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It is not only a lottery as to where you live and what hospitals are in your catchment area but what doctor/specialisr/surgeon you see is also a lottery!
I injured my knee so I went to West Middlesex and was told "nothing wrong" eventually was referred to another hospital almost two years later and was told I had a fractured knee!
West Middlesex also operated on my shoulder eight years ago and made a dogs breakfast of it I am still suffering two operations (one private) later.
In my opinion they should turn West Middlesex hospital into a car park and we would all be better off!

I had the misfortune recently of being admitted as an emergency patient at my local NHS hospital-the JR in Oxford-with acute abdominal pain. Being a bank holiday I expected things would move very slowly but I was very impressed with the 'system'.Following a visit to the emergency on-call GP at 4.45 pm, I was in the triage area of the SEU (Surgical Emergency Unit) at the hospital, by 5.30 pm,and after going through a quick medical history I was given morphine for my pain. By 6pm I was in a bed on the assessment ward feeling a lot more comfortable!
I only have absolute praise for all the doctors and nurses who looked after me throughout the week i spent there and think they should all be paid more for their tireless efforts!(One house doctor who visited looked like he hadnt slept for a week and i cannot understand why it is necessary for them to work such long hours?Surely not good for their health.....sleep deprivation being a long known form of torture, why put them through it?)

Doctors are not all delivering what is expected of them, and they want more money?

I had a storke 5-6 years ago, my doctor then weas called, he given me a tablet which I could not go and get as I was incapacitated and have no family. I was left alone. Othetrs, who were sent to hopspital were thought how to deal with it, I had none of that.
Consequently, I hade to discover things formyself. At 71, I can now hardly walk more than 100 yards.
Rec ently, I was asked to ask the doctor to book me a card to take me to hospital to seeto my eyes, The day came and I asked him for when the car was booked to be told that he had forgotten, now my next appointment is in August.

They should earn their money, which they don't. I was an operation manager and worked longer hours for mush less money and I delivered, ALWAYS.

Perhaps this is because they are too busy hiding mistakes and making sure the families of their mistakes do not get the information they need when things have gone wrong.

We have been trying for over 3 years to get my father's full medical records, we have managed to get some, but for some reason, in certain places on GP records No data recorded is entered, but what has been taken out.

TERMINAL drugs given to my father against his wishes when he was stating he was not in any pain. I was there, but I had been told he was dying and not to tell him.

2 Doctors informed my sister and I that he had oesophageal cancer, post mortem proves that not to be true, GP knew this was not true she had the results of the endoscopy faxed to her the day before dad's death, we have a copy of that fax sent on 22nd April 2004 at 1009 hours which she initialled "RSS" and wrote "file in notes", but still she told my sister and I dad was dying of oesophageal cancer.

Please see web page www.ralphwinstanleyofwath.blogspot.com

Why else would moral be low, hiding information can be extremely tiring and worrying.

Linda

'The NHS is in the best shape it's ever been in'. Who says so ?
As an elected representative serving on an advisory committee I can give two examples of problems. Firstly a patient finishes a proceedure in hospital- hospital cannot afford to call them back to outpatient clinic and passes them back to GP who has to read notes and second guess what the surgeon or his team would do instinctivly.
Secondly a consultant sees a patient on GP referral, feels another consultant should see patient. New proceedure refer patient back to GP and re-refer to new consultant. These are examples of practices which vastly increase paperwork and substantially reduce patient/ health professional face to face time in the name of reform. Centralized directive killing efficiency. I've got 15 to 20 more examples if you want them.

I am a student midwife who is about to qualify with a good degree classification. I have spent three years living on practically nothing, not seen much of my family and worked the same shifts as qualified midwives as well as studying. Now I have no prospect of a job because of budgetary constraints and will go to work in a shop. It cost the NHS 拢40,000 to train me. The wards I work on are so short staffed that I am waiting for the catatstrophic loss of a life to occur and hope that it is not one of my patients. If I am lucky I get a 10 minute break during a 13.5 hour shift and I am the rule rather than the exception. Maybe I am lucky that I am not going to work there?

Morale is rock bottom for juniors. One of the many reasons for that it that having put in years off work, racked up thousands of pounds of debt our employment opportunitites are so shaky. With over 30000 doctors applying for just over 18000 posts there is a very good chance you are going to be unemployed. But this isn't like other careers. Since the NHS is a monopoly employer there is nothing else. Unemployment means emigrating or changing careers. Right now my friends at Uni who became bankers, lawyers, accountants, etc all have better pay (fair enough) but also have better job security. When you factor in the emigrating every 6 months, taking postgraduate exams, stressful nights often with inadequate cover, daily abuse in the news about our apparent massive salaries and poor representation by the BMA to fight MMC you begin to understand why morale is low.

If I was 18 again I'd do something else. Now I've invested so much of my time in it I don't want to walk away but I'd advise all aspiring doctors to do something else.

I am retired and the majority of my younger colleagues in Obstetrics and Gynae cannot wait to join me.

What makes us demoralized? Fatuous statements like 'All women will have the choice of a home delivery' Oh yes? Where are the midwives coming from? Where are the experienced doctors who will come out during the day or night to retrieve risky and unpredictable situations - and why oh why are they shutting down small home-like units with dedicated staff who at least provided the more acceptable venue for many?

TAKE MEDICINE OUT OF POLITICS. Any management guru will tell you that money is not the employee's main or only goal Doing a job well and with personal and peer respect is what most crave.

I am retired and the majority of my younger colleagues in Obstetrics and Gynae cannot wait to join me.

What makes us demoralized? Fatuous statements like 'All women will have the choice of a home delivery' Oh yes? Where are the midwives coming from? Where are the experienced doctors who will come out during the day or night to retrieve risky and unpredictable situations - and why oh why are they shutting down small home-like units with dedicated staff who at least provided the more acceptable venue for many?

TAKE MEDICINE OUT OF POLITICS. Any management guru will tell you that money is not the employee's main or only goal Doing a job well and with personal and peer respect is what most crave.

Morale is rock bottom for juniors. One of the many reasons for that it that having put in years off work, racked up thousands of pounds of debt our employment opportunitites are so shaky. With over 30000 doctors applying for just over 18000 posts there is a very good chance you are going to be unemployed. But this isn't like other careers. Since the NHS is a monopoly employer there is nothing else. Unemployment means emigrating or changing careers. Right now my friends at Uni who became bankers, lawyers, accountants, etc all have better pay (fair enough) but also have better job security. When you factor in the emigrating every 6 months, taking postgraduate exams, stressful nights often with inadequate cover, daily abuse in the news about our apparent massive salaries and poor representation by the BMA to fight MMC you begin to understand why morale is low.

If I was 18 again I'd do something else. Now I've invested so much of my time in it I don't want to walk away but I'd advise all aspiring doctors to do something else.

There is no doubt that morale is incredibly low. Huge numbers of excellent junoir doctors have had their lives thrown into turmoil by the mismangaed attempts to change their trainging and the horrific recruitment process. Even now with only a couple of months before their jobs commence most do not know if they have a post and those that do have no notion of where the post is and what the terms and conditions are. For those of us not directly involved it is demoralising to see how little our royal college representatives value our junior collegues, it is distressing to see the miserable pay risesand therefore lack of value felt towards other NHS staff who mostly work incredibly hard. There is enormous waste in the NHS and cuts are made in wages to make up for this. Despite all of this I believe that most Drs and other staff believe in the values of the NHS and work hard (and much longer hours-which are un paid) to provide good care for the majority of patients. However this relies on goodwill which is rapidly failing.

Morale among doctors is under threat because of one huge issue, the debacle over postgraduate training. Those of us who are senior doctors are as concerned about this as our junior colleagues largely because we know how important a well-structured training system is to the present and future provision of patient care.

Much of the current discussion of the training crisis has focused on the failings of the application system, MTAS. This has been a disaster. But the problem started long before MTAS which has in some ways delivered what was asked of it. The real problem lies with the dogma of Modernising Medical Careers and its insistence that all applications be centralised and that they must all happen via a single annual process. The practical consequence of this is that all junior doctors applying for jobs have to apply in January for a maximum of four posts, in a limited range of specialties and ill-defined geographical areas (Units of Application). They were due to be informed in May - it will now be June or July for many - where they will be working from August for the next several years, and to which specialty they will be effectively committed for life, or that they have no job for August. There are no alternative processes, no other ways to secure employment in the NHS and effectively for most that means no way to work in the UK.

When I was a junior doctor I had to apply for scores of posts and get rejected for many without an interview. But each time I knew that the next week's BMJ would have another tranche of jobs and that eventually I would find one. It was stressful but never hopeless. This new system, dictated entirely by its ill-founded founding principle, means that you have one chance and no plan B. There are few things more degrading of morale than this.

Even if this system worked flawlessly it would be ideologically objectionable. With a system producing cases such as those publicised (see BMA News Review) over the last few months - of the doctor excluded because in citing published work he had correctly given his own name, breaching the 'anonymity' rule, or the London-born Cambridge-educated British doctor whose Vietnamese name saw him excluded because he lacked 'the right visa', and you have a disaster the consequences of which are only beginning to be felt and will resonate for some years whatever is now done.

Most doctors are not very political and most of the time just want to be left to look after their patients. We need a bit of a firm hand to do this in line with wider priorities, fair enough; but when our efforts are badly compromised by bad decisions outside our control we get unhappy. The politicians don't mind too much about that but if the reason I'm unhappy is that the system threatens to harm my patients then that matters. No amount of "stuffing our mouths with gold" can get round that, and never in my professional lifetime has this threat been achieved more comprehensively than this year. The responsibility does not lie with those who have implemented these changes, who have already begun to fall on their swords. The system has been politically driven and must now be accounted for by ministers.

There is no doubt that morale is incredibly low. Huge numbers of excellent junoir doctors have had their lives thrown into turmoil by the mismangaed attempts to change their trainging and the horrific recruitment process. Even now with only a couple of months before their jobs commence most do not know if they have a post and those that do have no notion of where the post is and what the terms and conditions are. For those of us not directly involved it is demoralising to see how little our royal college representatives value our junior collegues, it is distressing to see the miserable pay risesand therefore lack of value felt towards other NHS staff who mostly work incredibly hard. There is enormous waste in the NHS and cuts are made in wages to make up for this. Despite all of this I believe that most Drs and other staff believe in the values of the NHS and work hard (and much longer hours-which are un paid) to provide good care for the majority of patients. However this relies on goodwill which is rapidly failing.

I have no problem with what my GP does for me, but my big grumble is not being able to book an appointment ahead - say tomorrow or next week.
If the matter is urgent I can try 'phoning at 8am (and keep trying for half an hour to get through via the queuing system) then I will be given an appointment for today or the next available time. Last appointments are around 5.30 - 6pm.
How can a working person possibly organise one's life around such current constraints?
These constraints used not to be in existence. The system needs changing.

Morale among doctors is under threat because of one huge issue, the debacle over postgraduate training. Those of us who are senior doctors are as concerned about this as our junior colleagues largely because we know how important the training system is to present and future patients.

Much of the discussion of the training crisis has focused on the failings of the application system, MTAS. This has been a disaster. But the problem started long before MTAS. The real problem lies with the dogma of Modernising Medical Careers and its insistence that all applications be centralised via a single annual process. The practical consequence of this is that all junior doctors finishing basic training have to apply in January for a maximum of four posts, in a limited range of specialties and ill-defined geographical areas. They were due to be informed in May - it will now be June or July for many - where they will be working from August for the next several years, and to which specialty they will be effectively committed for life, or that they have no job for August. There are no other ways to secure employment in the NHS and effectively for most that means no way to work in the UK.

When I was a junior doctor I had to apply for scores of posts and get rejected for many. But each time I knew that next week there would be another tranche of jobs and that eventually I would find one. It was stressful but never hopeless. The new system, dictated entirely by its founding principle, means that you have one chance and no plan B. There are few things more degrading of morale than this.

Even if this system worked flawlessly it would be ideologically objectionable. Producing cases such as those publicised (see BMA News Review) over the last few months - of the doctor excluded because in citing published work he had correctly given his own name, breaching the 'anonymity' rule, or the London-born Cambridge-educated British doctor whose Vietnamese name saw him excluded because he lacked 'the right visa', it is a disaster the consequences of which are only beginning to be felt and will resonate for some years whatever is now done.

Most doctors are not very political and just want to be left to look after their patients. We need a bit of a firm hand to do this in line with wider priorities, fair enough; but when our efforts are compromised by bad decisions outside our control we get angry. The politicians don't mind too much about that but if the reason I'm angry is that the system threatens to harm my patients then that matters. No amount of "stuffing our mouths with gold" can get round that, and never in my professional lifetime has this threat been achieved more comprehensively than this year. The responsibility does not lie with those who have implemented these changes, who have already begun to fall on their swords. The system has been politically driven and must now be accounted for by ministers.

Whatever you believe about the junior doctors' recruitment debacle, just *don't* believe that the BMA - before Sunday 20th, at least - honestly represents doctors' opinions.

Specifically do not believe the misinformation that James Johnson put about as to RemedyUK's legal challenge. Remedy's is the only sensible voice we are hearing in this. They also *did not* do a '180 degree turn' on Thursday (look at their press releases from April for confirmation that they have held a consistent and fair line).

