大象传媒

I work as a clinician in the NHS. I watched the program with growing despair. Sir Gerry's summary was thoughtful and balanced, but his concerns are real and we should be worried about these imposed changes. Patients should have the best choice of treatments, but not be put in a position of choosing which services they need, or where might offer the best treatment. GPs cannot be expected to keep up with all treatment options available, which is why they refer their patients to experts. Commissioning will limit their options and they and we as patients will be non the wiser. Andrew Lansley needs to think again.

Broadcast at last! Third time lucky?

I welcome Sir Gerry鈥檚 opinion that the NHS requires strong management. But will the Coalition鈥檚 freemarketeers ever accept this and reasoned concern with outcomes when they really believe in freedom, self-interest, competition and choice despite reliable evidence that cooperation works best?

And why did he not cite the evidence against commissioning and the purchaser-provider split? Back in January, Prof Wendy Savage wrote: 鈥淭he new health select committee says that "more effective commissioning is key to delivery of efficiency gains" (but) does not follow up on the request to examine the cost of commissioning. DoH officials have said this was 14% of the NHS budget, but this was the cost of administration in 2002, and they are not revealing what it is now. What we do know is that administrative costs in the NHS were 5% of the budget before the 1984 Griffiths reorganisation (which brought in managers not administrators), rose to 10% in the early 90s and are probably 18% now. The cost of the market must be at least 拢10bn, but no one wants to discuss this colossal waste of money that has not been shown to improve patient care.鈥�.

In April this position was reemphasised by Dr Peter Fisher President, NHS Consultants' Association, Professor Harry Keen President, NHS Support Federation and Savage as Co-chair, Keep Our NHS Public.

Excellently presented programme such that your average member of the public could understand it.

I have watched ALL your other programmes on the NHS and again I am in agreement with you.

Regrettably as Ms Sarah Wollaston, Conservative MP for Totnes and a former GP says in the Guardian ( )

"But now that the changes are so advanced, even before the passing of the bill, the NHS will need a new legal framework and that needs proper scrutiny. Consequently, it is better to focus on where we go from here rather than how we could have arrived by a less contentious route."


Further proving the Tories intended to force through their reforms regardless. How Democratic? I am sure Mr Maummar Gaddafi, Mr Hosni Mubarak, Basher al-Assad and Mr Ben Ali, et al despots would fit in very well in the Tory Party.

In fact it is ploy reminiscent of the Tories another idiotic decision to cancel the British Aircraft Corporation TSR-2 strike and reconnaissance aircraft:

"..when Defence Minister Duncan Sandys [Conservative] stated in the 1957 Defence White Paper that the era of manned combat was at an end and ballistic missiles were the weapons of the future. Within a decade, this philosophy became thoroughly discredited, but at the time, and in the climate of the Cold War and "mutual deterrence", the missile as a weapons system appeared to make some sense, especially as it seemed missiles would offer significant cost savings over manned aircraft. This viewpoint was vigorously debated by the aviation industry and within the MOD for years. Senior RAF officers argued against the White Paper's premise, (as the BMA and others are doing now against the NHS reforms) stating the importance of mobility, and that the TSR-2 could not only replace the Canberra, but potentially the entire V-bomber force."


To ensure the decision was NOT reversed ALL the tooling etc was destroyed!!!


"The apparent haste with which the project was scrapped has been the source of much argument and bitterness since."

I also work as a clinician in the NHS, and can see the complex and mixed state of the NHS. I also see how crucial the government's decisions and structure is, in terms of the everyday care that is delivered. There are details to the proposed bill which can be technically debated, but the central issue which will have the most impact as I see it, is the over-riding principle of market and competition. Whilst such changes have been introduced before, this bill represents a huge change in the governance of the NHS. That this will have a devastating impact upon the quality of services is of no doubt in my mind. These changes will have a massive cost, worse than a "postcode" lottery, a systematic bias towards the distribution of resources away from those with more need. At a time when health resources are scarce we need to be having discussion at a national level about what we can, and cannot afford. The governemnt is shying away from this difficult reality, devolving the inevitable limitations to be rationed by a new, more wasteful system, without integration or planning (or rather planning that is limited by lack of national data and by disjointed services). It is hard to say how grief-stricken, terrified and enraged I am by this bill (and I am trying to, when I never usually post on the web). For the health of each of us and of our nation I just hope the bill does not get passed by our democratic processes.

