The Big Question: Why are health service workers so angry with the Government?

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Indy Lifestyle Online

What made the nurses boo Patricia Hewitt?

If your job was threatened, or those of your colleagues, you might boo, too. The Health Secretary was given a mauling by the 2,000 nurses at the Royal College of Nursing's annual conference in Bournemouth, angered by the job losses, record deficits and pervading sense of crisis in the NHS. An RCN report calculated 13,000 posts have been earmarked for the chop since October as overspending NHS trusts struggle to balance their books.

Is that unusual?

Very. Sylvia Denton, the RCN president, said she had never seen anything like it in the 26 years she had been attending the conference. Ms Hewitt was unable to complete her speech, was heckled and jeered as she tried to answer questions and eventually stalked off the stage. Aides said she had been set up, claiming senior RCN officers had stoked up the anger in the morning before her speech. "She was there to listen. Not all Secretaries of State in the past have gone to the conference or taken questions. We are a bit cross about it," one said.

Where does that leave Ms Hewitt?

Between a rock and a hard place. She was brave to face the nurses, but possibly unwise. Her arguments may be right but her tone was wrong - too nannying. The next year is going to be the toughest for the NHS. The vast sums of money ploughed in over the last six years have been spent on cranking the system faster - treating more patients and cutting waiting times. Now that the money is spent, hard choices have to be made. The real process of reform is set to begin, which means staff being redeployed, departments merged and hospitals closed. On Tuesday's showing, Ms Hewitt has lost the confidence of the NHS workforce. Labour MPs are wondering if she can survive.

Are the nurses right to be angry?

You cannot blame people for feeling aggrieved when their jobs are threatened - and showing it. But the wider picture looks different. An extra 85,000 nurses have been taken on by the NHS since 1997, a 27 per cent increase. That is whole-time equivalents - the actual headcount is greater because some nurses work part-time. The biggest cheers at the RCN conference on Tuesday were for nurses who complained they had been left to run wards single-handedly because of staff shortages. But this does not square with the vacancy rate, which at 1.9 per cent is the lowest it has been since records began in 1999.

Aren't they underpaid?

Nurses have always been badly paid, and recent reports of GPs earning up to £250,000 - 10 times as much as the average nurse - have contributed to their anger this week. But nurses are less badly paid now than they used to be. The starting salary for a newly qualified nurse has risen from £12,385 in 1997 to £19,166, similar to that of a newly qualified primary school teacher. That is a 26 per cent increase in real terms. The highest-paid nurse consultants can earn up to £86,240, not far off the average income for GPs of £94,000, although it must be said that very few attain these heights.

What about the doctors?

They, too, are a lot richer, but not much happier. GPs and consultants have had pay rises of 20 per cent or more over the last couple of years. Consultants' salaries now start at £70,000. With merit awards, a handful of the highest paid earn £165,000 from the NHS.

Are they angry too?

Doctors are permanently disgruntled. Enoch Powell, the Secretary of State for Health in 1962, observed that the NHS was unique in being run down by all those who worked for it. Nothing has changed in the four decades since. Doctors tend to be individualistic, with large egos, large brains and large bank balances, and unsuited to working for large bureaucracies.

Aren't GPs self-employed?

Yes, and they appear to be happier with the current arrangements than the consultants are. They have got rid of their out-of-hours work, which is now handled by agencies, their pay has risen sharply, and they are set to benefit from the Government's strategy to move more care out of hospitals. General practice is the future.

So, what about the consultants?

Though richer, they are grumpier. They resent their new contracts, which specify more tightly what they are required to do, and they dislike the "target" culture that they regard as constraining their clinical freedom. The ideal NHS, from a consultant's point of view, would be one with no managers, no interference from politicians, and unlimited resources which they could spend on their patients at their own discretion.

And the managers?

They are, if possible, the angriest of the lot - but they contain it better. They feel dumped on by the Government over the current crisis - blamed for the record deficits which they say are not of their making. They were ordered to deliver on the targets to cut waiting lists - but when they did so they were penalised for overspending. Some trusts have been badly managed for years - and are paying the price now. Others are being squeezed to assist the overspenders.

Managers are an easy target for politicians, who point out that their numbers have risen 78 per cent since 1997 (from 22,173 to 39,391 in 2005), while GPs have increased just 20 per cent (from 29,389 to 35,302). More investment in clinical staff and less in grey suits, they cry. In fact, contrary to popular belief, management costs are falling - from 5p in every pound spent on the NHS in 2000 to 4p in 2004.

But all patients care about is getting a good service?

Exactly, and on those grounds, this is unquestionably the National Health Service's best year ever. The maximum waiting time for in-patient treatment is now six months, down from 18 months in 1997, there are more than 200,000 extra staff, heart disease deaths are down 31 per cent, cancer deaths are down 14 per cent, and 83 major hospital-building programmes have been completed or are now under way.

Is this the best year ever for the NHS?

Yes...

* Maximum waiting times have fallen from 18 months in 1997 to 6 months today

* There are over 200,000 more staff working in the NHS, including 10,000 more consultants, 5,000 more GPs, 85,000 more nurses

* Deaths from heart disease are down 31 per cent and from cancer down 14 per cent

No...

* The NHS is facing a record deficit expected to exceed £600m after six years of record investment

* Hospitals are closing wards and shedding staff - 13,000 since October, according to the Royal College of Nursing

* If things are so good, why was Sir Nigel Crisp, NHS chief executive, forced to resign in March?

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