In the media coverage, do not give undue weight to what any officer from the BMA - and especially the junior doctors' committee chair, she's living on borrowed time - says. Rather give people from RemedyUK and other sensible figures like Prof. Morris Brown or Prof. O'Rahilly a fair hearing.

Has anyone compared the increase in doctors' pay since Tony Blair took office as PM with the increase in MP's salaries over the same period.

I note the SNP are looking to make productivity saving by a huge reduction in the size of their cabinet - can we expect Westminster to do likewise?

I'm a consultant neurologist. In 1997 when I was appointed my general neurology outpatient waiting list time was 18 weeks I rapidly got it down to under 16 weeks(without the help of HMG targets) and found a balance between seeing new patients but also being able to continue to see patients with distressing chronic conditions like difficult to control epilepsy, MS. Parkinson's disease etc. 16 weeks is still a long time to wait but at least you got to see me or another consultant and got a difinative opinion.

3 Months ago I saw a man who had waited 14 months - yes 14 months to see me. His GP had referred him to an orthopaedic surgeon with sore feet. But because of "new ways of working" and waiting list pressures he was not allowed to see the consultant rather diverted to a physiotherapist(hence he came off the waiting list and so did not have to meet a target)the physio didn't know what was wrong with him so sent him to a podiatrist - who didn't know what wrong with him - so sent him - yes to an orthopaedic surgeon - who saw him made the diagnosis and told the patient he needed a neurologist - when the patient came to see me his opening words were "I'm so worried I've seen 3 specialists and they don't know what is wrong with me" - his "journey" and HMG is very big on the "patient journey" from GP to me was 14 months. Had the GP been allowed to send him direct to the orthopaedic consultant it would have been 4 months at most.

Having spent 14 years training to be a consultant and spending time abroad widen my knowledge and skills in epilepsy I was told by my managers 3 years ago that a GP who had done some "extra training" could see all my "easy patients" I could see the "difficult" ones - as someone who as a young woman suffered from epilepsy I was aghast - there is no such thing in my opinion as an easy epilepsy - just people fixated on waiting list targets - sadly I think patients are not put at the heart of care. As a result of this change in how I delivered care to my patients I decided to find another job in a hospital that would allow me to offer the highest possible standard of care to my patients.

I have no problem with what my GP does for me. My big grumble is not being able to book an appointment ahead - say tomorrow or next week.
If the matter is urgent I can try 'phoning from 8am (and keep trying for half an hour to get through via a queueing system). I will then be given an appointment for today or, if all those appointments have been taken, then the next available time. Last appointments are early evening - around 5.30-6pm.
How can a working person possibly organise one's life around such constraints? These constraints used not to exist. The system needs changing.

Whatever you believe about the junior doctors' recruitment debacle, just *don't* believe that the BMA - before Sunday 20th, at least - honestly represents doctors' opinions.

Specifically do not believe the misinformation that James Johnson put about as to RemedyUK's legal challenge. Remedy's is the only sensible voice we are hearing in this. They also *did not* do a '180 degree turn' on Thursday (look at their press releases from April for confirmation that they have held a consistent and fair line).

In the media coverage, do not give undue weight to what any officer from the BMA - and especially the junior doctors' committee chair, she's living on borrowed time - says. Rather give people from RemedyUK and other sensible figures like Prof. Morris Brown or Prof. O'Rahilly a fair hearing.

Yes, we are working shorter hours: after 24 years of working an average of 80 hours a week, I'm now working only 55- still significantly more than the average person in the UK.

I do earn more than I did (though not the amounts that the Government's spin doctors would have you believe); as a GP, 45% of my income comes from payments for quality of care, based on a framework devised by the Department of Health. I doubt that that any other profession could point to such a close link between the quality of their work and the amount they earn. If Patricia Hewitt was paid on the same basis she'd be giving money back to the taxpayer.

As for morale, the constant interference with our work by people who will never have to do our job, and neither understand nor care about it would drive anybody's morale down. Despite that we carry on, not just to pay the bills but because we care about the patients , who are our primary reason for doing this job.

My 88 year old Mother has been at the Hammersmith Hospital for exactly one month. She was admitted as she had lost her sight in her left eye (I'm told because she had a stroke at the back of her eye). Since then she has had two colonoskopies (spelling?) and another one down her throat. They cut out something and did not close the wound in her insides so that she bled about a pint of blood. This wound was closed when they performed the second colonoscopy (spelling?). They then gave her a blood transfusion to replace the blood she had lost. She was also given an intravenous drip. Her legs have swollen quite badly (I had to point this fact out to the nurse as no-one had spotted it) I later found she had large red marks on her upper left arm and lower right arm (again it was I who had to point these out to the nurse as no-one had seen these problems). She is now incontinent which to my knowledge she has never been before. Her arms are black and blue from where the various pipes have been inserted for her drip, to receive blood and to take blood samples. All I can say is that she is a very sorry sight and much of the damage seems to have been caused by being in a hospital.

I鈥檝e been forced to visit her twice a day when she is given her lunch and dinner as there is no assistance given to her in cutting up the food or feeding her. She can use her right arm (she can鈥檛 use her left arm) but she needs help in cutting up the food and placing a piece of paper towel on her chest and getting the bedside table adjusted to the right level so that she can see the food and try to reach it. I鈥檝e heard that trays once placed on patients tables are just left there and if the patient can鈥檛 eat the food 鈥� that鈥檚 their problem and the unused tray is then removed when the dinner lady comes back to collect them. I suspect the nurses don鈥檛 even know or care if patients haven鈥檛 had anything to eat.

Having gone in for one problem with also an irregular heartbeat, she has now collected a number of other problems thanks to being in a hospital. I mentioned to a nurse recently that my Mother had come in with one problem but has since got four or five problems 鈥� I can promise you her reply was 鈥淭his is what happens when you come to hospital 鈥� you鈥檙e lucky it鈥檚 only four or five problems 鈥� it could result in ten problems鈥� 鈥� and that was from a nurse.

The Doctors and Nurses could make up a mini United Nations and it鈥檚 difficult to find many from the UK. Some of the nurses are very good but unfortunately others are obviously there purely as a way of being in Britain or to earn a living. They have little compassion or interest in caring for patients. To find a nurse when the 鈥淩ed Button鈥� is pressed can be difficult and my Mother has had to lie in her urine for long periods before she can get some help.

If this is what Tony Blair and his merry men think is the 鈥渢he best state that the NHS has ever been in鈥� then they are completely wrong and living in 鈥渃loud cuckoo land鈥�. They may have spent a great deal of money on the NHS but have delivered a very poor standard of service. Just try finding a Doctor at a hospital on a weekend 鈥� apparently there is ONE Doctor on duty on a weekend at the Hammersmith Hospital. The Management of the Hospital obviously haven鈥檛 yet worked out that ill people aren鈥檛 just ill between a Monday to Friday 鈥� although I have noticed that they is an attempt to reduce the number of patients in the hospital at the weekends. This obviously helps the Doctors and some of the nursing staff to have 鈥渘ice weekends鈥� at home with their families.

I hope when my time comes to leave this life that I鈥檒l remain fit to the end and then just drop down dead with a heart attack so that I won鈥檛 need to prolong my problems and experience any suffering by having to be 鈥渃ared for鈥� by one of Blair鈥檚 and Hewett鈥檚 wonderful NHS hospitals.

What a lot of C--p! Doctors have never had it so good, as good old Maggie Thatcher used to say.
I am between doctors at the moment because to be honest i have never found a good one yet.
I usually have to wait anything up too 10-14 days to get an appointment, and hospital visits, forget it.
one example- my last visit to the doctor took 10 days to arrange, and then i got nothing but panic stations from the doctor. But after having to make my own arrangements to get to the hospital, (my doctor said i was very ill and dying but could not justify calling an ambulance.
When i got to the hospital, they wanted to operate straight away, but i panicked and went home to let my landlord know. When i had plucked up enough courageand went back, they tried to blame me for taking so long to arrange it. Not the fact i could not get past the guard dog of a receptionist at the front desk.
Finally i have run out of tablets and am ill but i would rather do this way, rather than re-register all over again. Doctors are not worth even half the money they are paid. I wouldn't employ them with washers, and plastic ones at that.

I am a GP. My patients, I hope, trust me. In return I do the best I possibly can for them.
Our negotiators with the last contract episode, came to an agreement, with the government, on what we were worth. There were 2 parts to the agreement. One was to make allowances for the way in which our pay had fallen back compared to other profesionals, but moreover, to get paid for providing a quality service. The government set targets across the board, that they believed were necessary for the good of the nations health.
In response to the second part, we set in place structures and protocols to make sure that we provided for our patients this excellent level of service demanded of us by the government.
What was the Governments response to our hard work?
Was it to sing our praises from the rooftops? Was it to claim credit themselves for one sector of society not only doing what was asked of it, but doing it well?
No.
It was to initiate a media campaign calling us greedy and uncaring.
I did not write the contract. I did not set the pay scale, I did not set the targets.
I got on with the job.
My initial point about trust is all based on the Doctor:Patient relationship. I have not changed. I will still give my home phone number to the terminally ill. I will still work well beyond my contracted hours, and yet patients are looking at me differently recently.
In a careers sense MTAS and MMC have been a disaster. In a medical sense, the eroding of trust in doctors, purposefully carried out by a spin competent deceitful government is unforgivable.

At present there is a great deal of unhappy news regarding the NHS and doctors in particular. Morale is certainly low. This is in part due to the ill conceived MTAS system - never piloted or validated but rolled out in its entirety. Thousands of junior doctors and their families have been caught up in a situation which changed weekly. Many felt that our "union" - the BMA did not represent grass roots opinion and was indeed promoting many of the DoH's policies without effective opposition. When Mr Johnson, the chairman of Council opted to write to 'The Times' and sign his letter as Chairmanf of the Council of the BMA, this was rightly condemned by senior and junior colleagues. His position was untenable.

More concern should be laid at the Modernising Medical Careers (MMC) proposals. This will impact on patient safety in the future - without doubt.

Doctors are better paid - although the pay scales do not reflect that ALL GP's are on 拢106, 000 pa or that consultants get 拢100 000 pa on average. However that fails to be reported accurately as it is not quite so headline grabbing. GP's are independent practitioners - they effectively run a business. Many are self employed. The Govt. felt that consultants were not putting in the hours or doing the work and thought the new contracts would 'sort' them out. Little did they appreciate that many were actually working very hard, and that they were getting value for money.

The financial issues aside, morale is low for many reasons. The constant 'reforms' with headline grabbing initiatives have often been churned out in a "one pattern fits all" manner. We see wards closing, nurses, physiotherapists and OT's unable to secure jobs - but numerous other "managers" or "facilitators" being recruited. With BILLIONS being spent on IT/ computer systems- still not "fit for purpose,"- not to mention the expenditure on NHSDirect (with no great reduction in either A&E or GP attendances since its induction),Walk in Centres, 'Choose and Book' and a host of other private initiatives, cynicism is rife, confidence plummeting. Yet this is still praised by the SoS for Health as "the best year ever for the NHS!

The NHS is remarkable on many levels. It needs less bureaucrats and more "hands on" people. No one denies that some reforms are necessary.Doctors wsh to compete in a fair recruitment environment. However when headlines and short term gains are the sole focus of whichever political party is in power, the NHS will not be able to make lasting change or benefits.

I think a line has been drawn and the public are not going to allow our politicians to spin their way out of this. If you ask patients about their experiences, the praise is often for the doctors, nurses, physios, ot's and other carers. Their criticism is often about hospital cleanlieness, being moved from ward to ward, overcharged prices for phone calls,or car parks. I doubt that has changed despite the extra billions. You cannot buy courtesy, manners, dignity and respect.

There is no doubt millions has been poured into the NHS -paid for by increases in taxes such as NI. Yet

I have just had numerous tests and an urgent operation at the Royal Berkshire Hospital in Reading where I spent four days. I was at the receiving end of an organisation driven by compassion and professionalism. I had a first class experience of ALL staff, I have no idea how they could have done a single thing better. I am very, very grateful to them, and for the excellence of what they did during what was a difficult experience for me.

I never realized just how complex some medical procedures are, nor the many skills (and people) required to implement them.

Morale amongst junior doctors is at an all time low. Many of us are unsure not only where we will be working in 10 weeks time, but also whether we will be employed in the NHS at all.

None of us overly resent the long days or even the thankless (unpaid) additional hours we undertake for the care of our patients - we do this because we have a vocation for medicine.

Department of health be warned. Being a doctor is fast becoming more of a job than a vocation - amd there are far better jobs out there.

Why shouldn't doctors be 'better' paid? In fact, doctors are now paid what they are owed, for the work they do - particularly GP's. Perhaps more should be made of the inflation-busting pay rises awarded to MP's by themselves? Or the money-hungry ruling-caste of managers within the NHS?

The new selection process - a solution for a problem that did not exist, except in the narrow minds of New Labour class-war ideologues - has been an utter disaster. Regardless of whether computerised or not, the process structure remains the same. The design is ill-conceived, based on unvalidated concepts. The initial selection of candidates for interview has been subject to irregularities, and in some cases seems to have been almost arbritrary. Furthermore, no provision has been made for the cohort of partially trained, specialising doctors falling between the 'old' and 'new' training systems. The centralised rigidity of this reformed programme means thousands doctors face redundancy, or 'second-best' dead-end jobs (if lucky). There has always been competition for jobs in Medicine - the current situation is artificial, not a necessity. And remember, the NHS is the absolute monopoly employer for specialising doctors in the UK.