I would suggest that Constituents e-mail their MP links to the 大象传媒 iPlayer:

>> /programmes/b014gr72

>>

>> /blogs/panorama/2011/09/gerry_and_the_gps_-_join_in_th.html

To those who say or think that the NHS does need reform.

No. I think you are confusing "CONTINUOUS IMPROVEMENT" with reforms.


We just had a new Health Centre (replacing one built in the 1950s!!!) open.

>> It incorporates self-check in for your GP appointments via a touch screen tablets.

>> We can make appointments online 24/7/365.

>> We can request repeat prescriptions 24/7/365. the Pharmacist even collect the prescription so you just go to the pharmacy to collect the prescription.

>> Digital x-rays, scans, etc etc directly to your consultant/GP/Hospital computer screen via server. (Although the local PCT Hospital has a in-hospital MRI and CT scanners the Health centre has acquired a CT scanner too).

>> Diabetes and other health screening and monitoring goes on too.

I know think an addition of an AE unit to the Health Centre would greatly assist in delivery of health care.

Proving you can improve the NHS WITHOUT REFORMS.

However, it can ONLY happen with investment and that's what the Tories don't want to do!!

It is unfortunate improvements like the following (see below) one on the NHS are NOT widely publicised as it would greatly improve the NHS from patient feedback. If patients fail to provide the feedback then they have only themselves to blame if the NHS's failing them.

>> Find and choose services ( )

>> NHS dental services ( )

>> Rate and comment on NHS services ( )

Was this reform, or for that matter any of the others by this Government, mandated? NO.

Oh, it certainly is ideological! Lets go back to the beginning.

When the Welfare State (which included the NHS) was proposed the people of Britain gave Labour a very clear mandate - 146 seat majority!!!

"The greatest factor in Labour's dramatic win appeared to be the policy of social reform. In one opinion poll, 41% of respondents considered housing to be the most important issue that faced the country, 15% stated the Labour policy of full employment, 7% mentioned social security, 6% nationalisation and just 5% international security, which was emphasised by the Conservatives. The Beveridge Report, published in 1942, proposed the creation of a Welfare State. It called for a dramatic turn in British social policy, with provision for nationalised health care, expanded state funded education, national insurance and a new housing policy. The report was extremely popular, and copies of its findings were widely purchased, turning it into a best-seller. The Labour Party adopted the report eagerly. The Conservatives accepted many of the principles of the report (Churchill did not regard the reforms as socialist), but claimed that they could not be afforded.] Labour offered a new comprehensive welfare policy, reflecting a consensus that social changes were needed. The Conservatives were not willing to make the same concessions that Labour proposed, and hence appeared out of step with public opinion."


I see no such mandate has been given to the current Government!


I have repeatedly written to the 大象传媒 to suggesting that they show their two excellent documentaries shown on 大象传媒4 (repeatedly) on 大象传媒 1 before or after Holby City and/or Casualty:

>> The NHS: A Difficult Beginning ( /programmes/b00cjn9y )

>> Greg Dyke on Nye Bevan ( /programmes/b00dn9hl )

These doc. show why the NHS was needed; what a truly remarkable achievement it was by Aneurin Nye Bevan and so proving what "one of the outstanding men of the 20th Century".

These docs ALSO need to be seen by YOUR MPs and indeed the wider public rather than just the select class who view 大象传媒4. The 大象传媒 owes it as duty to the public.

I enjoyed the programme, but found it disconcerting to see so little discussion of social enterprises and their role in these NHS spinouts. Instead we had talk of for profit companies taking on services. This is indeed dangerous and the thought of services within the NHS being run on commercial grounds is alarming. However, what social enterprises can deliver is the efficiency savings they need run through a company whose primary motive is to provide a social good. The concern is that this message is not getting through. The press frames it as a form of privatisation - offloading services onto companies which will then sacrifice service for profit.

