SophieTW

Yes, I think there appears to be good GP involvement in parts of Sheffield. One of the aims of the reforms is to spread this more widely - to give GPs more responsibility for making decisions which affect their patients. Another aim is to cut costs (eg, by abolishing SHAs and PCTs). I don't like the way that politicians scapegoat 'NHS bureaucrats', but I do think that public expenditure needs to be cut dramatically and that abolishing PCTs and SHAs will save money. I'd rather that management posts were cut than roles which more directly impact on front-line services. And yes, there is a danger that the restructuring will simply result in most people doing the same job but with a different job title for a different organisation, as has happened in the past. Unfortunately, carrying on with the way things are isn't an option: we don't have enough money to do so.

I agree - I think I misinterpreted your earlier post as implying that there was some kind of sinister hidden reason behind the reforms (along the lines of MPs lining their own pockets). The rationale, as I understand it, is that GPs are likely to be more informed commissioners than PCT managers. My take on the current situation is that it's relatively easy for GPs to take more of a back seat and let the PCT managers run the commissioning show. That may well change when GPs are responsible for commissioning services, and have to think carefully about how much money they want to spend on management support. I think your points are fair, and you may turn out to be right. What I find irritating is the implication of the 'Save Our NHS' brigade that we can maintain current standards of care for an aging population without either massively increased investment or finding a radically different way of structuring the service that makes it more efficient. The 'No Cuts' slogan is emotionally appealing but I haven't heard anyone explain how we are going to maintain current levels of public sector funding without racking up ever higher debts.

What baby is being thrown out with the bathwater? The big principle of the NHS is for care free at the point of use - something which won't be affected by the reforms. I personally don't mind whether my treatment is delivered by a private company (financed partly by shareholders) or an NHS organisation (financed primarily by taxpayers). I'm quite happy to take drugs made by profit-making organisations, and to have scans using equipment made by private sector companies. Some GPs will want to focus on caring for the patient in front of them, others will be keen to get involved in shaping commissioning. Still others have an active interest in running their businesses - that's why some of them became GPs: because they wanted to be self-employed. I agree that lots of NHS staff do work very hard. And some don't. The 'people above them' are making decisions based on the money that is available. If we want to put more money into the NHS we need to vote for a party that has a clear committment to raising taxes. History suggests that there are very few occasions when a political party in the UK has won an election when it has committed to raise taxes.

Not knowing Andrew Lansley personally, I hesitate to speculate on the 'real' reason for the restructuring, but I would imagine that his aims include the following: 1. Commissioning to be driven by clinicians - having them represented on the PCT board hasn't really had that effect. 2. Cost savings - by reducing the size of PCTs. I completely accept that these reforms are very risky, and I don't think Andrew Lansley has done a good job of explaining them. However, I don't accept that a major motivation behind the reforms is to line the pockets of MP, as was suggested by the original poster.

Is that Professor Savage's view or your own personal opinion? Is this the kind of thing you meant by 'contributing to the debate in a constructive way'? Just so we're clear: you're saying that these changes are being introduced so that Members of Parliament can line their own pockets? You don't think it's anything to do with giving more responsibility for decision-making to clinicians? Would the Cumbria GP pathfinder group agree with you?

1. I express my own views. Why should the fact that other people hold views which are the same/broadly similar/slightly different/completely different influence whether I articulate my opinions? 2. As I wrote earlier, I know some of the protestors personally and admire them greatly for their work in their local communities. 3. I'm not comfortable with your assumption that I have not struggled in my life, nor with your interest in my employment.

1. I know that bankers as a group earned billions of pounds of bonuses, just as I know that the UK GDP is around £1,300 billion per annum. As I said, I haven't seen any evidence that passing a law that prevents the companies from paying their staff the way that they choose to will help the UK economy recover. I'm genuinely open to persuasion on that one. 2. I am happy for services in this country to be run by whoever seems to be most competent to do so - I don't mind what school they went to. Winston Churchill attended Harrow public school but I don't hold that against him. Michael Foot studied at Oxford University (which many would regard as an elitist establishment) but I don't hold that against him. I judge public servants on whether they have the intellect and ability to do the job, not on their gender, ethnicity or social background.

Hi fox20thc, I appreciate your response. But I disagree: 1. The problem is that people want to continue paying the same level of tax and have an increasing amount of money spent on public services. 2. If companies can legally avoid paying more tax I think we are naive to think that they won't do so. The government has to weigh up the benefit of getting more tax out of them with the risk that they will move out of the UK, taking jobs and tax revenues with them. I accept that the government may be getting that calculation wrong at the moment, but I don't think it's an easy call to make. 3. I have a feeling (I haven't done the sums) that if we stopped banks from paying huge bonuses to bankers it wouldn't actually make much difference at all to the overall ecoonomy (very rich people constitute a tiny fraction of the UK population). But as I say, I haven't done the sums, and I'd be interested to hear from someone who has. 4. I know some of the protestors personally, and I admire them enormously. As you say, they do a lot of voluntary work which makes a big difference in their local community. We could debate whether they are in the majority, in terms of people posting to this threat and marching on demonstrations, but either way I think they are wrong in one important respect: they are arguing that society should be better, fairer, more equal. However the evidence suggests that societies don't tend to work like that. Human nature being what it is we've never managed to create the socialist utopia on a consistent replicable basis.

If I've understood the protesters correctly they want: 1. No cuts in public sector services. 2. The services to be provided without them personally paying any more tax. So who is going to pay for all these services? I don't see many of these protestors heading down to the local tax office and enquiring how they can make additional voluntary tax contributions. I have a sneaking suspicion that they expect 'someone else' or 'the rich' to pay more, and my guess would be that by 'the rich' they mean 'people who earn more than me'. Conveniently forgetting, of course, that in world terms we in the UK are the rich, and if the protesters were really that bothered about poverty, justice, etc they'd be flogging their dvds, ipods etc and sending the money to developing countries to help people who don't have access to clean water. It's fun to stand on the sidelines and moan, isn't it? You get that lovely warm feeling of righteous indignation, but none of that nasty responsibility stuff. Of course, you could stand for election and see how many people vote for you.......

I saw it too - driving back to Sheffield from Chesterfield along the A61. Seemed too low to be a meteorite but didn't look like a firework - really bright and fast, moving across the sky.

Can anyone recommend a reliable roofer who knows what they are doing? I think my roof needs major work, and I'm trying to find someone who will actually keep their promise to turn up and give me a quote for the work.