Scrubbing up: Your comments

The National Health Service faces an uncertain future with health budgets likely to be very tight.

Dr David Levy, consultant oncologist and government adviser on cancer, argues that doctors must take a lead role if essential services for patients are not to suffer during the financial crisis.

Here are some of the comments you have been sending in to this week's Scrubbing Up.

I am consultant/interim manager to the NHS and I agree with the main points in the article. Cutting costs in admin or management only saves peanuts. Clinical re-design is the only way to really make change, and only by doctors and nurses working closely with managers can this be done properly and safely. We face a threat to the future of care which is free at the point of delivery. If we value it now, we need to close ranks, work together and if necessary make sacrifices. Better close and merge hospitals and surgeries than lose the NHS.
James Bunt, UK

As an operational manager in the NHS, I find it very disappointing when people suggest that the NHS is over-managed and that managers are over-paid. When I joined the NHS in 2007, managers made up about 2.7% of the workforce, compared with about 15% in the private sector where salaries are significantly higher. The reason the NHS continues to fork out for management consultants is because the organisation is significantly under-managed. There are not enough of us to carry the workload and make effective decisions because there is no time to do a thorough job.
Laura, England

Whilst clinicians are frequently tasked with reducing costs, it strikes me, as a doctor currently working in an NHS hospital, that perhaps there is a more intuitive source of "financial haemorrhage". The hospital I work at is a PFI (Private Finance Initiative) hospital - PFI will cost the taxpayer £7.5 billion per year for the next 15-20 years and has been an economic disaster - private companies of course cannot borrow money at as low a rate of interest as the government can, so it made no financial sense from the outset.
ED, Leeds, Yorkshire

The government has, no doubt in good faith, tried to manage the NHS from top down. It has shown insufficient faith in the ability of well qualified experts to manage affairs in the best interest of the public. Over bureaucratic (and very costly) attention has been established. Place trust in our experts, and stop issuing targets; they always lead to unintended consequences.
Keith Taylor, Huntingdon, Cambs

It is not through lack of trying, but PCTs are so dysfunctional. The left hand does not know what the right hand is doing. In addition while they say that they believe that GPs and consultants are the key to solving the problem, they do not hear what they are being told. They swamp us with paper and unnecessary bean counting, and forget that we also look after patients. I agree - please listen and hear what we have to offer.
Dr Michael Crow, Surrey

Ministers and managers should have planned for this many years ago. Doctors should do their best to ensure that the safety and quality of patient care is maintained. But they must not be scapegoats for managerial failures.
Mr Lawrence, London

It is truly amazing that this even needs to be said - of course medical professionals need to be taking the lead. It is the meddling of politicians and their attempts to micromanage the NHS that has caused the problems, and it is time that the experts regained control. The inmates have been running the madhouse for far too long and I am fed-up funding the waste. I pay my taxes so that healthcare can be provided properly, and I will not condone cuts in actual care.
Megan, Cheshire

My wife is a registrar anaesthetist who initiated a scheme whereby any irregularities or inconsistencies which could lead to patient harm can be identified anonymously by doctors, nurses and other clinical staff members. While there were initially many consultants in favour of the scheme, the hospital management ruled against it. Managers who are not medically trained and who are often paid more than some doctors, are being given responsibility for patients' lives. This is clearly idiotic, since doctors are the only people who know what is best for patients. Bottom line: get rid of useless management! Employ managers with a medical background or with proven positive results in clinical management.
Bob, Oxford

Why is it that true joined up working does not happen in this country? It is only the bottom line on a department's budget that matters. The total cost across departments is never considered. For example good healthcare can reduce the cost of sickness benefits. If only politicians would apply some real thought to these matters.
Peter Gregory, Surrey

I agree with the article. However, I think that this kind of pro-active action by doctors should have happened five years ago. The pending cuts will be savage in the extreme and the extra layers of management, and even the Primary Care Trusts themselves, will be looking at keeping their jobs. Expect American standards of healthcare from now on.
Peter, London

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