In truth there are many social enterprises bringing incredible innovation into the the NHS. At the company I work for we've dealt with organisations such as the City Health partnership - a social enterprise spun out of front line NHS staff - and Patients Know Best which offers a software solution which enables patients to communicate swiftly with every clinician involved in their treatment.

Such organisations can, and are, adding incredible value to the NHS and their involvement needs to be championed. Of course, doing so requires a greater level of awareness among public service commissioners about the benefits social enterprises can bring. But that's a topic for another thread entirely.

Interesting to see how Gerry Robinson has changed his position on the NHS.

When he did programs for Channel 4 - check the web - his position was on the side of the patients and the very bad treatment dished out daily by staff who couldn't care less about the people they were suppose to be caring for. The old, the dying and especially people who had no one to speak out for them.

One program for 大象传媒 and all he cares about is the people who work for the NHS and the patients and people who use the NHS are voiceless.

This is the contamination of the bias 大象传媒 - any changes that come from the Tories even if it improves the standards for the patients is condemned.

We who have the misfortune to have to use the NHS - not the one off emergency treatment - know that the whole system had been changed in the last 10 years - to a NHS that is run for the Doctors, Nurses and anyone else who works in this once great institution and at the bottom of the pile is the helpless patients.

I noticed that Matthew Wright of 'The Wright Stuff' on Channel 5 - a total lefty - and would never let viewer say a bad word about the NHS staff. In his eyes they were all 'little angels'.

He had a back operation and had an extended stay in hospital where he had his eyes opened and reports how the nurses stand around chatting and eating biscuits, drinking tea and ignoring their patients. They are angels no more.

The NHS needs very big changes, to go on as it is, no longer serves the patients but serving the Health Workers.

The only way to do this is to give all the power to the GPs who are answerable to the patients and have the most contact with the patients, before and after hospital treatment.

NHS must change now or more people will die from the lack of care being given in our hospitals and to every health worker who is made redundant, I say good bye to good rubbish.

There are too many of you who should not be doing this job, you are not fit to work in McDonalds. Culling is well over due for most of you as there is not a caring bone in your body.

Shame on you Gerry Robinson, you sold out to the bias 大象传媒.

I notice all the comments on the page are from NHS workers and don't want anything to change because they have a wonderful easy life on the NHS - which is Tax Payers' money and don't want to get off the gravy train.

Timeto speak.
I am not an NHS worker but do find your comments somewhat biased.
I have had the misfortune to have been diagnosed with a chronic illness but I cannot fault the care I received in my local hospital. The consultant and her team were dedicated and diligent professionals. I agree like in any other profession or job there will be certain people who should not be doing that job, but this is not true of every NHS worker.
I am genuinely sorry if you had such an unfortunate experience of the NHS to voice such comments.
I honestly do not think however that the proposed upheaval in the NHS will improve those 'unprofessional' professionals the only people that I can see being affected are the'poor' patients and poor being the operative word.
I have been a teacher for many years and the thing that improved 'productivity' were Ofsted inspections, teachers who should not have been in the job were found out!!!
Those who genuinely cared were given well deserved grade1&2s.
I am afraid for my future as I have a chronic illness and have a price tag on my head when I walk into my GPs I think it could affect our working relationship.
I am afraid all I can see ahead is further chaos from a Government that does not listen to the ground swell of opinion from the experts, they did the same when I was teaching and introduced far too many changes too quickly, no one listened to the teachers then, who knew best how students learned and billions were wasted, I was there I saw it happen please believe me!