Beyond this selection gateway, lies a future of restructured training of questionable worth. Indeed, I would say impoverished. It will produce doctors officially 'competent' on paper, (they will have the forms to prove it), but they will not be as well-rounded or as experienced as they should be. But cheaper, perhaps, and producing more 'measurable' results to please the DoH.

That Seniors within the profession have left a generation of their juniors exposed to the self-interested whim of Government, demonstrates a woeful neglect of their duty of care. Doctors feel utterly betrayed. So should any one who pays their tax, or cares about the quality of treatment received by patients under the NHS.

Not for nothing has Johnson been obliged to stand down. His graceless response clearly shows his lack of insight, and willingness to side with Government against his own profession. It merely emphasises why he had to go.

I just previewed a comment I was about to submit and then submitted it.

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Please rescue my comment and post it again if you would. Thank you.

Colin Cameron

The NHS is NOT in better shape than ever before. The government has just spent more money than ever before trying to manipulate the media to make the general public believe this. As a result, when things go wrong at the patient interface, the patient then blames their local hospital- not the NHS. Surely good jouirnalism can see through this. Patients care about getting to see the right member of staff (which may be a junior doctor, consultant/GP, nurse, physiotherapist...), who is well trained and has access to appropriate resources. They want this to be done in a time frame which will not let them come to any further harm and yes, they want all this in a service which provides value for money. This should be the priority for the NHS NOT "4-hour waiting times" or "online appointment booking" or "online patient records" or "picking your own consultant/ hospital/ specialist nurse." Unless you get the right front-line staff and resources, you can throw as much management, money and spin at the NHS as you like but the end result- patient care- will not improve.

I have worked as a GP in the NHS for over 20 years. I cannot remember a time when morale of myself and colleagues was as low as now. The problems seem to be a whole series of government changes that make our working lives less pleasant by the day. Contrary to your introduction, in mnay ways GP workload has gone up. Although we are no longer obliged to work out of hours, the workload during the day is now much higher, due to the Quality and Outcomes framework and various Directed Enhanced Services, some of it of questionable value. GPs voted for the New Contract a few years ago and losing the obligation for providing OOH care was a major reason why we voted for it. However, there are signs that the HMG is going to make this a contractual obligation again.
Many of us are looking for a way out.

Patients gets a better deal now, this is true.
The government have improved the short term care. As a doctor, I can see the infrastructural destabilisation and inherent inefficiencies in the reform programme that will hurt the NHS in the long term. This is one reason for low morale.

As regards training, if you find a group of employees who are paid more, work less hours and are promoted faster, yet are unhappy, you have to ask what is going on?

Doctors training is being shortened in hours, years and being undermined by a consultnat delivered service.

Doctors are having autonomy ruthlessly removed whilst similtaneously having accountabilty increased, this combination adds to stress.

Administrative costs of the NHS, as a direct result of the reform agenda, have increased overall administrative costs from 5% of a limited 70's budget to over 14% of a 92 billion budget.

Hearing ministers talking about the benefits of reducing bed numbers is sickening, for the last 30 years this country has had one of the lowest bed numbers per 10,000 population in the developed world. Despite record investment, capacity has further reduced. FACT. This is one of the mani drivers for hospital acquired infection, another political issue.

Doctors do not work long hours. We get paid well (in an average job, for a 3rd or 4th year doctor),we get paid 45,000 per year for a maximum 48 hr week)
Alright, the shift patterns are disruptive but we really cant complain about wages for hours worked. My dad works 86 hours a week and earns half what i do.

There will always be many problems with such a large organization.

Hospital doctors are unhappy because the nature of their jobs has taken us away from patients. The increases in doctor numbers (about 3.5% PA since 1995) have coincided with a drastic decrease in hours. This created problems with job satisfaction because it means fewer hours in hospital during office hours and has led to a fragmentation of care - patients are no longer treated by a small, tight band of doctors but rather a disparate team who work mutually exclusive hours. Obviously cutting hours from my contracted 72 in 1997 to 48 next year needed to be accompanied by an increase in doctor numbers greater than 3.5% PA to give better service. The 48 hour target has been achieved by working night shifts - many of which are a series of 7 12-hour shifts and for many, this means no daylight for a week and terrible sleep quality. So now we have about the same number of doctors in hospital at any one time but we spend more evenings and weekends looking after patients we'll never see again and therefore get little chance to form the personal relationships with patients which gave us so much of the satisfaction we had 10 years ago.

As with many other of the reforms, there has been no attempt to check if these changes are any better for patients and certainly little has been done to check if the staff prefer this way of working.

You might argue that it had to change anyway for family-friendly issues but I'd argue that the old system allowed doctors to gain experience earlier, to work antisocial hours for a couple of years and then become the trained supervisor, able to see the bigger picture at an earlier stage and therefore the later years were more suitable for those wishing to start families.

Combine this to a promise to cut the amount of training hours for the current set of juniors estimated at 30000 down to 8000 hours for junior surgeons to become consultants and the profession sees less job satisfaction and less reason for pride at being a highly skilled professional - not reasons to be cheerful.

I just wonder if we'd avoided all the recent controversial reforms and spent the same amount of money, if we'd have a health service delivering many of the headline improvements on waiting lists, more responsive to the needs of patients and more satisfying to work in for the staff - but of course we'll never know now.

These are just a few of the reasons why morale amongst junior doctors is at an all-time low;

It is not correct that doctors earn less and work fewer hours than before - after nearly 10 years of training I earn barely more per hour as a junior doctor than I did previously as a staff nurse in the NHS.

We are rotered to do fewer hours to satisfy government targets and the European Working Time Directive (and therefore to reduce the pay further) but the nature of the job is that you can not just drop everything and go home 'on time' and there is no facility for overtime. Junior doctors are regularly working upto 20 hours a week extra unpaid and unnoticed (on top of the 'basic' 55-70 hours per week).

We also now have a situation where tens of thousands of us (many in their thirties with families) have no idea what area of medicine (eg surgery, general practice, paediatrics etc), if any, they will get a job in and where in the UK they might be working starting on August 1st. Thousands face unemployment after this time after years of hard work and putting up with conditions within the NHS that would be laughable within any other organisation.

Morale is lower than ever before in the NHS and many of my friends have already left the profession for better paid jobs in the city and better job satisfaction. Yet more will be leaving the UK over the next few months and will be unlikely to ever return to the NHS.

Doctors by nature are extremely highly motivated and intelligent individuals who thrive on hard work and challenge. However, the NHS can only push us so far before we realise our skills would be better appreciated elsewhere and that is what is happening at the moment.

I'm a doctor, working in general medicine at a district general hospital just outside London. I've been working for six years now.

The reason why MTAS and MMC has been such a seminal moment is that it has shown somewhere between 8 and 13,000 junior doctors the possible end of their careers. While, as Ms Hewitt repeatedly points out, entry to training has always been competetive, there was always the promise of another go in the future. MTAS/MMC promised to remove this. In a situation where everyone was promised training (as in the US) this would be fine. But to dangle in front of committed doctors the possibilty of being service providers, rather than being trained to become specialists, and in such large numbers, was always bound to cause major concern.

If the government claim they were consulting, the evidence suggests that they were consulting the wrong people. Which presumably why such people are now resigning.

I have worked in the NHS for several years and have never known morale to be so low. In the unit where I work one out of ten junior doctors has a post for August, the rest of us expect to be unemployed. Motivation is unsurprisingly terrible. The only reason we are not all off with stress is that our patients and colleagues would suffer.

Doctors do not expect guaranteed jobs, and we relish competition, but we do expect to be treated fairly by our one and only employer, the NHS.

Thousands of Dr's will be tossed on the career scrapheap in the next few months and it won't only be us that suffer. Our patients are getting a raw deal out of MMC as well. This governments box ticking, short sightedness, will lead to a health service populated by unhappy, demotivated doctors who have been rushed through training, with minimal chance if a broad experience. The result will be an NHS in chaos.

As for Midwives, Physio's, Parameedics and the Nursing staff who keep the system afloat, they are also being dewntrodden by this governments target driven follies.

Liam Donaldson created this mess and should be publically lambasted. Professor Crockard and Professor Shelly Heard resigned due to his mismanagement of MMC, with utterly scathing comments for our Machiavellian teflon CMO.

Much has been made of doctors' increasing pay and decreasing hours. These have both come as part of political reforms and are factors which have no bearing on doctors' morale. Our morale is derived from having the professional autonomy to be able to deliver excellent patient care, world class research, and first class medical training for the next generation of doctors. All of these have been provided by the medical profession in the past, but it is the government's insistance on reform together with meaningless and unscientific targets which is making it increasingly difficult to aspire to these goals.

Targets such as waiting times and waiting lists have been largely met. But don't be fooled into thinking that this has been done by and increase in service provision. Hospitals have generally worked around problems to make the numbers look right, and a reduction waiting time here, usually means a longer (and sometimes less safe) wait there. These changes have required a seemingly infinite amount of bureaucracy which has no doubt swallowed a good portion of the 拢60 billion increase in NHS spending.

Pay increases have been long overdue and in the end came as a result of the government grossly underestimating the amount of work we do. Their aim was to ensure that consultants wouldn't be paid for time on the golf course, where in fact, as everyone working in the NHS will tell you, that's a longsince dead and buried stereotype.

With respect to hours; consultants still work the same long hours they always have done in order to ensure good, continuous patient care. They are just paid for less hours, because the government didn't believe how hard they worked (and indeed, needed to work to ensure adequate patient care) when negotiating the new contract.

Junior doctors still work long hours, although a reduction has been enforced via the European Working Time Directive. However, conversly, this has been very unpopular among juniors, and has dealt a large blow to their morale, because it has the effect of making it very difficult to train and get trained. Consequent shift patterns have meant that we spend less than 1/3 of our time working between 9 and 5 o'clock. This is obviously the time when elective operating lists, clinics and ward rounds happen, and hence it is the time we get most of our training.

The majority of hospital trainees would much rather go back to 70 hour weeks and 24 hours on call in order that we get properly trained to give our patients the best care that we can.

It would be a rarity to find a doctor that went into medicine for the money, and even rarer to find one who did not anticipate working long and unsocial hours - we all knew what we were getting into. So these factors don't really have a large bearing on our morale. What does damage morale however, is the deprofessionalisation of doctors into a body of workers whose role has been changed from caring for patients, to meeting government targets.

As a junior doctor, I couldn't write about doctors' morale without mentioning the MMC/MTAS debacle. This without doubt is the single most damaging blow the government has given the medical profession.

It's not just that it is unfair, unlawful and a complete disaster from start to finish. It is more the fact that the government have displayed such utter unrepentant arrogance in ignoring the profession from its very inception. The BMA told the DoH a year ago that this process should not be rushed. 10,000 doctors marched in London to protest. 500 doctors lobbied parliament to protest. RemedyUK have brought the DoH to a judicial review. The two most senior doctors on the original MMC review body resigned because they felt junior doctors were being forgotten. Patricia Hewitt has admitted MTAS to be a failure and apologised. And yet the whole thing is allowed to carry on. The government and DoH know the effect that it is having, but they carry on regardless. THAT is what is so damaging.

Greg Taylor
A junior doctor, Leeds

I would like to offer a counterpoint:

Pay for many hospital doctors has fallen in the past few years, due to progressive incremental reductions in official working hours in order to reach compliance with the European Working Time Directive.

Also, according to an article in Hospital Doctor on 17/5/07, a survey of 25,000 doctors found that between 18.9 and 20% of doctors had been asked by their managers to record fewer hours than they actually worked.

Therefore the official figures showing a reduction in working hours may not be entirely reliable.

Your mileage may vary, of course.

Reference:

current crisis has mainly stemmed from the new application system where you could only apply for 4 places for a training job if you did not get it you are out . Once you are out it is very hard to catch up with the herd.The SoS Heath states there should be competetion for the jobs but WE think when there is competetion it is illegal to restrict someone applying for the job they always wanted to do. I woud like you to ask the government on what basis they restricted to apply for only 4 places. I bet she would say we have discussed with the profession , royal colleges bla bla bla. But the colleges and doctors think yeh you have discussed with us but did not listen to us.

What is the criteria for judging that the NHS is in better shape? I am sorry, but I think that there is a different language being spoken here.

There are more admin staff than ever before and fewer nurses due to the current redundancies under the so-called re-organisation. In our area the cash strapped PCT has recently put in a Senior Team Leader and 4 new team leaders to the District nursing team -all admin posts at in excess of 拢35,000 per year. It is the patients that need the treatment dear politicians - the patients!

There is a two tiered NHS. Not so much from the 'haves' and 'have nots' or the 'post codes' but from those that know, and don't know how to negotiate the NHS so that they get appropriate treatment at the appropriate time in the appropriate place with properly trained, clear English speaking doctors and nurses.

I love my job - I am privileged to work in the region I am from, so I can be close to my ageing parents. I am in a specialty I love, and the vast bulk of my patients are lovely people. I care about my specialty passionately, raising money for research in my spare time, giving up my evenings to go out and speak to others about my knowledge and experiences.

