Tom, I am sure that you agree that it may be necessary to divert money for payrises to vital projects such as Iraq and Afghanistan. Only if we are succesfull here will our glorious PM`s place in the history books be assured. Remember he is a straightforward sort of guy and if he tells us to tighten our belts he must be right....right? PS Anyone seen any WMD?

So, there I am, sitting in the cab of my ambulance, debating the rights and wrongs of the budget for Yo Blair's grand warmongering schemes; I'm wondering whether we should be providing armour-plated landrovers, and flak jackets for "our boys", or spending it on the NHS. I'm also wondering it against the background of my son, whose regiment is currently squaring up either for its third tour in Basra, or its first in Afghanistan.

"In no more than 500 words, discuss."

"Our Boys" (no relatives for me, but a couple of friends) shouldn't be sent anywhere unless they're properly equipped. Least of all on the offensive. But they have been, and we're stuck trying to make the best of a bad situation.

One in particular, for years used to be proud of his role "defending the nation", doing UN stuff, seeing the world, representing his country, and I was glad there were men like him out there. The last few years he has become more and more disillusioned. Now he makes gloomy jokes about "defending the oil".

Reading this and NHS doctor blog makes me despair of the NHS in general. They have run it into the ground and seem to be seeing how deep they can go.

The politicians are too busy looking after their careers rather than looking after their constituents. It never going to happen but we need someone to take the challenge of getting it back on track, even better if it was someone with a bit of cop on.

I mean, exactly what will it take to make them realize the current system is a shambles. I shudder to think.

NHS budget in 1997-8: £34billion
NHS budget in 2005-6: £90.5billion

(from here) but the NHS is in trouble...

Now - how did this happen? Can I play devil's advocate for a minute?

Is this all solely the government's fault? It has been pouring money into the NHS over the last ten years. More and more control has been handed to hospitals and away from government - "doctors and nurses should be running hospitals", foundation hospitals, etc. etc. So is the government now being accused of not being controlling enough in the way hospitals are run?

I work for the NHS. I too am bewildered by the situation, but there is more money than ever available and yet we are apparently in crisis. Can anyone tell me what's going on?

Erm so where has all that money gone? Audits ,targets, managers, people to check up on people, people to check up on the people wh are checking up on people, treatment for people who aren't entitled to it ,do you want me to go on?

Yes, I do. Hospitals have more individual control over their budgets than they have ever had before. I can believe the first three categories you mention have an effect, not so much the fourth and fifth, and as for the sixth, that would seem to have very little to do with government - unless you'd like to elaborate on what you think entitlement is in terms of treatment and people. That still won't account for a £55billion increase in spending - unless you believe that there are an extra million managers being paid £55k each, or some other perm/com of that figure.

How much of that has gone into the (unwanted, unneeded and generally crap) NHS spine and 'connecting for health'? I'd say that IT is a huge chunk of that budget. I would imagine that a fair amount has gone on more expensive drugs that people expect to get no matter the cost.

Also think on the cost of PFI hospitals...

I'm not saying that the NHS as a whole is blameless - but it doesn't then follow that the government aren't a bunch of gits.

Apparently, they're on budget. At £12.4 billion.

http://www.connectingforhealth.nhs.uk/faq/mythbusters/the-cost-of-the-national-programme-for-it-is-spiralling

Regards
Nick
http://nickhough.blogspot.com

So that's £12.4billion over ten years - multiply that by ten and it still doesn't cover the extra money in the NHS budget between 1997 and 2007. AfC was a good idea done badly - possibly because it was left to individual hospitals to sort out (and mine was an early implementer) rather than centrally. Having a physio and a medical secretary do my job evaluation was as sensible as ... er, the idea that I could do theirs. "Expensive drugs that people expect to get no matter the cost" - well, there's an ethical minefield that goes to the very heart of what the NHS is, does, and provides. Love the word "scads" - never heard it before.

As for "it doesn't then follow that the government aren't a bunch of gits" - EVERY government is a bunch of gits after two years max, let alone eight, nine or ten. Of course, I remember that sweet cuddly Margaret who was so nice, and I'm sure John Major / William Hague / Iain Duncan Smith / Michael Howard wouldn't have been gits over the last ten years. Things could be better nationwide, of course, and I feel I may have to apologise since other people feel the NHS is falling apart but in my particular part of the service (sorry for being selfish) they have got better, and I've heard patients say that too, and I don't think that would have happened under the Tories.

Oh - and add in the Agenda for change fiasco...

...Plus spending scads of money on getting waiting lists down at the expense of actual medical care.

(I should go to bed now)

My only thought here is that money is 'pushed' at problems in the form of big initiatives. More often than not, in my experience, money is put to better use when it's 'pulled', or asked for, rather than thrust upon an organisation.

For instance, if the LAS response times are slipping, the solution may be to unclog the hospital EDs so ambulances can hand over more quickly. In this example, I get the impression that the ED staff can't just demand a couple more nurses, trolleys, and another room to put people in -- the system just grinds to a halt and a manager somewhere comes up with a plan to make the ambulance service more efficient (e.g. using a fleet of paramedics in cars instead of real ambulances).

I wish less problems were being "solved" by leaflets and brochures and marketing.