I am a physiotherapist in the NHS and I have worked in both private and NHS settings as well as abroad. I am in agreement with Gerry Robinson and I am deeply concerned about the impact these reforms will have on the delivery of quality services to patients.
In response to the above comment I would like to point out that the majority of health care professionals working in the NHS work under high pressure situations to do the best we can for patients. I know I can speak for myself and many of my colleagues that we do not go into nursing/physio for the money, but because we are driven by the satisfaction of providing good care and seeing people get better.
We are already used to working with staff shortages, but recent further cuts to budgets are seeing further staff posts 'frozen' and no training budgets to further our professional development and improve our skills.
I feel slightly aggrieved to read 'Timetospeak' 's comment that its an 'easy life' in the NHS because in my own experience it is far harder to work in the NHS than the private sector.
I think the other slant on the reforms to consider is the impact it has on NHS frontline workers who are already stretched ... this will, and already is, directly affecting our ability to provide the best care to patients.

I don鈥檛 know how TimetoSpeak (9) knows all the comments on the page are from NHS workers but I can assure him I am not one! Nor is he right to imply Sir Gerry Robinson has made only one program for the 大象传媒. He has made several on Rotherham Hospital in South Yorkshire, starting five years ago. And while he would not agree that all NHS workers have a wonderful easy life, he has been very critical politicians who spin good stories but fail to plan effective strategies and managers who fail to manage. Both of these demoralise staff.

TimetoSpeak claims the biased 大象传媒 has caused Robinson to condemn changes that come from the Tories that would improve the standards for patients. He is right that Robinson is highly critical of Lansley鈥檚 reforms but I suggest his experience of running large organisations and his understanding of the NHS cause this not the 大象传媒.

I wonder if TimetoSpeak is a freemarketeer who has not yet come to terms with the failure of deregulation and is determined to see off any competition from the good, rational, cooperative management Robinson cautiously advocates.

Golden2011 and sweg.
The majority of every day staff who come into contact with patients are doing their job like a factory worker. They don't see people - they might as well be objects on a conveyor belt.

Unlike the factory worker, who works non stop to reach targets the NHS staff can move around faking working and ignore that helpless person and ignore their suffering. You have to have a heart of stone to do that.

Vet nurses are 1000 times more caring then these health workers, they should not be allowed anywhere near a human, they would not be tolerated near animals.

We have seen enough programs on TV to know that. Walk into any Ward that has elderly patients - in the last days of their lives - and you can see it for yourself.

They can't make official complaints so are left thirsty, starving and dirty. This I know from experience. If a member of the family visits the hospital every day, only to clean and feed that member of their family - not complaining about the nurses - just doing the job because they love their family after three days they are refused access.
Why? The nurses do not want witnesses to their cruelty.

While the patients suffer they sit around chatting and doing nothing for their patients even when they are crying out for help. Yes crying out.

The same attitude I have found both as an in-patient and out-patient. Total lazy useless nurses.
If you are working in the hospital and are caring for your patients, take a look at your fellow workers and note what they do for their patients.

They may be lovely to you, their fellow workers and a friend to you but to their patients they are the devil. The weaker you are the worse they are.
We have to have whistleblowers in the NHS.
Note, all whistleblowers in the NHS are sacked, unbelievable in my eyes.
Just by doing that it proves to me that the NHS only takes care and protects the staff.

If the NHS staff were any good Whistleblowers would be honored by their fellow workers and rewarded by the hospital.

The NHS needs total overhauling and a system where the patients is God with strong Management.

The Doctor who has the budget and can sent his/her patients to hospitals were he doesn't get complaints from his patients about the care they received will soon have to change it ways and sort it's staff out.

Right now who do the patients have to complain to?
Only the Managers of the hospital.

How many millions of the yearly NHS budget is paid out in%

Timetospeak- I disagree completely with your veiws re NHS, although I do conciede there are fundamental problems with the current system by which the NHS works. I am a physio working in the NHS and the one fundamental problem I have observed is that there is a conflict between administrators making decisions based upon costings from an office experiencing no patient contact, and professionals with patient contact with a realistic veiw of the problems that face the service on the ground. These problems will not be over come by introducing private ventures into the NHS field/ Southern cross nursing homes should be a stark reminder of how faciliating a profit making private company to provide "care" often leads to poor decisions to insure best possible return ! The lack of consideration of nurses/doctors/Ahp's concerns over decades has generated an environment were the status quo has been accepted as it is too difficult to change, and persons who voice concerns are far from rewarded for their efforts.