Being a doctor isn't easy. We see the best of people and the worst of people. I get to share the joy of a successful kidney transplant recipient. I also get to meet those beaten by strangers, abused, scarred by childhood experiences. I get screamed at, spat at, sexism, I witness racism & bullying. I walk from a room, where I held a dying patients hand, to be yelled at by a relative of another patient. There is no time for my thoughts and feelings. Everyone of us tries our best.

Then we get interference - targets, dictats, paperwork - things that stop us from actually connecting to our patients and doing our job. We get abused in the press. Apparently we are well paid - though the figures quoted never match the money we see & 7 years after qualification I am still paying my debts off.

Officially I work shorter hours, though I still get the pleasure of weeks of nights when each shift overruns, 24 hour on calls & late stays on normal working days. We can't work to rule - much of our work is done on fast diminishing goodwill, and who can walk away from a poorly patient.

Then the government interferes with the very structure of medical training, adds uncertainty. They even produce major barriers to working in the same region as loved ones - even husbands and wives. They cut job numbers when all around us we are already short of staff. They tell the public we are lying, spoiled & are only self interested.

Why is morale low? Because most of us just want to do our jobs, train in a branch of medicine we are interested in & have contact with patients. Instead we are pushed around, abused, fill in reams of paperwork, have major uncertainties about our future & above all are represented as selfish liars - whats to feel good about?

DR Anila Reddy,MBCHB,MRCGP,MRCP(UK),Gp(VT),DGM,DCH,DCCH,DRCOG,
Dear sirs is it any wonder that doctors have low morale when on the one hand they are all treated as potential Shipmans with increased regulation but at the same time they see the hypocrisy of the DOH's lack of attention to patient safety in the new NHS with reduction in regulation of nurses .

Here is a prime example of the NHS talking the talk but not walking the walk.Expediency comes before honesty safety and proper planning

Last year I was the lead gp in the flagship nurse led walk in centre in Canary wharf run by a private company.I resigned with another gp and a nurse at the state of things in that walk in centre because of dangers to patients vis a vis nurses not using standard protocols,nurses acting outside their abilities and trainin,.We gave factual examples of many near misses.There was a whitewash of an investigation by the private company itself.I have been stonewalled by my local mp,the DOH,Carol Flint.Patricia Hewitt.I wrote to the chief medical officer,Sir Liam Donaldson.the head of the BMA James Johnson,the GMC,the NMC.I wrote to all the shadow cabinet and cabinet ministers,the heads of the BMA,the heads of the Royal Colleges,The National Patient Safety Agency,the Health care comission.I was absolutely never told I was wrong but met with an attitude of yes its bad but it is government policy.The medical magazines and the daily mail gave me a lot of press coverage.

Yet still there is no regulation of the nurses who are now seeing children and patients in these walk in centres.Still there is no advanced nurse practitioner register so any nurse can technically decide she is competent to act like a nurse practitoner.Still there are absolutely no standards set for the nurses acting in these new diagnostic roles in the specific specialiteis of medicine .As a dr you need to do 5 years at medical school and at least 3 years gp training to see the same patients nurses are seeing unsupervised after just a nursing degree .There are no other legal requirements and it is frankly obvious to all drs that this situation is a danger to patients.The point of gp training and the GMC registration is to avoid quack medical practitoners.Surely these new walk in centres should be governed by similar regulations.It is for reasons like this madness why morale is low.

If anyone has common sense and a sense of decency they will see the dishonesty and political shananigans that is going on.I am emigrating as a gp as soon as I can,Good luck and remember as patients the government public body that is the NHS is required by incorporation of the European convention of human rights into the Human Rights Act 1998 to act in a responsible way to safeguard the basic human rights of the UK's subjects.It is obviously failing to do this and Drs can see this.

As one of the low morale junior doctors the reasons seem obvious:

1) the MTAS lottery on jobs which has seen serial re-arrangement of the deckchairs but no one try to either stop the ship from sinking or organise the lifeboats (if you will allow me to overuse a Titanic metophor)

2) the slow loss of the autonomy and clearly defined role with ever increasing management input into care pathways etc and the rise of non-medical clinicians such as nurse practitioners etc - neither of these things is intrinsically bad but in context are negative for doctors

3) pay - although we are reasonably well paid this is largely due to "banding" of our posts so that the number of hours and proportion of them at night, weekends etc leads to massive rises in take-home pay (often 1.5 to 1.8 times basic salary) but with the rise of nurse practicioners etc and the EWTD and "smarter" rota management we are seeing these banding supplements falling while we are often asked to do the same amount of work in less hours.

It is worth remembering that the basic starting salary for a new doctor (5+ years training) fresh out of medical school is just under 拢20k - similar to a nurse (3 years training) or police officer (6 months training) and often less than a teacher (3-4 years training) and even now as a junior doctor with (almost) three years of experience my basic salary is still around the 拢25k mark which is enough to live on but not enough to buy a house, especially as I am moved every 6-12 months around the country, typically finishing at 5pm on a Tuesday and expected at my new employer, hundreds of miles away, at 8 the next morning. Moving house costs a lot (deposits etc) and this can easily take months to pay off.

In summary, junior doctors are seeing their future placed in jeopardy, their role diminished and their pay failing to cover these insults.

I cannot think of any other professional group who are treated like this, I really cannot, please post and tell me if anyone can think of similar.

DR Anila Reddy,MBCHB,MRCGP,MRCP(UK),Gp(VT),DGM,DCH,DCCH,DRCOG,
Forgot to mention the walk in centre at Canary wharf is neither covered by NHS monitoring or private haelth monitoring.The services at Canary Wharf Walk in Centre areprovided by an independent provider under contract
with the Secretary for State. This is outside of the
scope of Care Standards Act 2000 which is the
legislative framework within which Independent
Healthcare is regulated.The facility is not registered with the Healthcare Commission.IThis is depressing to Drs who care for patients as this simply makes it easier for these private companies to flourish in the NHS,Surely the regulation is for patient safety and this deregulation is a violation of the 1998 Human rights act as the NHS is a public body and has responsibilities under that act to not put the rights of UK patients in jeopardy.

Morale stems from appreciation and a feeling of self worth. Of working hard and reaching your goals. Being treated farily and with respect. Most importantly having control of your destiny and being able to influence and shape your working practise.

Medicine at present is not about caring for patients or even about providing the best quality of care it is about processing numbers (patients)and meeting non-clinical, often non-evidence based targets, which may or may not improve patient outcome. Care is not patient centred it is money and sound bite centred.

To add insult to injury, we have seem billions wasted on useless computer schemes and reorganisation and yet the DOH scape goats for the over spend are Nurses, GPs, and Consultants who's pay deals in reality simply represent fair renumeration for the hard work that they do. Furthermore, the careers and lives of Junior doctors are in chaos, and thousands of Consultant hours are now being wasted picking up the pieces of the abandoned MTAS recruitment system.

Privatisation by the back door lack of control and WASTE are at the bottom of this.

Waste of money, waste of time and more depressingly waste of talent.

I'm a junior doctor working in a busy London DGH. There are a number of reasons why medical morale is at an all time low.
One of the main reasons is the constant shift in government policy often new changes are being insitgated before the last lot reforms have been given an chance to bed in. the classic example is the introduction of PCTs, which many within healthcare felt was a good idea, but now we are basically going back to GP fundholding, which in 1997 the then labour oppisition rubbished as a step towards privatisation.
There has also been large amount of covert privatisation, such PFI's which while on surface appear great because lots of new hospital are being built, but are in reality are only a short term solutions as many of these PFI hospitals have only 25 year leases and revert back to the private company when they are up. They also have other headaches such as it can cost nearly 拢100 if you want to change a light bulb as you have to call the management company for the PFI to do it.
The development of independant treatment centres have also caused alot of problems. Alot of these have been tendered for by private companies recently BUPA won a large contract. This has lead to a reduction in training opportunties for juniors as most of surgery is done by consultants or surgeons from abroad (how are we supposed to be fully trained if we have limited access to surgery)and often there is little or no back-up if anything goes wrong, i.e no ITU, so these patients get transferred to the nearest DGH. I have seen a whole host of complications as well for patients who had to go abroad for surgery. We as a profession do not like to see our patients suffer, and it does get to us when it happens.
Due to the recent drive to reduce hospital trusts spending as led to huge amount of fustration for all healthcare professions, as services are cut also fustrating is needless spending, several of the trusts I have worked for have spent fortunes on mangament consultancies firms as the management executives are paralysed by fear of making the wrong decision they need to justify everything they do with someone from KPMG (for example) agreeing with them, this is even when they are millions in debt.
Then there is the whole training fiasco MMC and MTAS. An example of the government pushing through untested and unwelcome reform at any cost. Whilst the orginal priniciples behind MMC are laudable what is has become is anything but, Lord Hunt's orginal promise of enough training posts for all british graduates was broken. Not to mention the curtailing of training would make the next generation of consultants unable to do half the things the current generation are doing which is keeping the NHS going, (how is this keeping patient safety a priority). To rub it all in the government's arrogrance in ingnoring the pleas of the BMA last october to delay it as real problems were being noted in the pilot schemes and with scale of the whole centralisation, went unhead as the BMA was a dinosaur not wanting reform like Scargil's NUM, in the 80's apparently and now continiuing blindly as many junior doctors careers face ruin.
Yes many senior GP's and hospital consultants have had bumper pay increases in the last few years. Mainly as these were the result of long overdue re-organisation of contracts, in the past GP and consultants were underpaid for the work they did, and this founding priniciple to these neogations. Yes part of the payoff was to be more productive, however they have been working flat out already, I am amazed and inspired by the amount work I see my seniors doing in order to insure that their patients get the best care possible. Long gone is the image of the hospital consultant sneaking off to do their private work during NHS time, one they would get sacked; two their is too much NHS work to allow them to do so. Yes there is still private practise but that can only be done in their own time. So to read that you are a greedy so and so by tabloid media when you are working hard for your patients is going to wear away at your morale.
For juniors the pay balance is not so good as oft claimed by the government. Yes basic pay is up but in line with inflation, and our trust's do their best not to pay our overtime properly, which is also fustrating. We also see the fustration from our colleagues in nursing, ot and physiotherapy who had raw deals from the agenda for change.
These are just some of reasons why morale is low in the NHS today. Despite this we are all working hard to be as professional as we can in providing the best care possible for our patients. Testament to this is the reduction in waiting lists, improved cancer survial rates (these can and will get better) and high patient satisfaction levels for the most part. I am saddened to hear Mr Reed did not have the best experience at his local DGH however now their are systems to help address such problems so they do not happen again.

The government is trying to replace consultant with half baked juniors in the name of mmc/ fast track system. when the politian have a toe nail to be removed they go for the most experinced in the country.But when it comes to others it is ok to be treated by some people who are half trained specialists.

They are also trying get doctors on the cheap by creating a more unemployment ( flooding the market). I will tell you if pay peanuts you will get only monkeys. When next application round comes this bright A level atudents are not going to apply for the medicine instead they head for the city. The only reason medicine in this country attracted so many bright people is the job stabilityin the job ( NOT ALTRUISM)When that is in danger they wont touch medicine at least the talented ones. so 5 - 10 yrs down the line you will have a substandard work force.

I am an Emergency Nurse working in a large, understaffed teaching hospital in the south. I cannot see how "the NHS has never been in better shape" when more wards than ever in my hospital have been closed, 200 nurses that we badly need made redundant and we now have more administrators than ever. The "off sick" record has climbed out of all proportion.. why? because nurses at the end of the day are fed up with having their good will relied upon to work extra hours for very little/no money and they are exhausted. They feel very undervalued, not by surrounding colleagues, but by a management team that have very little empathy of the conditions they are imposing on the staff just to meet their targets. 2 months ago I arrived at work to be the ONLY staff nurse on duty for that shift. We normally have 8. I question the legality of this.. if we had had a cardiac arres, we simply would have not had enough pairs of hands to treat the patient. A few were off sick, and other spaces, normally filled by full time staff but now filled by agency were not filled as there was a budget clamp down on agency staff. We cannot go on like this. Nurses came in off their own free will to staff the ED on that day.
GP Out of hours services: Generally are good, however I know for a fact that on occasions, the on call GP has been flown in from another country, put up in a hotel and flown home again at the end of the weekend. They have no access to previous medical records and our ED attendance for GP related queries is correspondingly higher on these occasions as the patients cannot understand what the GP is saying or feel very unsafe in their care.
I could go on, but I won't. I just feel that if this was a large busy office, the staff would not put up with this treatment, however because we all have a vocation to care for people, our goodwill is used and we are trampled on. Which normal nurse on a hectic day would go for her coffee break (as dictated to by management) knowing the rest of the staff would struggle without her and patient care would suffer as a result? I am sorry but not me!

I would contest your assertion that doctors are now paid more for less work. On the contrary, doctors are now paid for the work that they do. However there is still a great deal of extra work that goes unrecognised. The audit commission recently published a report that stated a consultants average hours per week had dropped from 56 to 52. I would point out that this is still an extra 12 hours per week that are unpaid on the basic 40 hour/week contract. But, as professionals we accept that this is part and parcel of our job.

