials who falsify their figures to convince the public that they are fulfilling their promises?
Dr James D Stevenson

Your Health Day happens to be the 30th anniversary of my start in nursing. How things have changed, or have they?

I started in the days of an "apprentice" based training, and I was lucky enough to do this at Barts, in London. I received excellent ward training, which has been of great value since those days.

It was during that time that I had to do six weeks working in the operating theatre. It was a valuable placement, the result being that I have been a theatre nurse now for the last 21� years, enjoying the majority of that time very much.

I also initially trained as a midwife, joined the army, serving in the Qaranc for eight years, have worked in the private sector and now work for an agency, gaining experience within the NHS.

I wish to make 3 points:

Training

Firstly, as I mentioned, I did what I call an "apprentice" based training. I had to sign a four-year contract with Barts, three years for the training and an extra year to work for the hospital as a staff nurse. It was a stipulation that a hospital certificate from Barts would not be forthcoming unless this fourth year was undertaken.

We were paid during our training, and I can remember my first payslip, when I thought I was quids in, with �30 for the month!

However, in recent years things have changed drastically. It was deemed by the powers that run the profession, that, in order to call nursing a "profession," training required a degree or diploma. This was called "Project 2000."

I have to say that I do not object to nurses having degrees, but I do not think that all nurses need these paper qualifications, and as a result, the "professionals" who decided on this have basically shot themselves in the foot. By insisting on a degree, the basic educational qualification was raised far too high. In my day, the basic requirements were 5 "O" Levels, including English Language and Maths. For some hospitals, a higher base was required, but it also depended on interview.

Now various "A" levels are needed. I believe this has taken a whole layer of individuals out of the equation, who are frightened by these requirements, but who would make extremely good, caring nurses.

The training itself has changed to a college-based course, which gives very little time on ward-based work. This mistake is fundamental. How can nurses learn to nurse if they are not allowed to get "their hands wet"?

By working in the ward situation, they absorb the stresses involved almost by osmosis, so, when they take up a post, they do not come as such a surprise. Also they learn what nursing is, not what they think it is.

It is not unknown for newly-qualified nurses to say that it is not their job to feed patients, do bed baths, that it is boring doing observations. This is basic nursing care. If nurses do not do it then who will?

The answer is Health Care Assistants, and here there comes another basic mistake. When I started there were two levels of training, either a three-year training to become a State Registered Nurse (SRN), and a two-year training to become a State Enrolled Nurse (SEN).

SENs were not allowed to do certain things, like carry keys for controlled drugs, and their career prospects were limited to practical work on the ward.

SRNs had the opportunity of going "up the tree", if they so wished. The basic educational qualifications were different for the two courses, but SENs were a fantastic base of extremely valuable, experienced nurses.

Several years ago now, the powers that be decided that there should only be one level - of Registered General Nurse or RGN. This was divided initially into two levels, but SEN courses were stopped, and all SENs were initially encouraged, and then virtually coerced to do a conversion course to become a RGN Level 1, or old SRN.

To cover their loss, more Health Care Assistants were employed, and they have no formal training or qualifications.

It is a backward step, as it is these very hard workers, who now do the work of the old SENs.

Pay

The pay that nurses receive is dreadful, taking it against other professions. The hours can be long, and, although they say they understand, management has no idea what is involved.

As I have mentioned 30 years ago I started on �30 per month net. Now that is �1700 per month, doing four days a week, on agency pay, with 30 years experience. It really is an insult! All these issues, except pay, never seem to get any real publicity, and so the general public have no knowledge of these matters.

Politics

Secondly, the NHS itself. It is a monolith of monumental proportions. And it is run by politicians! Big mistake.

The NHS managers are subject to the various changes in government over the years. So much so that when one Minister, or Secretary of Health is appointed, they change the goal posts, and then they are changed again a few years later etc.

In the end I would suggest that, basically in the last 30 years, nothing has changed at all!

We are still where we were all those years ago, except that the media has informed the public about all the medical changes that have come through, and, with the recent scandals that have occurred, the general public's expectations of what can be done have gone through the roof.

In some cases, these expectations are totally unachievable.

The public

And thirdly, the general public.

I really believe that the public have no idea about the true and real costs involved in healthcare. I have no quibble whatsoever about the basic ideal of the NHS being free at the point of delivery. But this has got to be tempered by reality.

I would be interested in what the general public's view of the NHS was if every patient received a bill at the end of their treatment, itemising all the costs involved, noting that this would be for information only. I really believe that if this were possible, then a great number of attitudes would change overnight.

I hope that this e-mail will be of help to your day.

I realise that:

a) These views may be viewed as simplistic.

b) They only scratch the surface, but they are not only my views, having spoken to professional colleagues, especially of my generation.
Name supplied

I feel that the media does not realise the demoralising affect that they have on an already downtrodden, hard-working force.

I have been in the NHS for 20 years. I have seen at least three large managerial changes, all of which have deteriorated into a top-heavy organisation where the "shop floor" still has to deliver high quality care against the odds.

Some changes have been for the good - empowering patients to question the service that we give has made us all look at our practices - but the downside of this empowerment is that there may be an over-expectation of medical and nursing ability to cure all and do it within the constraints of a ever-tightening budget.

So my message to all your listeners is this:

We try very hard to make every contact with the NHS an experience that we can all be proud of. We do not intentionally go out to do harm, or make you have a bad experience, just because we are having a bad day.

Please remember we are only human, with feelings too.
Claire Dick, UK

I work in a specialist tertiary referral centre in London. We receive referrals from all over the country and, as a consequence, there is a long waiting list for our clinics.

It is however very disappointing when patients do not turn up for their appointments - and do not inform us in advance. If they did, it would give us the opportunity to allocate the appointment to someone else.

I have often been in the situation where roughly 40% of the patients have not attended a particular clinic.

The NHS has a great many problems and deficiencies, but I certainly think that some patients need to be aware that they have responsibilities to the NHS as well.
Dr Kevin Shields

Return to the top of the page