Some trusts have run up deficits, but as a proportion of their budget these deficits are small. Closures have had to happen in places, but in the end there is a limit to the resources available and NHS Managers have to determine how best to allocate  those resources to maximise services. Closures are an unfortunate but inevitable result.

Overall the NHS is in a good state.

My observations are;

Brilliant in emergencies and dealing with a heavy duty illnes quickly and efficiently.

Too many people are in patients for too long because the consultants don't do Ward rounds often enough.

There are too many nurses. Morale is low because there is no leadership to ensure best use of staff time on the Wards.

Cleaning is abysmal on certain Wards. ie. sloppy and un supervised.

Consultants pay has sucked up too much of the budget without the requisite productivity, one told me this himself and explained how he earns XXXX more for doing less, plus private work.

This is based on observations in Castle Hill Hospital, Hull. Hull Royal Infirmary and University College Hospital London.

http://dermotrathbone.spaces.live.com/

Plese feel free to ask me more specific questions....

Remember the NHS in the 1980's? Then it was in crisis.

Today, when the NHS is getting more funding than ever, there are many more doctors and nurses employed than in 1997 and there are new NHS buildings and redevelopments springing up all the time - these are good times for the NHS, not bad.

The NHS has a lot of problems. There is a huge amount of reorganisation and better management required to enable higher productivity and, more importantly, better quality of care. But let us not forget that the NHS was on it's knees in 1997. I remember when it was not uncommon for patients to wait 2 years for a hip replacement. Yes, 2 years! Now no one waits more than 6 months and the vast majority considerably less. It isn't good enough yet. But let's not let people forget how bad it was under the Tories.

The NHS has still got a lot of work to do. A shopping list should include:

*    We still have to ensure that Trusts live within their means. Financial discipline in the NHS should be a Labour legacy.
*    We need to use private capital and expertise to increase capacity and provide enough services - but ensure that we are not being used by private companies and that we are getting value for money.
*    We need to continue reducing waiting times for procedures but the focus also needs to be on quality of care.
*    We need to ensure that there are no further fees for prescriptions, eye care, opticians, dentistry etc. The health inequalities that have persisted over the past 10 years will not be helped by charging for services. The poorest feel these charges the most.
*    The Choice agenda within the NHS needs to be changed to ensure that all, not just the middle classes, benefit from choice.
*    The NHS needs to be designed as a caring service. This is not a factory churning out new hips, hernia and cataract operations. Every patient with an ailment, no matter how trivial feels scared when they walk through the doors of a hospital. Hospitals must be a place where care can be given speedily and effectively, but most importantly with the compassion and dignity that people deserve.
*    More resources are needed on public health and preventative measures. It's better to prevent ill health than treat it once it has occurred. The NHS should aim to be a health service once again - not a `sickness' service.

I agree with most of what Dermot says. I recognise the issues he has pointed out. I've worked in the three hospitals that he mentions. However, I've never felt there were too many nurses.

Glass House, here's an article I wrote on the merits of reconfiguration a couple of months ago. I think reconfiguration of trauma and highly specialist services is necessary to improve quality of care. However, I disagree with reconfiguring most maternity services.

http://progress.squareeye.com/Magazine/article.asp?a=1493

Ignore the tabloids. We need to win the country's trust back.

My local trust admited this was the reason behind closing a local hospital. Instead of trying to spin this, we should be asking why there are problems when so much money has been spent.

Hewitt became a liability when she appeared on TV being booed & jeered by nurses. She looked stupid telling nurses that the NHS was having its best year when they had very different experiences.

Media-wise, theres no point having some stuck up woman insulting nurses because people respect nurses.  Its an own goal.

Brown should appoint a new set of health ministers-ones who come across as less arrogant. Its important not to send out mixed messages. Its better to be honest and admit that theres a crisis rather than trying to downplay the problems.