As to the question of morale. Disregard the current fiasco of junior doctors training for a moment. Focus on the fact that the NHS has undergone nine major reorganisations in ten years. To what end? We have landed up exactly where we were with the Tories internal market in 1997. Add this to fact doctors wages are now blamed on an almost daily basis for the current financial mess, no mention of PFI, exorbitant management consultancy fees or ballooning numbers of managers.
The solution. The NHS needs to be kept out of reach of meddling politicians imposing change for the sake of change on a four yearly cycle motivated principally by tabloid headlines. We also need to have a sensible debate about what level of care the NHS will actually be able to provide in the years to come. Aka the political no go area of rationing.

Having been working in Australia for a few years and then returning to the UK, there are a number of reasons for the unbelievably low morale, compared to that in Australia/ NZ, or even the UK 10 years ago. There are a number of factors and I can only mention the main ones.

A central premise of medical training is that reward is proportional to effort. This relationship has broken down spectacularly with MTAS and MMC with the introduction of non-consultant 'specialist' posts for doctors finishing training, and the BMA has been complicit in selling their future colleagues down the river.

The fact that pay for junior doctors has always been poor compared with other professionals has been compensated by the knowledge that for the best, there was gold at the end of the rainbow. To take some of the brightest and best and work them hard for 12 years and then tell them that they are not a 'real' consultant is a big demotivator, and a breach of the implied contract.

Doctors are unhappy about the uncritical conumerism and de-professionalisation of medicine. A good example of these is NHS direct, and walk-in centres, which do not change health outcomes (there are good quality studies that prove this), yet suck up vast resources which could be spent more productively. Using nurse practitioners is not cheaper than using doctors, and has resulted in an increasingly inflexible workforce.

The concentration of power at the centre has been coupled with a gross misunderstanding of what senior doctors do. Government negotiators messed up completely because they had a blinkered politically-driven picture of what most GPs and consultants do. The loss of good Out Of Hours GP provision has been a disaster for patients. I advise my relatives to never ring - always good straight to the nearest Emergency Department.

Doctors are wildly conservative and to get 12,000 out for a march was a measure of the unhappiness. That the media largely ignored this at the time only added to the frustration and the perception that the problem was being shoved under the carpet.

I think the mood is definitely there for a limited strike, similar to that which is occurring in Ireland.

Medical morale, certainly amongst junior doctors is in my opinion lower than at any point in recent memory. I don't think it has reached its nadir.

There are numerous factors contributing to this, but constant ever more brutal rotas imposed by managers in order to save trusts money with scant regard to the impact on training, quality of life for staff and most importantly on the continuity of patient care certainly don't help. Junior doctors who form the backbone of the NHS out of hours have remarkably little say in even day to day issues, let alone any strategic planning, and this lack of self determination clearly errodes morale. Disasterous manpower planning means that many doctors completing specialist training are facing the prospect of no consultant job with little alternative employment opportunities open to them as the NHS in the UK is effectively monopoly employer. EG many ENT/Cardiothoracic Surgery/neurosurgery and others

The basic pay (without out of hours intensity banding) though it has improved, is, I would argue still significantly below that of other professionals of similar standing at similar stages in their careers.

The whole MTAS debacle, and the lack of government accountability (Hewitt and Donaldson) is just the straw that broke the camels back.

Scott Queen

A Junior Doctor

I am due to start as a Foundation House Officer (the first step in junior doctors' training) this August, following graduation from medical school.

So far, my future employer cannot (or will not) tell me:
a) the hours I will be working
b) my pay

Furthermore, I am prevented from taking a job at any of the other local hospitals that have vacancies, and which have published their hours and wages.

I am tied to my future hospital - I either take the job or don't become a doctor.
In any other job market I would be free to choose to simply take my labour elsewhere; not in the NHS, which claims to be an "Employer of Excellence".

Would any other professional person - a lawyer, a vet, an architect - stand for this?

I feel demoralised before I have even begun my career.

I work in NHS. Morale is rock bottom. Agenda for change means no-one knows what is required. Infections are sky high. Hospitals are filthy. Death certificates hide real causes in the case of some deaths caused by infection. You cannot see your GP and pity help if you are housebound and need a home visit. Staff are working at minimum numbers and are streched to the limit. This government should keep out of medicine.

Re NHS. I have spent more time using the NHS than most. This year I have seen three specialists, had Xrays, Cystoscopy, had to use A&E for six stitches in my head (Fell over in B&Q) Had physiotherapy, blood tests and see my Doctor every month and I have never had better service, or had to wait for any lenght of time to see a specialst. I went into A&E and saw a Doctor in 25 minutes. In 1987 I had to have a Triple By-pass and waited nearly 18 months before I could get it done. I know who I trust with the NHS and it isn't the Tories. Cheers Terry Yates

I've been a doctor for a few years now, since I was 24, a young fella thinking back. I think I work less hours now, around 50 instead of 58. Some weeks are up to 90, every so often. My pay is a little better, roughly half of my university mates that went into normal, sensible jobs.

I turn up to work and join my team to find 40 sick people have arrived over the last 24 hours, we must see each one in turn and try and make the right decisions for each one. There may also be 20 patients on the wards under our care that we must continue looking after. Halfway through a morning the cardiac arrest call might go off. It might be a familiar patient that you have built a rapport with. Patients you get to know can sometimes tragically die.

Walking into a hospital is like walking onto the battlefield. Death, disease, pain and suffering all around. Staff sometimes cracking under pressure, tears, screaming, endless repetetive squeaks and bleeps from human and machine alike. There are constant demands, complaints, questions and queries from staff, patients, relatives, colleagues. Through this fog of war I present a calm and considered front, I never lose my temper or raise my voice. I am constantly thinking about the particular problem or question in hand. Incessantly talking, communicating, reasurring, making decisions. Sometimes life or death.

I'm also expecting to attend clinics and theatres, teaching sessions and departmental meetings. Perform research and prove that I am continuing to train, getting better at looking after patients, be considered for promotion to a more responsible role, consultant eventually. I always take this extra work home with me. This often eats into weekends and nights.

But I like it! People can get better, the staff can be inspirational, you walk out having hopefully learned something new. You feel like you've done something difficult, useful, good, and you walk out feeling a litte bit proud of yourself and pleased for the patients.

What the government have done to my training, to my job, is ruining that. I can't concentrate fully on my work anymore. My contract ends in August and I have no chance of a job at the moment. I am absolutely convinced that this process has for most of my colleagues been completely unfair, unjust, probably illegal, and a gross abuse of power by the Department of Health and its cronies.

I am angry. I am bitter. I am totally dejected. I will not rest until whoever has done this is punished somehow, and we have saved this tattered and sorry profession.

So long as the nation's health is a political football, things will deteriorate. I live in France and we have a National Health Service too. It's so good there's no point in having private medical cover. There aren't any queues to jump! As a user, and oh boy do I use it?, I cannot believe how simple it is to get medical problems sorted out here. Perhaps that silly Hewett woman should sub-contract the whole sorry mess to France, but I doubt they would want it.

Like Dr. de Souza (#24) I did a back of the envelope calculation and some 35% of my income is now performance related pay. Without this I would earn somewhere in the region of 拢60,000 like I did before 2004. This is a substantial income, but from it I have to pay my own (employers) pension contribution, which was paid by the health authority before 2004.

Taking this 14% of, my income would be close to 拢51,000, not bad. However I get no holiday, so taking 15% of this brings it to 43,000. Could be worse, but I get no sick pay and have to insure myself privately. Taking 10% of income for this brings me to 39,000. To be able to work I have to pay liability insurance and this brings me to 拢35,000. Again this could be much worse and I am not unhappy about my income.

The question I thought was asked 鈥� would performance related pay increase productivity? As you can see, a substantial proportion of my income is now P4P, but to earn it I have to spend large parts of the day collecting information and polishing data. These activities do not help to make the patients any happier nor give them the feeling the service they are receiving is any better than before. I am not surprised patients do not see 鈥榠mprovements鈥�, these are happening on paper only.

The morale of doctors around the world has been decreasing, and the UK is not unique. Patients have rightly come to expect more, and this has shown up the shortcomings of medicine. Doctors were in the enviable position of being admired and thanked for doing their job, this is no longer so (nor should it be) and this will inevitably affect morale. If it were so high, it could only ever come down, but is morale really low? I doubt it.

The NHS is in a state of meltdown. The senior managers are only interested in balencing their budgets to give the appearance of sound management. They achieve this by fair means or foul-more often the later. They are under huge pressure-financial bonuses if they meet the targets & unemployment if they fail. Patients are suffering & thats what makes us so angry.

The government are spinning that their reforms are working but standards of patient care are in freefall. Its bizarre the way people appear to believe the statistics trotted out by the ministers. I always voted Labour-never again-they are intent on privatising our health service.

The management consultants, PR companies and building contractors are making a fortune out of the health service as are the privately run ISTCs. This is a scandalous waste of public money.

Gordon Brown only gets told what senior civil servants think he wants to hear. If obnly he knew what it was really like in the NHS. He needs to understand that the privatisation is transfering money from patient care into private company profits and NO IMPROVED PATIENT CARE IS NOT THE BY-PRODUCT. Patient care is getting worse. The most vulnerable are suffering.

I qualified as a nurse in 1989, things have never been so bad in hospitals. Too much money was poured into the community. Most of that money was wasted on gimmicks, too little gets through to hospitals. The government mistakenly think that public health campaigns will avert the need for hospitals. Money has been poured into the NHS, but its all gone into community projects, centralised initiatives and quangos-Oh yes and GPs back pockets. Hospitals are desparately short of staff. We need more hospital nurses, HCAs and hospital doctors to give patients a safe and dignified standard of care. Trusts cannot recruit because the money they would have got is being paid to ISTCs for operations they are no doing. Its crazy.

I have no idea why everyone gets upset about GP partners pay. Partners in law and accountancy firms earn 拢100,000 a year.

They get paid to maintain their offices and other staff.

Salaried GP are at present well paid but that will change as more GPs are trained and competition for jobs increase.

Family doctors watching the maneuvering of Government Ministers trying to force them into providing more "convenient" appointment times must wonder how this will affect their own personal lives.

One would have thought that looking after your health was important enough to be able to have the ocasional hour off work for an appointment - but Minister's seem determined that the workforce must be able to work all day every day, and get patched up in the evening instead, when their family doctor might well have been hoping to see his/her own family....

In the course of discussion of your programme with my wife, who is a Nightingale nurse trained at St Thomas's in the '70s, she made a number of comments one of which I thought particularly insightful. She wondered whether the question you posed -- that doctors are better paid and work fewer hours than ever before, but morale has never been lower -- might not in itself be part of the answer as well. Is the modern emphasis on pay and conditions partly to blame? Do some doctors now want to be paid too much? I'll try to quote her (our discussion was over the telephone).

In any job that's a vocation, she pointed out, you shouldn't be paid a pittance, of course you should be paid a good wage for the work you do, but once you are paid too much, human nature being what it is, it becomes a job more than a vocation, and the money and conditions matter more than the job satisfaction. It becomes a case of wanting to work fewer hours, of not wanting to work unsocial hours, and just goes on and on. It's undoubtedly happened in the dental profession (where patient care and such things as Saturday surgeries are either totally lacking or cost unheard of amounts of money), and in General Practice (where few GPs now will visit at night or weekend, and those who do work for obscene amounts of money as locums in call centres), and may be now the case in the hospital medical profession. Not so much amongst the junior doctors, most of whom have high ideals and are prepared to put in all sorts of hours in the service of the sick, but more particularly higher up the ladder.

None of this is intended to slight or to disagree with the many doctors who have already written to complain about the frustrations of red tape and bad management. She would be the first to agree with them. We have for years bemoaned the path the NHS embarked upon with Salmon and the mismanagement and poor administration that has grown incrementally worse with every subsequent review and restructuring. But I thought her observations above added a fascinating and insightful new slant to the discussion.

gosh isn't life a bitch I really feel sorry for these people taking home 拢5000 pcm just a third of the average wage for a year without stoppages!!They have obviously no knowledge of the Thatcher years when we stood out on the streets on strike in support of the nurses who could not strike. Perhaps it would be better if we poor patients were to be totally healthy.
68 years old and NHS for 59 of them my experience and that of my family is nothing but good and grateful for it. My eldest daughter has recently gone back to the NHS after seeing and not believing what happens in the private sector,never again she says will she complain about only a 10 min break in an 8 hour shift.
Must be some funny GP practices down South I rarely fail to get an appointment when I need it. Course I am north of Watford!

Having read a number of posts on this subject I'm pleased to see that some Doctors, at least, are realising that they have, in fact, though I suspect not intentionaly, been colluding with the Government in a huge SPIN exercise. It's not that Doctors have 'sold out, many still understand what's actually required to provide an effective service, though I suspect most of these are older Doctors. It's that they have been manipulated into the current position where the norm is accepted as a 'transactional' relationship between doctor and patient. It's interesting to compare the different approaches of Doctors and Financial Advisers, your GP will give you ten minutes before he arrives at a conclusion (which could have huge implications) the Financial Adviser will have to spend at least an hour gathering information before he can make a 'safe' simple recommendation. Both are running on government guidelines. What's the prority ? For the sake of my own health I want Doctors to be regulated by the FSA !!

did you not like my comments on wingeing doctors?