The reforms proposed are being rail roaded through by a government who came together when neither party had enough support for an overall majority. They will lead to further inequality in care and will undoubtedly affect the most vunerable members of our society.

The NHS needs reform-but could trusts not take an approach of employing trouble shooters to identify areas of waste/ ineffiency and give them the role of improving these areas?

Gerry is a man with a public platform and has respect from both business quarters and NHS staff, I propose he is a figurehead to lead the case for a stringent reveiw of the current proposals and formulate an agreed reform plan that should be put to the nation to vote on!

Golden2011 and sweg.
The majority of every day staff who come into contact with patients are doing their job like a factory worker. They don't see people - they might as well be objects on a conveyor belt.

Unlike the factory worker, who works non stop to reach targets the NHS staff can move around faking working and ignore that helpless person and ignore their suffering. You have to have a heart of stone to do that.

Vet nurses are 1000 times more caring then these health workers, they should not be allowed anywhere near a human, they would not be tolerated near animals.

We have seen enough programs on TV to know that. Walk into any Ward that has elderly patients - in the last days of their lives - and you can see it for yourself.

They can't make official complaints so are left thirsty, starving and dirty. This I know from experience. If a member of the family visits the hospital every day, only to clean and feed that member of their family - not complaining about the nurses - just doing the job because they love their family after three days they are refused access.
Why? The nurses do not want witnesses to their cruelty.

While the patients suffer they sit around chatting and doing nothing for their patients even when they are crying out for help. Yes crying out.

The same attitude I have found both as an in-patient and out-patient. Total lazy useless nurses.
If you are working in the hospital and are caring for your patients, take a look at your fellow workers and note what they do for their patients.

They may be lovely to you, their fellow workers and a friend to you but to their patients they are the devil. The weaker you are the worse they are.
We have to have whistleblowers in the NHS.
Note, all whistleblowers in the NHS are sacked, unbelievable in my eyes.
Just by doing that it proves to me that the NHS only takes care and protects the staff.

If the NHS staff were any good Whistleblowers would be honored by their fellow workers and rewarded by the hospital.

The NHS needs total overhauling and a system where the patients is God with strong Management.

The Doctor who has the budget and can sent his/her patients to hospitals were he doesn't get complaints from his patients about the care they received will soon have to change it ways and sort it's staff out.

Right now who do the patients have to complain to?
Only the Managers of the hospital.

How many millions of the yearly NHS budget is paid out i

@12. At 00:31 7th Sep 2011, George Talbot

I wholly agree with your post but I had decided to not respond to @TimetoSpeak because it was clear he is not one can reason with.

I too have ONLY connection with the NHS as a Customer (or patient when ill). S/he clearly hadn't read my posts.

I am a professional who knows as Sir Gerry Robinson. All Sir Gerry Robinson has done is independently vindicate my independent view.

Indeed I would urge Sir Gerry Robinson to get the likes of Sir Leahy, Sir Branson, Lord Putnam, Mr Greg Dyke et al and convince this fool Government this is no way to run the NHS or indeed the country. They really haven't clue what they are doing, as Labour before them - remember the 10p tax fiasco?!!!

@15. At 01:29 7th Sep 2011, TimetoSpeak wrote:

"Right now who do the patients have to complain to?
Only the Managers of the hospital."

Proving you didn't read my posts such as this @6. At 00:14 6th Sep 2011.

Why not try it?

How many millions of the yearly NHS budget is paid out in compensation to badly treated patients?

This money should be spent on drugs and patient care. This is tax payers hard earned money being wasted because the so called health workers are mistreating the patients.

We all know that the Drs. and Nurses are putting each other first and watching each other's backs and not taking responsibility for proper care of their patients.
The reforms cannot come in too soon for most of the chronically ill and elderly.
Just today I had an appointment cancelled - it was made 4 days ago after waiting 3 weeks for it to come through. Why? The Dr is going on day something or other. I know it is some jolly given by a Drug Company and his patients can wait.