I also wish the targets were more meaningful. When I see my doctor it sometimes feels like half the appointment time is dealing with whatever problem I've gone in with, and half is for asking questions, taking readings, and ticking boxes for stuff we already both know (like verifying for the umpteenth time that I don't drink, don't smoke, could lose a few pounds but am not worryingly overweight, etc). This is not an efficient use of anyone's time or resources.

hmm, accountability.
I think it's rather important in the public sector.

yes but blaming people you uniformly distrust and dislike is far easier to think about... ;)

I hate Patricia Hewett, her attitude , her voice ...
In today's telegraph they described a brochure her dept had produced to show health authorities how to make cuts, by calling them adjustments or some such nonsense.
Also, did you hear about the welsh ambulance service having to queue ambulances up waiting for beds outside an A & E?
And some people still want to join you??

And at the same time, other Welsh vehicles were having to be re-routed to hospitals, hospitals that were even outside of Wales!

There were a number of minor cases taken into Royal Shrewsbury A&E department, that were simply there because the crews had nowhere else to take them. It's madness.

Regards
Nick
http://nickhough.blogspot.com

"Also, did you hear about the welsh ambulance service having to queue ambulances up waiting for beds outside an A & E?"

Is that news? I gather it's a fairly regular occurrence around these parts.

off topic slightly, but, great film that!

yeah I must admit I agree with you, really good, if not off topic a bit

Unfortunately, in Italy, EMS is not recognised as a job, that's why we earn a very modest wage, because we are compared to unskilled workers, earning about € 1,000 per month.
Even if we deal everyday with traffic risk, biological risk and responsibility, none of these risks are adequately rewarded.
Unfortunately, we also can't strike, because we'd risk to go to jail for "public service interruption".
I don't know how much an English EMT earns per month, but I suppose that in the wage those risks I've mentioned before let you receive a fairer wage.
This helps you to consider that "there's always somebody worse than you" (Italian proverb)

That is awful !! I earn arround £36.000 a year. Come here ,with your good english you would be most welcome.

that's well over the average uk salary

I earn around £24K. I think - each month, after tax I take home around £1,600

Which is think is crap, but then I actually enjoy the job.

Well... £1,600 are about € 2,300. That's about twice my average wage and England is not so far...

there's the nub, I suppose. presumably they don't have too much difficulty filling posts because people like it, market forces and that. if they can get good people for that money then I think there is some sort of duty to the tax payer not to raise costs. I'm still with you on the inflation though!

Yeah, this is a kick in the face... I hope you guys manage to twist some arms and get a better deal.

I work in Local Government- we have not had our annual pay insult yet- but i doubt we will fair any better.
What really got my goat was the governments justification- that those that get spine points do get a payrise above inflation, because of the spine point.
WELL as spine points till and employee reaches "max pay" is part of the top of our terms and conditions. Those staff at the top of the pay scale for their job are by definition the most ecperianced and "loyal". Those staff will only get the below inflation pay offer. As usual Pblic sector pay drags behind others, and for the joy of working in the public sector we have to take a low pay settlement for that.
Many of us are abused by the public- in fact i was assaulted for doing my job last year- and the public sector and still we have to make sacrifices "for the good of the economy".
Rant over.

Tom, I too work for the public sector and have just had my 2.5% (1% below inflation) pay rise enforced on me, 7 months late (and suprisingly all the senior management had like 7% on time.........). I know how you feel. You work your guts out doing something that you hope will do some good and change things for the better. In fact, my union has just had a strike - the first in 25 years (google that and figure out who I work for), but I doubt that will make any difference (apart from COSTING me a day's wages).

Wasn't it Nelson that said "Don't mess with either a man's pay or food" (I think it was something like that anyway!).

Couldn't agree more Tom- whats the point in strking. A days pay is lost at least- which kind of cancels any possible increase achived. The words "over a barrell" spring to mind.
Essential staff are being priced out of a job.... and then it ends up costing more money to replace them.

Bad Boy - MOD right? We got the same deal as you if not - and also 7 months late. My pay scale has also been contracted at both ends which puts me closer the the bottom after struggling for several years to get off the starting salary. Doesn't say much for longevity or loyalty is all I can say. But hey, at least I get an extra £6.90 a week before tax & NI - should help pay the increased council tax.

Got it in one mate!

Well we (Civil Servant) were offered a crappy 2.5% by Gordon Brown and his treasury bean counters

We went on Strike last wednesday, other civil service unions have already gone on strike too, and I can't see Unison standing for this....

Spring/Summer of Discontent on the cards?

I used to be a GP in the NHS. Had I still been part of the 'gang', I would be just a little upset with a 0% pay rise. I think I would reguard it as a slap in the face from Tony Blair. Since the New Contract many GP's have increased their income as a result of the quality framework. That is, they have shown that they have reached the quality targets set by the government. So to now penalise the GP's seems quite incredible.

Anyway, as I said, I used to be a GP in the NHS. I left 3 years ago for a far off distant place called New Zealand. I remain on-call ( I am currently sitting in my surgery on a beautiful sunny Sunday awaiting the arrival of a teenager with potential meningitis), I took a pay cut, the nearest hospital is miles away.......but am I moaning?....not a bit.

Whoo Hooo!

Now can we refuse to pay any price increase that are placed on us, such as council tax, water bill, fuel bills/tax etc etc above 1.9%?

"Dear Mr local councillor, I am not paying anything above a 1.9% increase in your council tax, as Mr Brown has said that is all we should be entitled to, to keep inflation down?"

I do think it is unfair that earnings do not keep up with inflation, I expect there are going to be a few families for whom things were very tight that will be really flored by this.