The government is trying to strip doctors of their professionalism. I think that is the crux of the dissatisfaction prevalent at the moment. Hospital doctors are being forced to clock in and out so as not to breach the European Working Time Directive. They are being stripped of the right to apply to a particular hospital for a job. Now they apply for jobs in one of several huge regions without knowing where they will end up and what exactly their employment will be. They are denied the right to persevere with their career aspirations and as a result many doctors will find themselves thrust into the wrong speciality for them without any mechanism for changing track. They want to excel but are now constantly bogged down by having to demonstrate tick box competence. Thanks to the government the medical world seems to be insisting on dull production line doctors. Forcing bright, creative, ambitious young doctors into this box requires them to rip out their soul. No wonder medical morale is so low.

It is sad that no one seems to have grasped what the government has been doing for the last decade. Basically, they has tried to destroy the position of doctors and senior medical staff by attempting to undermine their professional position as they have done in the police force and teaching profession ie by bringing in the cummunity police and terachingt assistants.
This Government has been taking away the role of the doctors to define the clinical needs of the patient and moved this to unqualified penpushers in the PCT and the administrations staff, whilst attemting to show it has nothing to do with the central government.
Take Politics out of health and see how it iimproves based on the needs of the patients not on performing to meet some one at a distance who just churns out statistics to please his master.

BMA negotiates a 40% pay rise for GPs amongst other things, in return for support of NHS reform, and thus adding to the considerable deficit. Now that they don't like reform, the doctors are grumbling. Boo hoo. You don't have my sympathy. The rest of the public sector have been suffering for the last ten years.

What I really detest is the role of the BMA, supporting such reform when in fact they are a trade union representing a professional group. They have shown to have no interest in what is best for the NHS, save for ensuring that their members receive the maximum benefit.

DOctors want to gain some respect? How about giving up some of that hefty payrise you all had last year, and donate it to the nurses.

Next time the BMA decides to offer it's views on service delivery, please remember what they are: a trade union of doctors and consultants, who are mostly overpaid and underworked.

The woman from The Observer commentating on your programme demonstrates just how out of touch some people who hold themselves out to be experts are in this country today. What DOES she think she is talking about saying that nurses are not 'plugged into the nation's psyche like doctors are' - most of us will not even know what she means by this fatuous statement. Nurses do the most fantastic job against all odds in todays' NHS. The general public (in the main) have the utmost admiration and respect for them all. And by the way, most of the ones working in my local Tunbridge Wells hospitals are supplied at vast expense to the Taxpayer via agencies and come from The Phillipines.

I am listening with interest to your debate on the moral of doctors. I currently work as a Staff Grade Doctor in Accident and Emergency. The views expressed regarding targets are interesting. The current targets bare little relevance to patient care. An example being the A+E 4 hr target. Every patient needs to out of the department within 4 hrs. So much pressure is put on us to meet this. As a result patients are admitted unnecessarily, sometimes receive delayed care and often transferred to wards without investigations reviewed. The pressure on us from management is unbelievable. The extent to which we go to prevent breaches is amazing. I love looking after patients and wish i could just get on with it. If a patient has breached they are no longer important and a patient that has not breached will be moved to a ward bed!
We should be aiming to provide the best care at the earliest stage of peoples admission. I have trained for the last 11 years. Daily I am prevented from using this knowledge to help patients You wonder why morale is so low, just let us do our jobs, give us some control and introduce some relevant targets. The current working environment is unsustainable

The A & E target of nobody waiting more than 4 hours is a public relations exercise. Sure one no longer see patients lying on trolleys in the corridors. The problem has been shifted to other parts of the hospital. In order to meet the target of 4 hours, A & E admissions are given priority over all other admissions with the result that very often especially during the winter months, routine admissions are cancelled because the beds have been occupied by A & E admissions. To avoid breaching the 4 hour target, inappropriate admissions take place, or ambulances are made to circle round the car park until a 'slot' that will not breach the 4 hour target becomes available. Typical of many NHS reforms, they do not anticipate the ripple effects of so-called targets and therefore adequate provisions such as beds are not made and patients suffer cancellations. When surgical admissions are cancelled, the entire surgical team of consultant surgeons, trainees, anaesthetists, theatre nurses and theatre technicians are left with nothing to do - a waste of valuable and expensive human resources and fall in productivity. There is a lack of joint up thinking by bureaucrats in the D o H who do not understand how hospitals work!

Yet again the point has been completely missed over the junior doctor fiasco. They are not complaining about competing for the jobs they want merely to have a fair application system that they can trust. What other career gives the trainees one opportunity to obtain a training post without them knowing where they will be working or what the conditions of employment will be. The junior doctors applying for the new "run-through" training could apply for one specialty in four locations or four specialities in one location. Each Deanery covers vast areas of the country, for example Scotland is just one Deanery so a husband could, if lucky, obtain a post in Aberdeen or Inverness and his wife one in Edinburgh or Glasgow. As the mother of a junior doctor I could go on and on and get so angry that it has cost the tax payers 拢250,000 to train each junior doctor and they leave medical school with huge student loan debts only to now be faced with the possibility of one chance to continue their career or have no alternative but to go abroad.

Yet again the point has been completely missed over the junior doctor fiasco. They are not complaining about competing for the jobs they want merely to have a fair application system that they can trust. What other career gives the trainees one opportunity to obtain a training post without them knowing where they will be working or what the conditions of employment will be. The junior doctors applying for the new "run-through" training could apply for one specialty in four locations or four specialities in one location. Each Deanery covers vast areas of the country, for example Scotland is just one Deanery so a husband could, if lucky, obtain a post in Aberdeen or Inverness and his wife one in Edinburgh or Glasgow. As the mother of a junior doctor I could go on and on and get so angry that it has cost the tax payers 拢250,000 to train each junior doctor and they leave medical school with huge student loan debts only to now be faced with the possibility of one chance to continue their career or have no alternative but to go abroad.

The NHS is better? Do you get emergency angioplasty and stenting for your acute MI?? NO. Do you always get high quality nursing care on a HDU after your major cancer surgery? NO. Emergency CT after your CVA? NO. Fracture your hip ladies and where do you go? To a ward with one trained nurse on and perhaps 5 demented confused elderly patients who are wandering at night. Does not having to wait long for substandard care constitute improvement? Mind you, go to a cancer ward and enjoy listening to the gossip and chatter of the nurses as they struggle to find things to do. Does anybody listen to doctors and nurses who can see its crap? Draw your own conclusions

At last, a reasonably enlightened debate on junior doctors, NHS morale, and the future of the NHS under Gordon Brown. I'm a junior doctor currently caught up in the MTAS (online medical training) fiasco, still unsure of where I will be working on August 1st and whether it will be in a hospital or in a supermarket. As I studied medicine as a mature student, I had a very clear idea of where I was heading and how to get there, and was excited at the prospect. Within one year, this government has completely shattered many of these plans by imposing an untested training scheme from the top down. While I find it awkward to agree with Andrew Lansley, he was spot on - this is just typical of this governments actions. They constantly impose poorly thought-out and inadequately debated schemes with a "we know best" attitude, then insist on micromanaging their so-called "reforms". As doctors, we are generally not resistant to change - after all, we are trained to deal with constantly changing circumstances - but medicine is difficult enough without these unnecessary stresses. We just want to be free to get on with our jobs. Most of us have a passion to treat our patients to the highest standards and with great integrity, despite the constant (often inaccurate) newspaper stories bashing our profession. As pointed out in the programme, we are not "working in a biscuit factory", we are caring for people - people often at the most vulnerable times of their lives, people who don't want to be treated by demoralised, stressed out "service providers" but by professional doctors. Come on Gordon, cheer us all up...please!

how weary I get hearing about the morale of doctors in isolation. Working within the NHS I have first hand experience of this dedicated work. However there continues to be far less attention paid to the views, experience and hard work of other allied professions (OTs, social workers, family therapists, service managers and admin staff to name a few). This has much to do with these groups having less `status' and voice. Nevertheless, typically these professionals are far less well paid, working long hours - and in some cases managing considerable clinical risk. It was a relief to hear these and related points made by Jo Revill of the Observer this evening - too few of which were followed up in the ensuing debate.

All that doctors ever wanted to do was to look after their patients to the best of their ability. Unfortunately the government seems intent on putting obstacles in front of us to prevent us doing our jobs properly. I know many doctors are demoralised, and I have seen several suicides amongst doctors.

I have been a consultant for many years, and I have never seen so many doctors, both trainees and consultants, actively making plans to leave the service, and to pursue different careers. I get the impression that the exodus may be quite abrupt; but I am sure it will not affect the government at all. The DoH will no doubt continue on their present course.

Does it matter? Probably not. I am sure there are plenty of doctors from EU countries who will be elegible to fill the empty posts.

GPs are paid an average salary of over 100K a year and whereas I wholeheartedly agree that money is rarely an incentive or guarantee of high morale and good performance, I have to say I find it hard for my heart to bleed too much for them. I don't quite understand how their professionalism is being disrespected. Any professional should be subject to performance management, the same as any non-professional, and from experience being the top of your field certainly doesn鈥檛 give you the ability or insight to manage or make strategic decisions for your whole organisation or the people within it. I鈥檇 like to see the budget deficit in Jeevan鈥檚 (above) idealised NHS without it鈥檚 鈥榩enpushers鈥� and politics 鈥� doctors and sick patients don鈥檛 generally make great accountants or managers but watch the complaints from Joe-public when those 鈥榦h-so-political鈥� taxes go up to compensate for the inefficiency.

The worst thing though is the way Cameron鈥檚 鈥榥ot-really-changed-at-all鈥� Tories are trying to capitalise on this issue - they (quite rightly) introduced targets and management but didn't back it up with any money. Like just about anything else good that's happened in the last ten years they either wouldn't have done it or tried to do it the same without providing the money. Perhaps the doctors would prefer to lose their huge increases in salaries under Labour 鈥� actually by their own logic waiting lists would have plummeted without paying them more, but simply by treating them as professionals, if only we鈥檇 known then鈥�

I am a Junior doctor and an NHS user as well ..I am Unhappy on both fronts ...Job in NHS is a mess anyway but i Had to call up thrice and got an appointment in 2 months for my 2 yr old son who had recurrent ear infections and suffered a seizure because of that.MANGAERS ARENT DOING THEIR JOB NHS DOESNT HAVE ENOUGH MONEY TO EMPLOY MORE DOCTOR.A single doctor can see an x number of patients a day if sees more ,leads to errors then time spending putting it right.Vicious cycle
Simplest way to say is NHS IS A MESS...Patricia Hewitt should resign

At the risk of stating the obvious:

A large part of the GP "pay rise" is actually a perfomance-related bonus that the government didn't believe the GPs would be able to achieve.

To receive further bonuses, more targets will need to be met. This is not a permanent pay rise for all GPs.

More importantly, GPs are not junior doctors.

Junior doctors have not had a pay rise. They don't even know whether they will have a job in August.

Why?

The government's bizarre appointment scheme is not allowing fair competition for posts. Some good candidates have been rejected due to computer glitches, etc.

Worse, the application process is openly getting rid of experienced doctors (who are able to look after you) in order to "ringfence" training posts for new graduates (who will require many more years of training before they are able to look after you).

I would happily work more hours for less money if i thought it would make me a better senior doctor. However, the combination of the European Working Time Directive, the so-called "New Deal" on doctors' hours and now the ridiculous Modernising Medical Careers project are limiting my useful educational exposure to patients. By the time I am a consultant I will have less than a third of the experience - as measured by hours spent on the job - of the people who are my current bosses.

This is a huge problem. In ten to 15 years' time there will be no-one left in the medical profession with sufficient hands-on experience to diagnose and treat the truly rare cases that come through the door. This will have a real impact on patient care.

Yes, it is true that some doctors are currently paid far too much for doing far too little, and that thanks to some stunningly bad negiotiating by the Department of Hralth, the taxpayer picks up the bill. It is in nobody's interests, though, to reduce the training opportunities accross the board and in turn, the expertise of future senior doctors.

It is not in anyone's interest for training opportunities to be reduced but Doctors don't face any bigger challenges by the WTD than any other organisation. I do not for one moment believe that Doctors do not have the best interest of their patients at heart but I also don't believe that any government would purposely try to 'ruin' the NHS. The moral argument of who 'cares' the most may sell tabloids and score reactionary votes for an opposition, but it's not really helpful in a serious debate. I'd like to see the sudden exodus of Doctors that Thomas Fuller predicts and I'd like to see what jobs they go to on a similar salary (I doubt it will be management)

NHS or private hospitals?
With all the problems this institution still manages to cater for millions of people. May be there is a need for more introspective constructive criticism; thousands of nurses and doctors have been recruited from countries like Bangladesh, India and from the African continent, because the hours are long and the pay has not always been that great, possibly there are not many in England who wnat to choose to work in such conditions.
Let's not confuse NHS with the people who work in there.
I ahve had terrible experiences in a ccouple of hospitals, whether it was unprofessional service, or lack of commitment,have had to put up with staying in a ward where men and women were in the same room, ansd around 30 of them, but have also had superb service from the University of London Teaching Hospital, where my daughter was born in 1988 and she was chosen to be part of baby research, the personnell wasw just divine, Guy's Hospital as well, discreet, professional and very helpful; my daughter gave birth to her son three years ago, as much as she was moaning about midwifes etc, I thought well how can you complain? Nurses were at hand all the time, the midwife would visit her almost every day after being releassed.
yes there are ups and downs but may be both government and citizen should work together to make sure that this structure is repristined to the symbol of a nation that cares.