My complaints about Drs. are nothing compared to Nursing staff. They really are the pits. If only they would bring back Matron - the NHS would be a better and cleaner place.
There are good nurses but it is like finding a needle in a hay stack. Very sad for all the people using the NHS esp the in- patients.

Goldenrose2011 - sounds like you use a small local hospital. Go into a City hospital and you may die of shock if you were ever unlucky to be admitted. Fear for your life unless you can get a family member to visit you daily. I have been in enough City hospitals and can tell you stories of nursing care that would make your blood run cold.
I am young enough to be able to complain when Drs. did their rounds but the very old and weak were so badly treated with no one to speak up for them.
As an in-patient I'm usually looking after other patients who cannot reach food or water. Isn't that sick. The nurses are all outside the Ward chatting and laughing. Don't bother asking for water - get it yourself.

The school changes were made because so many children were leaving school unable to read or write. Don't you think something was very wrong there.? These kids left school with no future - who is to blame for that ????

sweg - Don't be afraid of the impact these reforms will have on the quality of service to patients. We are getting NONE so any changes can only be for the better.
You NHS workers only talk about the NHS from your point of view - try seeing it from the patient's - you will not be so proud if you did.

Everyone in whatever job they do, works under pressure. You really are kidding yourselves. Every job has staff shortages, cuts, wages freezes etc but it is only the Public Sector that%

sweg - Don't be afraid of the impact these reforms will have on the quality of service to patients. We are getting NONE so any changes can only be for the better.
You NHS workers only talk about the NHS from your point of view - try seeing it from the patient's - you will not be so proud if you did.

Everyone in whatever job they do, works under pressure. You really are kidding yourselves. Every job has staff shortages, cuts, wages freezes etc but it is only the Public Sector that bleats on about it.

You really are a pampered lot. If you can't cut it in the NHS go find a job where you can. Please don't stay because the only ones who will suffer are the NHS patients.

If all the NHS staff got down and did their jobs while they were on duty the work load would be spread evenly and none of you would be under pressure. Give your lazy fellow worker a kick up the ass and tell them to get on with it.
Then maybe we will get "best care". We sure as hell are not getting it now.

@19. At 03:06 7th Sep 2011, TimetoSpeak wrote:

"You really are a pampered lot. If you can't cut it in the NHS go find a job where you can. Please don't stay because the only ones who will suffer are the NHS patients."


You really have got a bee in your bonnet.


"You really are a pampered lot." You could equally be talking about Mr David Cameron, PM, Mr George Osborne, Chancellor, Mr Andrew Lansley et al?

They clearly couldn't cut it in the REAL world and so went off to become Politicians. Just look at their personal career history.

Judging large organisations by citing individual cases can be misleading especially when they are subject to repeated reorganisations. But when judged on a range of factors, international comparisons show the NHS scores above average while being below average on total costs. And with the sharp rise in spending, it has been improving. See, for example, the two pages of charts from the Commonwealth Fund at

See also the OECD鈥檚 Health at a Glance 2009 webpage at and, if you have time to study their informative charts, the PowerPoint file at

And in Radio 4鈥檚 Analysis, Michael Blastland realistically considered the basics of providing healthcare, 5th June. Unhealthy Expectations? is still available from /programmes/b011j7vr

With reference to Timetospeak.
I am genuinely sorry that you have obviously had some very bad experiences of the NHS and do hope that formal complaints were made to the right people and followed up.
As I said in an earlier post if the Government paid for regular and stringent inspections in hospitals then perhaps this would help to address inefficiency and where money is wasted. These inspections need to be done unannounced to be of any value, as they should be in schools.
As regards schools yes there will always be a minority of children who will leave school who have poor reading skills, unfortunately there always have been despite teacher's best efforts. I was fortunate when I taught in school (not private or middle class)all our pupils moved onto secondary school with a a reading age well above their chronological age. However in some areas because of dysfunctional families, disadvantage, books replaced by computer games etc, special needs and disaffected youngsters, you will sadly always have a percentage of children who underachieve and yes this continually needs to be addressed. The changes I referred to were the National Curriculum. The Government of the day rushed through drastic changes and every teacher in every school from nursery to secondary were issued with many files on every subject , it soon became apparent that these were totally unworkable and before we had a chance to take the cellophane packaging off we had to throw them away and a more sensible and revised version was to be introduced. Changes are still being made to this today!!! This is what I mean about wasting billions, a knee jerk reaction to things is not the answer, the Government need to listen to the people before they forge ahead and cause further upheaval. Yes I agree things do need to change, especially in the care of the vulnerable but let us be sensible about these please and don't throw the baby out with the bath water!!!.

