You got us in to this mess. You get us out of it.

A former Minister who has responsibility for NHS reform, Lord Warner, has launched an extra-ordinary attack on all those who work in the NHS. He cites "productivity" issues and resistance to change within the NHS as the major causes for the failure of Labour's investment programme and programme of reform. Now I know the NHS has come under fire from all quarters over the past few years, Picking Losers alone seems to lay in in to it least three times a week, so I guess it should be expected that the government comes out to defend itself (rather than wheeling out a spokesman with no answers). But this statement is ridiculous and completely unhelpful. It is classic Labour, not taking responsibility and not listening to the people who actually know what they're talking about.

Is spending £12bn on an IT system that the Commons Public accounts committee has warned will deliver no clinical benefits a small reason why we have not seen improvements in the NHS despite massive investment of public money? Or maybe we could look at the cock up with the recruitment as they have an online application system that doesn't work and have created an environment where there are too many doctors and not enough jobs? Perhaps you agree with the the British Medical Association who lay the blame on "ill thought-out Government policies" such as the target driven culture and the headline grabbing figures which actually stop people getting the attention they require just so the targets are met. As Dr Jonathan Fielden, the chairman of the BMA's consultants' committee claimed "Doctors are under severe pressure to meet targets and keep their mouths shut." Or you could go for the reform that gave the option for GPs to opt out of patient care in the evenings, nights and weekends and for the Primary Care Trusts to organise alternative cover which was described by a cross-party committee report as "shambolic and ran hugely over budget." Or how the government's decision to award all their consultants with a 27% pay rise and then cut the amount of work they do (real value for money that one)? Or maybe the NHS isn't working because it appears the Labour strategy when it comes to investing in our hospitals isn't done on a needs basis but on a political basis - giving money to constituencies that are loyal to the Labour party?

This post could go on forever, I fear. Suffice to say, don't blame the people doing the hard work Lord Warner. There are plenty of reasons why the NHS is in such a mess and the root cause of a lot of all of them are the Labour Government's reforms. It's not the doctors and nurses who caused these problems and it's not in their power to sort them out. In the words of a famous football manager to his team after a dismal first half - You got us in to this mess. You get us out of it.



Hmmm-I'm a fulltime NHS consultant with no private practice. When I transferred to the new consultants contract my salary went DOWN by £531 per year (so much for your 27% rise). The Trust 'generously' allowed me to continue on the same salary scale. My contracted hours are 10 sessions (40 hours a week)-in practice I average around 56 hours work in a normal week. Maybe I'm stupid for doing the extra, but the work has to be done, no-one else is going to do it and I know that many of my colleagues are doing exactly the same thing. You've fallen for NuLabor spin about us I'm afraid.

Thanks for your comment -  a very interesting story from an "insider". 

Far from falling for the NuLabour spin, I am criticising it.  The 27% figure was produced from the National Audit Office and was an overall average for all consultants working in the NHS.  The report also found that, on average, consultants were doing less work.  This is by no means a crticism of the consultants - if someone offers you a pay rise then it is your right to take it.  The fact that in your experience you are doing more work and have had to take a pay cut really demonstrates the poor management of the NHS at the moment.  It also highlights the vast discrepancies across the NHS.

There have been various reports on this - such as the Guardian,,2060593,00.html

I guess my real criticisms on this point was the poor financial management, the inability for the Government (and DoH in particlar) to forecast and get value for money and the DoH insistance on introducing the new "big ideas" when it is not properly consulting with the those people who are on the ground and know what they are doing - people such as yourself.

The report can be found here -  It is by no means sympathetic to NuLabour.  I would be very interested to hear you views on it, as someone who has had a very different experience to that desrcibed by the NAO - either way you look at it though, it is not a good reference on the DoH.

I haven't read the report in full-although I don't recognise many of their figures. For example,  their average consultants salary of over £100 000 per annum doesn't apply to me either-my annual salary is £79, 812 (from my last pay slip). I've been a consultant for 7 years having been in training for 10 years after qualification before that.

It was my experience that the diary exercise was a complete fudge. The diary exercise was undertaken in order to determine how much work a consultant was doing-each day broken down into 15 minute segments. When it came to calculations my 'sandwich at my desk while dealing with emails and correspondence' lunch break was coded as 'no work done' and therefore wasn't included. Many other fiddles went on in order to get hours of working down. My trust had the approach of 'the answers 10' no matter what the actual number of sessions worked were. My diary exercise was taken 3 years ago when I was creating and building up the service (I work in a regional, subspeciialized area). The work I was doing then bears no relation to the work I am doing now-I did another diary exercise on the advice of the BMA but this was not accepted by the Trust. The BMA were not helpful (to be fair, I know of other Trusts where they were successful).

 I have no intention of working for the NHS until retirement-I'll be leaving in the next few years.

There is definitely more to this than the current picture we have at the moment (though I am yet to see a good angle for Labour - it seems that things just get murkier and murkier).  Your experience would also be backed up by Dr Rant who claims that the pay increases are a myth (though for slightly different reasons).  However, the NAO report is the most comprehensive report I have seen so far and, if nothing else, appears to give an overall picture.  I would be very interested to see any other studies done on this, if you know of any...

There is more than meets the eye to all this, but as I have said whatever way you look at it, it doesn't read well for labour continuing to try and portray Consultants as port-swilling golfers. I too am an NHS Consultant of 11 years who does no private practice.

Before i accepted the Department of Healths preferred New Contract, i was doing 55 hours a week for a salary which was based on me doing 40 hours - i did 15 for free.

I accepted the DoH's contract because it would pay me for what i do. I now do 48hours a week and am paid at the rate the DoH promised.

Is it my fault that the DoH consistently ignored the polls which showed consultants worked an average of 56 hours a week?

Is it my fault that they underestimated the number of Consultants who moved over to the new Contract?

Is it my fault that the European Working Time Directive limits my working week to 48 hours?

Is it my fault that the DoH cannot do the sums and that the previous 55 hours per week is now 48 hours maximum - err thats 7 hours less but despite this 'productivity' has gone up 3%.

I would call that a result.

It does appear that the biggest cock up in all of this was the way they calculated the full time equivalents (FTE) and the hours every one is doing, so it is hard to know if who is doing more and who (if anyone) is doing less.  Seems the DoH can't get anything right - hence the poll - is time to grant the NHS freedom from political control?  Vote in the right hand column...

No. The biggest cock-up in all of this is that we have a health-service structure that requires centralised calculation and negotiation. Each hospital should be paying what it needs to get the staff that it needs to provide the services that its customers demand and are willing to pay for.

Whether you want to look at it as a simple question of supply and demand (both in terms of wages and services), or a Hayekian information deficit, or an example of the Misesian theory of the impossibility of economic calculation in a socialist economy, attempting to ration by central planning and calculation is always doomed to this sort of cock-up and ultimate failure. It may sound harsh, but there is no alternative, given almost infinite demand for goods that are free at the point of consumption, to exposing people (staff and patients) to the reality of the market.

We discovered on Boris Johnson's website that at least some junior doctors would be in favour of this. I'll be interested to see if some consultants feel the same.