bridge too far

Not a bad idea actually! Because it's better for the economy to have people in work. Not only does it reduce the costs of JSA at a stroke, but those people will then all pay tax and NI and buy stuff, reducing the burden on the rest of us. Brilliant! Much, much better than slashing public services and increasing the costs of unemployment dramatically. That would mean less taxes, less consumer spending, and many more houses being repossessed (thus decreasing the value of everyone's house). BTW did you read all the letters? Or just the first one?

Actually budgets aren't 'index-linked' as you say. As I just said, NHS Trusts are charged with reducing their costs year on year. If a Trust, or a department within that Trust, reduces its costs, its budget the following year is reduced accordingly. They don't even stand still - they reduce. Increases in NHS spending are largely capital - i.e. buildings, equipment etc. and therefore cyclical / one off. They are predicated by the comparitive cost of doing nothing and it has to be demonstrated that it is cheaper to replace a building / piece of kit than to retain and maintain.

This is quite a good riposte - far better expressed than anything I could come up with http://www.guardian.co.uk/society/2009/sep/17/productivity-public-sector-cuts It's difficult to measure and increase productivity in the public sector. Unless we all go out and injure each other so that more people are treated in hospital :smt102 Or set fire to each other's houses? Oh hang on - why don't we make people wait longer for operations - like they used to - so we don't need so many doctors and nurses and equipment. Tch!

But I've also worked in the NHS since 1991 (with a break of 5 years when I worked as an auditor in private practice but still auditing NHS Trusts amongst other public services). Much of that time was spent as a Procurement MANAGER (eek - unclean) for a very large NHS Trust. So I know a little bit about procurement. I know that, year on year and by clever procurement, the non-pay spend for that particular Trust met its target of a 5% reduction - yes reduction - in costs. Nick, you still haven't answered my question. Who do you think should do ordering, invoicing, receipting, stock control etc. etc.?

Vraiment! And it's because they drink so many, they blur their Ss

Thanks Bungle The IT procurement has been a disaster. I suspect that the main providers don't have the nous to deal with such a major, major project. NHS IT procurement has been beset with difficulties since time immemorial. I vaguely recall a huge scandal with the old Wessex Regional Health Authority and an IT project many years ago. However, at some point, I think it's important that there is a national database that clinicians all over the country can tap in to. Imagine having an unusual medical condition and being in a coma after a road accident, say, at the opposite end of the country. It could be life-saving for the A & E team treating you to have access to that data. Already I can see how useful it is for my GP to look at test results on line instead of waiting for a piece of paper to arrive in the post and that's just a little example. What the answer is, heaven knows. All major IT projects seem to fail these days, public and private.

I shall be working 3 days a week (because I look after grandchildren the other 2 days) and have taken a huge drop in salary to do this job. So that's a 0.5 FTE equivalent. Currently there are at least 3 nurses (quite possibly more but I haven't started yet so don't know for sure) providing a home respiratory service for the whole of Oxfordshire. They need to establish a number of protocols to manage the service and just don't have the time to do so in a way that is central and therefore efficient both in terms of cost and patient standards. In simple terms, they can treat more patients more quickly if they can leave the administrative dross to me. They also don't have the experience to, for example, set up databases and they don't understand NHS procurement to be able to negotiate contracts and deals (for home oxygen supplies for example) as I do. In my previous job, I had a lot of dealings with major construction companies. Guess what! When costing projects, the QSs listed the materials needed for each job but a procurement CLERK did the actual buying. Because it's cheaper to do that than to 'waste' professional time on a process job. Exactly the same as in the NHS.

But Nick! SOMEONE has to oversee the tendering process. SOMEONE has to order the bandages at the point of need. SOMEONE has to process the invoice. SOMEONE has to check in the delivery. If we take your position to its logical conclusion, and we don't have any managers / administrative staff, who on earth do you propose does all the above tasks? I'm about to start work back in the NHS administering the Home Respiratory service in Oxfordshire. At the moment nurses are having to do this and the time this takes could be much better used to treat patients. Because they are working in isolation and don't have the time or experience to instigate a joined-up service they've decided to employ me to do this. The cost of employing me to do this is far less than the cost of employing additional nurses to cover for the nurses trying to administer this service at the moment.

I think it's meant to be ironic and a pastiche, i.e. stitching together two facts to make a jest.