Timetospeak obviously has had a bad experience in the NHS, but I think that you cannot tarnish us all with the same brush.
We do regular patient satisfaction questionnaires with very good results (94% happy with our service and how they are treated) and so we have factual evidence of providing a good service.
As for working else where ... been there, done that! I think you misunderstand my point about this. I am not having a whinge about how we as staff are treated in the NHS, far from it. My point is that the further the staff are stretched (due to rearranging services and budget cuts) the more the negative impact on the patient. This, unlike in other jobs, can have serious consequences.
Take this simple example. On Sunday we had 3 staff on (one nurse, one doctor and one physio) and 28 people waiting in an Urgent treatment centre. They had to wait considerably longer(2-3 hours) than if we had been fully staffed with 6 staff. You can see how this directly impacts on a patients waiting time and experience. This kind of scenario is not new in the NHS - but having just had our PCT disbanded, I can see a direct impact of the reforms on our service already.

Is it possible to discover what percentage of the NHS bill is paid to "outside service providers".

Thirty years ago hospitals were given much larger budgets to support agency staff than to employ permanent nursing staff. As was mentioned in this evening's programme, permanent NHS staff are always preferable to "outside service providers" precisely because they are permanent and familiar with everyone and everything within the service. It does seem that the NHS is funding more and more private enterprise. Has this worked to our benefit with transport - or the power companies? "Choice" has not proved to be all it is cracked up to be for us, the consumers, but still company profits rise as our bills increase, just as the spending on health (providers) goes up and the system becomes more cumbersome.

It is shameful that GPs and medically trained experts who have studied for so long to treat patients have been obliged to jump through hoop after hoop to justify their every move and their very existence. Another public service bites the dust.

To begin yes I have worked in the NHS- for nearly 30 years working at all levels from healthcare assistant to senior manager but have also used the service and I am carer to elderly parents so have witnessed the system from all levels.

I have heard Mr Lansley speak and have had opportunity to question but what came across then, also in Gerry Robinson's programme and in the last year, is the lack of open discussion, from either those who use the service or work within it. There is no listening and I like many have already took the option suggested by respondents and left. Not because it was an easy life, but because I could not face what was being suggested and can only see the end of the NHS.

However as Gerry Robinson pointed out at a time when the NHS requires those with experience they are already gone - as encouraged by Mr Lansley, but ironically these people can work as freelance or in some cases return now to substantive posts - so what if any efficiency has been achieved?

The NHS is facing a critical time and I am delighted this programme went out as many do not know what is happening and how this could change the face of our health care system, at least it put a range of views not sure Mr Lansley has ever done this- he had a view before he came to power which he expressed in November 2009 and followed it through but with greater consequence in 2010, cuts of 50% of staff taking out levels of the system now he continues with the same rhetoric as Anna says another public service bites the dust, all hail the market or is that those who can afford it or who do not have a long term illness and cannot get insurance?

I find that whenever Gerry Robinson or others deal with the NHS problems they always forget when this breakup of the NHS started. Go back 30 years and the same promises, when the Conservatives brought in the Trust system and got rid of the word National from the NHS. The fragmentation was then and carried on with the Labour Government. All this government is doing is continuing with the Thatcherisation of the service. They are doing away with the word Service from the NHS.

I have been paralysed since 1953 and worked for the NHS 10 years before retiring 16 years ago. I have seen Stoke Mandeville Hospital, especially the Spinal Unit, slowly become smaller and under-staffed.

Gerry Robinson shouild really speak to people who know what has gone on inside the NHS instead of thsoe who have a vested interest in their own power.