The 4 hour A&E target.
Three weeks ago, my 7 year old son became an unwitting victim of this ridiculous target. He broke both bones in his wrist while playing football and we took him straight to our nerarest A&E department.
He was assessed, x-rayed and his problem diagnosed within an hour of our arrival-brilliant I thought at the time.
Then began the absolute farce of waiting for him to be treated. Because of the nature of the fractures, it was necessary for him to have an operation under aneasthetic. He was therefore starved and given nothing to drink so the operation could be carried out later that day. We waited...and waited...and waited....
I asked whether he would be kept in overnight and did I need to make arrangements to bring in his pyjamas etc--no-one could tell me.
Finally, after some 5 hours of waiting, we were told the operation would NOT now take place that day and we would have to go home and ring in first thing the next day to see if he could be treated then!
Yes, they did apply a temporary cast to stabilise the injury and yes, he was given pain relief but that was it.
Remember, we are talking about a 7 year old child here, who was in pain, distressed and very frightened. He also went a total of 8 hours with nothing to eat or drink.
No doubt, as far as the hospital staff and managers are concerned they met their targets-the NHS has never been in better shape? Don't make me laugh!

i understand idris hardings frustration with ewtd but it must be remembered that back in the 80s our shifts were so long as to be incompatible with "useful educational exposure"aswell.try on call every day ,every alternate night and straight into a weekend starting friday,fridaynight,saturday, saturday night,sunday. sunday night and then a normal monday .by monday afternoon we junior doctors were on our knees. i think any useful educational exposure petered out by about satuday lunchtime. oh yes and it was back to work on tues ,tues night and wed........... we dreamt of the time that the eu would put limits on our working hours it essentially protected us from our employer , the nhs ,who was quite happy for this dangerous situation to persist even gaining exemption from the directive for years after they had been introduced elsewhere in the uk. one thing idris must never get wrong is that the people that run the nhs have no interest in their workforce beyond how best it can achieve their own political end. it is very demoralising to discover this but some of us older docters have reexperienced this over and over again.

Paxman hit the nail on the head when he likened the doctors to trade unionists who didn't like the owners running the business their way without their consent. The recent fly-on-the-wall documentary "Can ...Robinson save the NHS" pointed in the same direction with doctors aloof from reform & resentful of non professional pragmatists.The CEO of the Healthcare Trust did not have effective control of the total business and the Consultants were the alternative power base. No wonder doctors are unhappy - reform is crowding them and clouding their rosy future.
I am not a health worker of any description but am married to one. These are my observations and speaking of unreconstucted expensive public services- who dares to look long and hard at the police force?

No congratulations to Jeremy Paxman and the panel for bringing us an informative debate last night - at the time that it is most needed.

The panel was terribly chosen - Jo Revill's ideological slip showed in all her ill-informed talk about doctors vs. nurses, Lansley was vapid throughout and Paxman (probably not having done much good journalist digging on the current crisis) off form.

But the biggest misjudgement was inviting James Johnson, disgraced ex-chairman of the BMA on to the programme. Johnson said that morale amongst doctors was at an all time low. He naturally failed to mention that he himself was the cause of much of this! How on earth did the Newsnight staff think that he would shed any real light on the crisis if he was part of the problem all along?

This terrible choice for a panelist made absolutely sure that the one real shining reason for doctors' low morale wasn't mentioned during the debate: The Dept. of Health are systematically de-skilling and de-professionalising doctors by making sure that the next generation of consultants do not receive the general and thorough training that the previous generation enjoyed. The figures speak for themselves: a consultant surgeon used to get 30 000 hours of experience in training, from now on, they'll have to do with 6 000. (And don't say 'it will be 6 000 quality hours' - there is no substitute for experience in surgery; only a 'medical educationalist' can say that there is.)

Doctors' morale is low because of Modernising Medical Careers, Jeremy. Of course Johnson wouldn't mention THAT, because he is a defender of it.

The only revealing part was when the old 'doctor knows best' straw man was shot down out at one point. Some people (but, funnily, never any patients really in need of expert medical advice) resent doctors' expertise. MMC was designed and promoted by people who hold this grudge: it aims to ensure that 'doctor DOESN'T know best', by giving him/her a fifth of the training (s)he needs. All of the recruitment chaos recently (deplorable as it is) sometimes obscures this fact: Future doctors are being systematically dumbed down under MMC, because the DoH anticipates that a de-skilled workforce will be more pliant.

contd.reply to idris.
it is of course a concern that new seniors will have less hands on experience a balance needs to be struck between the old ridiculous hours ,many wasted in terms of education,and the new system .this needs to be worked out by exellent educators whom doctors respect.
your next point that there will be no one left c sufficient hands on experience to diagnose rare disease is a worrying one for us gps .the need for good generalists is only going to increase as we try to negotiate our patients through outpatient appts with consultants who are expert in narrower and narrower fields.
this brings me to my final point. from hospital it may look as if we 'do too little",but alot of wonderful work is carried out in general practice, i wont elaborate here but it is so important not to buy into government spin.they told us to do certain pieces of work to
get paid, we did the work and so we got paid.the government now leaks negatively against its own workfoce . demoralising or what . remember the government wants you and the public to rise up against doctors 'high pay'.general practice is made up of a large percentage of part time often women, who are not on high salaries and who find the spinning degrading and undermining at many levels.

contd.reply to idris.
it is of course a concern that new seniors will have less hands on experience a balance needs to be struck between the old ridiculous hours ,many wasted in terms of education,and the new system .this needs to be worked out by exellent educators whom doctors respect.
your next point that there will be no one left c sufficient hands on experience to diagnose rare disease is a worrying one for us gps .the need for good generalists is only going to increase as we try to negotiate our patients through outpatient appts with consultants who are expert in narrower and narrower fields.
this brings me to my final point. from hospital it may look as if we 'do too little",but alot of wonderful work is carried out in general practice, i wont elaborate here but it is so important not to buy into government spin.they told us to do certain pieces of work to
get paid, we did the work and so we got paid.the government now leaks negatively against its own workfoce . demoralising or what . remember the government wants you and the public to rise up against doctors 'high pay'.general practice is made up of a large percentage of part time often women, who are not on high salaries and who find the spinning degrading and undermining at many levels.

90 - you have not got it quite right. The programme made it clear that it was the doctors and nurses that had the good ideas and that it was the management who were incapable of or unwilling to progress. Please remember it is the "non-professional pragmatists" that are responsible for turning the potential of the 'old' NHS into the administrative shambles it is today. The thing that keeps it on the rails is the unfailing hard work, duty, goodwill and proficiency of the health care professionals despite the shocking incompetence of political interference and fourth rate management.
91 - spot on! 90, and similar, please read 91, here speaks the reality.

If doctors and nurses' moral is in decline i am seriously worried about the patient's. I have first hand experience of low compassion and poor care when a family member was ill in hospital. The level of care was so bad that my relative had not been outside his room in 4 weeks! There were also incidents where junior doctors made sweeping generalisations about this patient. We should not be giving doctors more power to make these quick decisions in the few minutes they have to diagnose - Nurses and family members could take up some of the strain. I agree that doctors might be over-stretched and this is why i i do not want any more mistakes made where my family is concerned. Organisations like Mind and Samh and the mental health foundation are vital because at the minute we as patients are compelled to fight against the system. Political nonsense. We are being forced by the politicians to accept these abominable circumstances and unacceptable care. It's not the doctors it's the processes and mechanisms which have been set up by business graduate politicians.

We seem to have a core of habitual whingers within the medical profession; they are the best paid in Europe and still have low morale. Perhaps this low morale is nothing to do with the NHS, but all to do with the people themselves.

Personally, I am more concerned with the plight of those needing treatment, yet are still waiting an unacceptable time, albeit that it has reduced significantly with this Government. Perhaps if those suffering low morale got their act together and used their resources, both personal and NHS, more effectively to provide a timely service to those paying then the satisfaction of doing that may just raise their morale.

If this doesn鈥檛 raise morale; as Europeans they have the right to work in any other European country. They would of course take a salary cut, but I am sure it would be worth it to relieve their personal anguish with the NHS. As the highest paying country for doctors in Europe and given that English is almost an international language the NHS could easily replace those leaving with other European nationals who want to be here

to start with, Doctors are somehow good to some extend and also bad expecially in our African setting.Example one, they are good because they are trained and or assist to save life which we cannot live without them, two, they are also bad that money comes first and then life flow later, which is very bad.

All NHS staff are low as the institution has become a political tool.

I am tired of 'Trust policy', 'government policy' and targets.

I find it embarressing that A and E patients who are quite poorly (ie need to lie on a trolly and have pain killers but under no immediate threat of death) are put infront of someone with a sore toe just because they booked in early.

Children are no longer the priority that they were - they are seen in time order along with the adults. Kids in the main dont like hospitals and would certainly prefer to be at home - and that what I want.

Managers phone me up and demand this and that - inappropraitely most of the time. If I refuse I am reminded that its 'payment by results'. If I dont help to met these targets (meaning compromising patient care) it means the trust getting less cash.

I take each situation as it comes, but working with in the NHS has become somewhere you have to argue and defend every decision - utimatly because of cost.

Just thought i better post a reply to Mr Smith, comment 68. In your comment you mention that the GP will spend only 10 minutes with you before making a diagnosis, and a financial advisor will spend about an hour before making a recommendation;
Two points here,
1) before all of NU-Labour's ridiculous meddling into the NHS and GPs contracts, much more time was spent with individual patients' as many GPs have suggested, their salary is now based on foolish quango-dictated "targets" - Hence the production line-esque NHS you see now
2) I would imagine the fact that the finacial advisor WILL be charging you by the hour, and therefore it's in his/her best interests to keep you talking for more money, if i can be seen and treated in under an hour, i would rather that, especially if it were costing me to talk to the professional

M
(COI Junior Doctor)

Afraid i will have to take issue with P Patel, (comment 72) as well,

I think you'll find that a large and unavoidable number of doctors also despise the BMA for siddling up with the government and not showing proper leadership, over a good many things, but to refer back to your point, as has been previously mentioned, the "REFORMS" agreed by doctors representatives, have resulted in 9 major reforms in 10 years, and therefore no telling data can be gleaned from ANY of the reforms. (is it better as PCT, choose and book, etc) and in fact we are right back at the same point that we were under the tories, in terms of NHS organisation! ALL that has been achieved in the last 10 years, is short term fixes, and the majority of increases in funding going on paper exercises that "prove" the NHS is improving. The NHS is better on paper only, a statician's dream, a patient's nightmare!

Finally, (sorry for long post!) but where exactly do people get this idea that we are all so horifically underworked and overpaid? I have trained for 8 years, i work on average 50-60 hours a week, and i get a REASONABLE salary, however, comments like 'doctors should give their money to nurses' show no knowledge at all. My hourly rate is less than almost all of my colleagues in other NHS vocations, Nurses work max 37.5-40 hours a week, junior doctors (despite what you read) work 50-60 hours, 1.5 x more hours = slightly larger take home pay than other NHS workers - but crucially LOWER hourly rate of pay (about 拢11 an hour, if your interested)

Sorry for the rant, but Government and media, have really damaged the reputation of doctors on this...
M

I am a dentist working within the NHS. We are being told that the new system is the best thing since sliced bread.

All I know is that after over thity years I cannot wait to retire.

