You believe this from a party that referred to ambulance crews as van drivers/removal men years ago when a chubby (heart attack in waiting) politician gave all in his pursuit of bull, to put a stop to the ambulance strike.

Forgive me but I am something of a sceptic, when large swathes of public funding is to be withdrawn, you can bet it is the 'real' responders who suffer.

I have commented in a similar vein before, and I am sure you are aware of to whom I refer.

We all know what they did to the health service last time. If they get in next yr, I dread it tbh, Labour may have a lot of bad points and things needing attention but the connies are worse.

As I say - I'm not saying that it isn't going to happen, but that I believe that Mr. Boff is telling what he thinks is the truth.

And the end of the day we'll just have to wait and see.

On a slightly different topic, I was discussing the work ambulance crews do the other day with social care researchers, and they were surprised to discover how much social care crews actually do. I've a feeling you might be seeing some research done soon ;-)

I spoke to the private secretary of the then social care minister - he too was also astounded by the amount of contact we have with Social care. I think he thought that we just picked up people having MIs all day...

I never heard anything back from that discussion though...

Andrew Boff is referring to cutting the 'fat' within the NHS, i.e. the waste that exists in NHS' middle management - aka the 'Administration.' The NHS has never before experienced such colossal cost allocations to non-operational, largely unnecessary areas, causing those operations to be less effective.

I don't want to get into party politics, but I think it is safe to say where the blame lies for poor policies and a dereliction of duty with regard to continuous improvement. Some of the comments here seem to want it to remain status quo. I would question where it is they believe their voting power will continue to lead the NHS, should they vote for the incumbents.

In my opinion, the answer lies in the lack of accountability mandated to the individual in the UK. Social medicine is something to be proud of, but the original vision failed to foresee the lily-livered 'leaders' that we would eventually vote in, and the imbecilic nature of today's Briton; without goals, without purpose, and without a sense of social and patriotic reciprocity.

The resulting costs are immense, and furthermore the costs are being paid by the wrong citizens, including those on the front line. The answer then is fairly clear - every case of intoxication answered and attended to by the emergency services should be billed back at full cost to the recipient of the service. The same should be mandated for those morons who cause injury to one another by fighting.

Perhaps the large bills, and County Court Judgments for those who fail to pay, would leave such offenders in no doubt as to the consequences of their actions.

It is somewhat astounding that those charged with policy making in this country, continue to use the lowest common denominator as a benchmark for good. I wonder how such 'leaders' would respond when, having sought urgent, life-saving treatment from the NHS for one of their loved ones, were advised that there was simply no money left for the treatment, as it had all been spent on social disorder.

It's all well and good politicians threatening to cut waste - well, it's the only way the Tories can possibly promise to deliver LESS TAXES on the rich without CUTTING PUBLIC SERVICES for the rest.

There is a really good podcast on this dilema by David Mitchell on
http://www.channelflip.com/2009/08/20/david-mitchells-soapbox-waste/

Cheers

Blippie

Interesting link, but outdated, as there is already a 'Lean' initiative gaining momentum within the NHS.

Also, I empathise that those working within the NHS are angry, and they have a right to be. But partisan attitudes to politics and the politicians will only lead to further deflection away from what really matters, and further towards modeling the US; an even uglier proposition than the ones currently available to us.

Demanding a merit based approach from our local elected representatives, and applying constant pressure to them on those points that promote change, will quickly eliminate the weaker representatives and diffuse the autocracy from Downing Street. The same degree of autocracy that seems to be present in today's unions, despite what the union leaders say they stand for.

The union leader should be non less accountable for results than the politician, as there is seldom a degree of difference between the two.

Interesting post. Reading 'between the lines' of what you appear to be trying to say - your view is that individuals need to take more personal responsibility. This is 'Compassionate Conservatism', is it not? So what about those individuals, who, for whatever reason - lack of education, mental illness etc - can't? What happens to these people? Do we leave them to die, or do we, as a responsible society try to address their needs and give these individuals the same entitlements as everyone else?

Regarding your suggestion that drucks and people who fight should be billed for treatment, how exactly do you propose that this should be administered and who pays for this extra layer of paperwork?????