You have to look at the overall cost Nick. I think you're a business man? Then you must know all about overall costs. The overall cost of employing a ward clerk and a supplies clerk to order bandages at a significantly cheaper rate has to be far less than the cost of employing an additional nurse (to cover the cost of the nurse who you would have doing the ordering) and the cost of the bandages ordered in dribs and drabs. Presumably you've heard of volume discounting? In your business (assuming it's large enough) do you do all the wages, HR work, IT support yourself or do you employ people to do it for you because a) you haven't got the time and b) you haven't got the knowledge? If you were to cost your hours for doing these tasks, no doubt you would find it cheaper to employ someone to do them for you? Clinicians' private work is sacrosanct to them. They will not give it up but will work their contracted NHS hours (and more). Most clinicians I've worked with work in excess of 90 hours a week so that they can do their private work. You must remember that they are independent contractors to the NHS.

"Southampton's owner, Markus Liebherr, has a background in hockey – a revelation that will send a shudder down the spines of Saints fans who recall Rupert Lowe's spells as chairman with anything but tenderness. But before St Mary's agitators use that fact as a jolly hockey stick with which to beat the owner of League One's only winless team, it must be pointed out that Liebherr only played the game at university. And as a scion of Europe's 42nd-richest family, the Swiss-based billionaire does not look like someone Southampton fans should be driving out of their club." http://www.guardian.co.uk/sport/2009/sep/17/flavio-briatore-renault-formula-one (bottom of the page)

There's no conflict there, Nick. I have worked in the NHS for 15 years and have just secured a job back in the NHS so I do speak from personal experience. Most clincian / managers combine the two roles very successfully. The clincians in particular will work extra hours to do so (although they won't give up their private patients and, some would say, why should they). But here's an example for you. Many years ago, if a ward required, say, more bandages, a nurse would phone up a bandage supplier and order a dozen bandages. The flaws with this process were a) valuable nursing time was being lost on simple clerical work and b) best value was not being obtained because a small volume was being purchased. So each ward will now employ a ward clerk (some would say a manager but that's not the case because the ward clerk would earn far less than a nurse). That ward clerk would place an order via the supplies department who would have negotiated a contract with the bandage supplier to 'call off' bandages at a deeply discounted rate. So valuable (and comparitively expensive) nursing time has been saved and the bandages have been purchased at a much better rate. Win Win! In fact, it gets better, because most hospitals use a Materials Management System to ensure Just In Time deliveries to the wards - saving even more money.

Quite right Bungle - 10 out of 10. I have Swine Flu and cannot, therefore, produce my usual high standard of grammar, spelling and vocabulary. :oops:

You know what'll happen TDD. They'll outsource the work to a private company who will use less people to do the work but cost more in real terms. That's what always happens.

No but they are MANAGING the people who do - hence the title 'manager'. Pen pushers fill out forms, do costings and get quotes so that nurses and doctors don't have to. Or would you rather nurses and doctors carried out these tasks instead of treating patients?

There is a widely held misconception about 'management' Nick. Many, if not most, managers in the NHS are clinicians carrying out their 'proper' jobs as well as carrying out management responsibilities.

Feeling a tad better today. I haven't been able to talk for 3 days. This annoys Mr TF as he's on a night shift, therefore asleep during the day and unable to revel in the silence I think I've had swine flu

Hmmm not with ours there wasn't! In any event, the tickets only arrived about a week or so before the event. Anal person that I am, I needed to know where I was parking well in advance, especially as I no longer live in the area and hadn't been to the RB before.

Heh heh I'm not nice to know atm H - I've got a wicked strep throat so that would be a hindrance. To talking I mean

I absolutely agree with you there H. Trying to find out info when we booked our tickets for last week was a nightmare. No info on parking - I had to get that from TSW! There was not much more on the tickets when they arrived. In the end we parked at my brother's mother-in-law's house (in exchange for a bunch of flowers) - just a short walk from the ground.

BBC also reporting that he will be continuing as Scotland's manager

I was hearing on the radio yesterday that the PL is proposing to stop clubs with financial problems from buying new players. I guess this will hit Poopey hard.

Great, great dancer and did a lot to make boys realise that it's OK to be a bloke and a good dancer.

This is very important. I think, but I'm not absolutely sure, that diabetics can get free eye tests. Mrs H might know for sure. My mum had type II diabetes and she lost her sight because of diabetic retinopathy. She coped with everything else life threw at her but found losing her sight very hard. So do get your sight checked regularly. I'm just about to finish participation in clinical trials to do with diabetes. I'm not diabetic but I'm at risk because of my age, my mum and my smoking. This trial is looking at a combination of drugs to try to minimise the risk of heart attacks. Risk of heart attacks and stroke are heightened for diabetics. As well as watching what you eat / drink, moderate exercise is a good way to control diabetes. And check your feet - they are at risk of injury. This all sounds scary, but thousands of people manage diabetes very well and research is resulting in new drugs all the time as well as understanding the genetic predisposition to the disease. Good luck JLeT xx

Can't see how you could put Apps on, sweetie, cos you have to buy them from the Apps store (even when they're free) and you have to have an account to 'buy'.