No doubt I am an anomaly

I have had too much experience of NHS care over the past few years and feel able to comment from a personal perspective.I was misdiagnosed with TB/Meningitis in 2002 and despite trying to find out how to control the chronic condition I was diagnosed with,I collapsed in 2002. Initally, I was deemed a "depressive" at the first hospital I was taken to. Thankfully my family were concerned enough to get a solicitors letter and threatened to hold the Chief Executive of the NHS Trust personally responsible in the event of my death. Hence,I was moved to the Oxford hospitals within 12 hours and after many tests by some of the best NHS care I could have been given, I was finally diagnosed with renal TB/meningitis just before Christmas 2002. I battled my way back to better health and prepared for kidney removal and reconstructive surgery,I already had had a VP shunt in my brain to help deal with hydrocephelus caused by the meningitis. The doctors and all the care I have received from the Oxford Hospitals has been second to none and it was a doctor who alerted me to the fact that a report in my notes mentioned TB. In 2004, I finally traced this pathology report and saw that the original consultant had requested the rport but failed to act on the advice of a very diligent pathologist who "flagged up the possibility of TB. So what should have been treatment with antibiotics cost the NHS thousands in eventual diagnosis and ongoing outpatient treatment.But just like ripples on a pond...the effects on my family were profound and my youngest son's mental health went into a "tailspin". He injured himself and called for an ambulance, he had an Emergency Psychiatric Assessment and said that he tried to kill himself because he felt so depressed but dwespite the fact that he was in the recognised highest risk group for successful suicide, he was sent away with a leaflet and told to take responsibility for himself. So next day he went to his GP and received infomation on a referral "which may take a couple of weeks" (meanwhile his mental health was deteriorating rapidy....and would this 'care' happen if this was a suspected heart attack?) The following day, my son harmed again and called for an ambulance again and I have seen this described as "Screaming in Silence" After cardio-thorasic surgery, my son was Sectioned under the Mental Health Act for observation. Despite being weak from surgery, my son was allowed to collect plastic knives (under observation?)and I am still asking questions as to why my son was "found" stabbed in a bathroom on a mixed sex ward in a specialist psychiatric unit whilst under 1:1 Observation "24/7" My 29 year old son died in August 2005, his belongings were sent home to me in a black bin bag with "NHS Household Waste" printed on it and nobody made contact with me until I reminded them that a human being had died in their care. A Serious Untoward Incident Review should have been independently commissioned and the police should have been called but none of this happened.A Critical Incident Review was commissioned six months after his death and I am still asking questions today. Money has been invested in the NHS but not at the right level, funds that should be used for patient care is being used for damage limitation and the maintaining star-ratings I fear! We need to have an independent review of the whole mental health system. We need integrated services which recognises socio/economic factors as potential triggers to fragile mental health. The use of drugs and alcohol as a crutch to support lack of self esteem brought on by bad health, bad housing, debt, lack of work or just the fact that we now have many more people from less weathy countries who believe that we are able to sustain their expectations....this too will lead to much depression and crime.We must look at it all and not "demonise" people. It is wrong to just expect to be able to "chemically cosh" people in the community who show distress. Treat people with timely compassion and provide our most vulnerable citizens with decent humane care. My son was not a criminal, he was not known to the Mental Health Services and he called for help. He was failed at every level and we,as a country,should be ashamed.
I have heard too many times that "lessons will be learnt" but tragically my son will not benefit from those lessons and if they "keep doing what they are doing then we get what we always get"

Thanks to the governments constant interference and mismanagement of the NHS, morale is indeed at rock bottom for all members of clinical staff.

Junior doctors (defined as any doctor who is not a consultant or GP - the 2 groups that received the recent well publicised pay rises through the governments own incompetence) in particular are suffering from low morale for a number of reasons:

Firstly MTAS - an application system designed not to differentiate good from bad candidates. It has failed not only to adequately allocate interviews but also to protect the personal information of those applying. Furthermore this system required interviewing panels to make decisions about candidates without even seeing their CV's - this would never happen in any other industry.

Secondly - the loss of choice. For one year it is possible to apply for a maximum of 4 jobs in four regions (not hospitals). Regions are huge, an example is the eastern deanery that is norfolk, suffolk, cambridgeshire, bedfordshire, parts of essex and hertfordshire. Any job you get will be somewhere within this region but no-one can tell you where, making it impossible to plan your life, or more importantly, that of your partner and family.

Thirdly - the new training scheme is inferior to that which it replaces. It is a response to the loss of hours doctors will be able to work following the european working time directive.MMC reduces the number of years doctors train, whilst at the same time doctors will be working less hours per week. The net result is that doctors will have a lot less experience when they become consultants - not a situation that will leave most patients feeling comfortable. Training should be lengthened, not shortened, but that does not agree with the government's goals to produce more consultants quickly. Sadly, the government don't care whether these consultants will actually have the experience to do their jobs well.

Fourthly our union the BMA does not support us or represent our views and in fact used our fees to pay for a lawyer to support the department of health against its own members (in the form of RemedyUK).

And finally August the first rapidly approaches. We don't know where we'll be working, only that we'll have to move on short notice. We don't know whether we will have work. We don't know whether we will have to immigrate to have a meaningful career. So yes our morale is low.

Junior doctors work hours more weekly than they should. They don't complain - my daughter will not take time off when ill - because of her patients. She receives a lower salary than most of her contemporaries for far more hours and committment, dealing with things that most of us out of the profession cannot comprehend. We should value these doctors, not throw them on the scrap heap. We should be amazed how they continue to work despite the huge stress of impending unemployment and low self esteem owing to the MTAS social project. It is not the junior doctors fault that there are not enough of them to deal with patients in the manner they would like - daughter frequently worries about the little time she has to spend with patients - but with so many admissions to emergency on nights and so few staff, she does the best she can. Start appreciating them - they will be abroad soon.

hi
doctors and consultants are off on hoilday alot of the time mine is off for three weeks as from next week my husband works in civial service and he dose not get paid any where near a doctors salary and frankly I find doctors dish out pills and send you away.
I have been told to write lists of the problems and he take a glance and then just carries on pill pushing his ok but as I am long term sick due to this NHS service putting me on pills at 17 now 41 still on pills alot more the doctor hasnt a clue how to treat and has attmitted this which is a real mickky take i am the patient and he is the Doctor and I am the looser in all this awful NHS srvice if you can call it a service.
I was an ex pat from Hong Kong came back to UK in 1982 and in 1983 I was put on diazepam 50mgs daily and Bolividon90mgs Daily and now I am on Seroxat suing the company cant say anything due to leagle reasons and am on daily 26 diffrent drugs a day pop 34 pills and ihalers 4 its rubbish I was on zero when in Hong Kong but this counrty has messed my life up total. and I can hear you all asking why came back forced by a move by perants to young to stay so left the place where my heart is not this place the awuful thing is i got married and had to start payinfg for my drugs and I didnt put me on these at 17 years old paying for a doctors mess up for years so why make me pay why cant we be like Wales And Scotland free sometimes its not the person who is on these pills fault it the medical proffession it a laugh proffession my dog has a better brain than these so called Doctors I have been abused by doctors and other things hence my hate of these so called proffesionals messed up my skin cancer removal and my bowels cutting to much away so god help you all

Jeannette somerset

This country gets the health service it deserves. Some patients will get rubbish treatment and some will get very good treatment. Some patients are horrible as are some doctors and nurses are incompetent. The sooner the whole thing goes private and patients then value what they have to pay for the better.

For all those people out there moaning about their terrible experiences because of "incompetent" doctors, stuff it!!

We doctors work bloody hard! We more than deserve the salary we earn and we stay on hours more than we are paid to do. My salary is far less than the 拢100 000 reported.

Its quite clear the public don't care about the doctors' plight. Why should I bother staying on slaving away for you lot! I regret a career in Medicine, and wish I had worked in the city instead! Especially caring for you moaners!

PS. I am moving jobs to the city next month.

Re Junior Doctors Pay. My son is a junior doctor has passed his exams for what was registrar level which cost him in excess of 拢2000.00 (exam fees and courses). He is now in the fiasco of waiting to see if he has a job or if he will be looking to go abroad to find work. his rate of pay with London weighting is 拢13.00 an hour, he works 50 hrs paid)and for Mr Patel thats 拢33,800.00 per year. A qualified nurse in the same department is on a salary of 拢29,000.00 a year for 37.5 hrs a week. I agree that nurses should receive these wages. Doctors work long hours sometime without time for food and water my son has worked 13hr nights and not had time to eat or have a drink, he and his fellow medics do not complain about the hrs or the abuse they get from consultants, managers and the people they are trying to help. Also the areas where they are being told to go to for work is splitting up families as his wife could finish up working in one part of the health area and he in another How do they see each other working 50 hrs and not working in the same town / city. I have told him to abandon the profession but after 11 years training he is loathed to waste his knowledge and feels he is trapped in medicine. What my son and his wife want is to work in the speciality of choice, live in an area of choice. Stu

A lot of the reasons for low morale have been covered but let me give you an example of why a doctor's life is so frustrating.

I recently spent a week as a locum junior doctor in a large tertiary hospital in London. I arrive for work and there is no indication for whom I'm working for, no bleep, no computer passwords, or ID badges in order to enter wards.

The team greet me with relief and inform me that I am the only junior covering three consultant surgeons and there is only one senior (registrar) available all week.

The registrar has to attend his duties in surgery and clinics, while I, the newbie must see sick patients on the ward whom I've never met before. It goes without saying that I have clinics of my own, endless administration, and time consuming battles with radiologists, nurses, etc. all for the good of my patients.

Many consultants are oblivious to the staff shortage and frankly don't want to know.

Meanwhile relatives and patients are angry that their discharge paperwork is not ready, nurses bleep you every 5 minutes, mostly inappropriately and
guess what.... you have to learn (forget eating)something in the middle of this carnage.

The above is not an infrequent scenario. Then I come home 2 hours late in a foul mood and get subjected to another inflammatory Newsnight topic about us greedy, lazy, ungrateful doctors.

I cant dwell on this because I need to get some sleep so I can go through this all over again.

I love caring for people and helping them recover from illness but its the
above that gets me down.

I have had two entirely different experiences of health care provided over the last two years in two different areas of the country, one in London, which after nine months of stress with an appallingly managed pregnancy, (with problems from GP's, Midwifes and Consultants)resulted in my husband having to deliver our second son; and one in Nottingham where my baby was taken ill whilst visiting relatives and was admitted to Queens with respiratory problems, (this was a stressful time but the staff where great, informative and able to put me at ease, and the facilities were second to none).

I believe that there is evidence of the post code lottery you hear mentioned. And as a result of this I can clearly understand that the morale amongst health care professionals is at a low. However, I do not feel that it is the professionals that are to blame. The root of this problem has to go to the very top, it is ridiculous that the standard of care received depends on where you live.

It is glaringly obvious to most that there are severe problems in the NHS throughout the whole organisation but for those who have to tackle the mental health services things are even worse. There is no "choice" of treatment despite what the governement says and waiting times are atrocious. Three year waiting lists for psychological therapy is an absolute disgrace and in many cases Talking treatments are not offered as an alternative to medication. And people who feel isolated, unhappy and desperate to talk are given costly medication with terrible side affects for years and years that in many cases robs them of any normal life and the chance to contribute to their community. When will the government realise that by investing in realistic, humane services that offer dignity, empathy and an alternative to chemicals they will eventually save money as well as improving health and life prospects for many people living with poor mental health. A lot of the problem is hidden because organsiations like Mind end up supporting people who have no alternative support from the statutory services and if you want to start talking poor salaries then try working for a voluntary organsiation!

Originally a radiographer, latterly (dare I say it) a manager in the NHS and now retired (early & voluntary following disappearance of job in organisational restructure) I think there are a few key points contributing to poor morale.

1 Constant NHS restructuring and re-organisation. The ensuing uncertainty takes people's eyes off the ball and the constantly changing working relationships make it difficult to develop relationships and systems that people trust and can work within. For many NHS staff these changes happen not just occasionally but every 2/3 years. It's hard to maintain morale and give of your best in such circumstances.

2 Public expectations that the NHS can deliver everything they want. This is stoked by government promising the world before they've any idea what it will cost and what the implications will be. NHS staff are then burdened with delivering what are sometimes impossible agendas to meet questionable targets whose value to actual patient care is often debatable. Is it any wonder the staff are demoralised?

3 Mismatch between funding and expectations/requirements. Yes, a lot of money has gone into the NHS over recent years but the goalposts have moved a long way also. In my experience it is rare for developments to be fully funded, rather a pot of money is allocated apparently abritrarily and then managers are required to deliver within the provided funding without compromising patient care. There is also the perennial cost improvement programme and/or the need to recover budget overspends (? underfundings) which leads to vacancies not being filled, stock not being ordered etc. Managers are often blamed for this but many managers have a clinical background, they do understand the services, and, like their clinical colleagues, they want to deliver good services and they are unhappy when the compromise seems to go too far and staff are not given the resources they need to do the job. They may well express their concerns but it usually cuts little ice especially if a target is involved.

4 Training budgets are often a target for saving money when there are financial problems. How can staff be expected to develop their skills and knowledge without some level of support? Another demoraliser!

We do have a great system in the NHS but we need to have an honest debate about what healthcare costs, what we are prepared to pay for it, what it is and isn't going to provide and the responsibilities of the public to take better care of their health. Otherwise we will go on placing too many demands on it and its staff and the problems with morale will remain.

The NHS is finished or that's what the Government are working towards.

I have worked as a nurse for 15 years now. Never in all that time have I seen so many nurses leave all in one go. The Government say there are no redundancies. How very true that is. What happens now is hospital management make the nurses working life so intolerable that the nurses leave the NHS for good. All the very many Modern Matrons have been reduced and now they look for redeployment as a ward sister, that's fine but what happens to the ward sisters already in post? Yes, their working life is also made intolerable and they in turn leave. Well done, the Government and NHS management you have done a great job of overspend and moral busting.

I have worked in the NHS for about 8years now and as the days go by, my interest in medicine dwindles. If I readily had alternatives I would not think twice. In Africa where I trained, the people show their appreciation and seem to value every effort of the doctor. You have a good feeling about the work you do and have a sense of purpose. In this country, doctors are not valued to say the least. While a few patients and carers do genuinely appreciate your efforts, a good majority of the people make very 'racist' and derogatory comments. The sad thing is these people do these things in a manner that suggest - if you don't like it then leave. Even the other para medical colleagues cannot camouflage their prejudices either. One is careful not to be seen as unduely sensitive so what can you do but to turn a blind eye. How long will this go on? If doctors had other professional skills that will pay as much then alternative career paths will be flourishing. Hmmmmmm the moan continues and the fact remains the medical profession has lost it's attraction and prestige. I sometimes feel like returning to my country of origin and contributing my bit to my motherland. At the very least my hardwork and effort will be appreciated. And that is far more rewarding anyway.