Dear Anthea,

Indeed, your conclusion that I suggested personal responsibility is, of course, correct.

If you wish to compartmentalise for yet more partisan politics, then one could call it 'compassionate conservatism' along with myriad other badges. Your term is especially apt if looking at society 'down the wrong end of a telescope.'

Had you read what was 'on the lines,' I did not say that people with mental illness are charged for such services, or that we leave anyone to die.

Those with a 'lack of education? Well, the excuse for not taking the initiative outside of what the schools provide, i.e. picking up a book is another subject. However, surely if the intoxicated individual was able to repeatedly procure the funds, source the alcohol, select the alcohol, request the alcohol, use the alcohol and subsequently be 100% successful at making others lives a constant misery, they must possess some ability in being intelligent enough to know where it will lead? Thus I draw no distinction between the violent drunk with no schooling and the violent drunk with a degree.

I would suggest that it is due to those in 'leadership' in the UK that seem to like looking at things 'upside down' and sharing a bed only with those with exactly the same unrealistic opinions, that are the specific cause of the uncalibrated, irresponsible aspects of society.

If there are few consequences and all is forgiven in the name of "trying to address their needs and giving these individuals the same entitlements as everyone else", we will forever be picking up the pieces. The upside down approach of 'addressing their needs' will result in the recipients dying prematurely without having ever contributed back to society, or their own existence.

Despite that which you seem to think, human beings need solid leadership. They respond far better to this, than being given carte blanche.

As to your final question, accountability is relatively simple to facilitate. After all, far less fruitful measures are facilitated daily within the system, and the tax payer pays for these, of course.

The system could be facilitated at street level in the same way that someone caught intoxicated with a vehicle. At facility level, if they are brought in, suspected of and tested for intoxication, they be forwarded a bill for services rendered. When one looks at the 32 Million per annum one London borough makes from parking tickets alone, it's not too difficult to fathom funding for such a system.

With the way things are going, and if matters continue in the same direction they are today, there will be no NHS in the future. We will lose that which we used to be proud of, and still should be. But, it already costs more than it should, and taxpayers will eventually say no, if individual costs outweigh those in eg the US, (and using your apparent benchmark they soon will).

Then there will be privatisation. Do you think your sense of entitlement for the irresponsible will be enough to pay for their treatment in such circumstances? I happen to know it will not. So better to start showing people that if they abuse the social standards of the UK, they will pay and pay dearly. Lest we all lose due to their ignorance and our 'leadership.'

Andrew - what you are suggesting is a classic case of treating the symptoms and not the cause... unless the reasons for all these issues are addressed things will never change.

I moved out of London back in '97, but I do remember the Conservative Health Secretary, Virginia Bottomley, putting forward proposals to close a number of large London Teaching Hospitals.... I honestly don't believe that the Tory party has moved on from looking after the rich and penalising the poor - it's just not what they're about.

Regarding your comments about how to administer a charging system - our children have been treated as emergency patients in the US - and I can tell you that the staff processing the bill for the treatment appeared to outnumber the staff who treated with us and certainly spent more time with us that the medics did! Unless all the drunks that are picked up give accurate, traceable details, the fines will never be recovered and the cost of trying to recoup the fine will soar and soar.....

In every A&E department across London at least there is pretty much a 24 hour police attendance.

I suggest a dedicated 'hospital liaison police officer' - much like schools have dedicated officers - this officer can then deal with the assaults, criminal injuries and other reasons for officers attending the department (victim statements and the like).

They can also be the ones issuing fixed fines to those 'drunk and incapable' once they sober up enough to understand.

Deputise me, I'll do it...

I Am suprised that with all the Ambulance Today magazines sent to all Ambulance services that you are not aware of the Labour Minister responsible for the Ambulance service MR MIKE O'BRIEN.
HE 'MAKES NO APOLOGIES FOR MAKING TOUGHER TARGETS' Summer 2009 issue 2 volume 6 with all my years in the service i have worked under them all. And they make the rules up every day! But we all know that there are massive savings in management, that can put more bums on seats.