On the 3rd September 2009, there were news reports of possible job cuts in the National Health Service, in the UK. As one of the minions who work for the NHS I listened with some interest and some apprehension. Of course, apart from being an employee I am also a customer and so have a double interest. As my retirement approaches, I will no doubt have some health issues requiring medical intervention. I can only hope that the NHS will serve me wll.

Ministers throughout that day in September kept stressing that job cuts had been disregarded as a means of cutting the huge bill for the NHS. However, many times in the past such feelings have been expressed and then the changes have occurred anyway.

A couple of years ago the NHS underwent a UK government initiative called the Agenda For change which set about equalising some of the negative pay differences in the NHS. Agenda For Change looked at many things such as overtime payments, the definition of the working week and pay structures. How ironic all of this will be, if jobs are cut.

Agenda For Change.

It was hoped that the Agenda For Change would help those workers at the bottom of pay scales to receive a more appropriate rate of pay. In fact, much of this became vital once the minimum wage was in force. The poorer paid NHS staff were barely above the minimum wage, despite the stresses and strains of working for the Health Service.

The McKinsey and Company report

This report had been leaked to the Health Service Journal. Well thank the Lord for that, is all I can say. If it had not been leaked, it may well have succeeded. It still may, even though Ministers say that it has been disregarded.

Of course the press has had a field day as, after all, the cost of this report will have been substantial. The government are damned either way. If they simply disregard the report voters and the opposition will cry what a waste of money. If they act on the findings staff, unions and members of the public will be up in arms. One of Labour's longstanding claims has been that "The NHS is safe in our hands".

Personally, I can see that the government will be looking at ways to, in effect, make the NHS cheaper. Running such a world class health service does not come cheap. The NHS has been plagued with problems for years and many are hard to solve. However, overall it is a great service and well worth protecting.

Yet again, the Tories are rubbing their hands with glee, at what seems to be another of this Labour government's inconsistencies. We are all aware that the NHS is anything but safe with the Conservatives, but of course that does not come into the argument.

Whether or not job cuts are to follow, remains to be seen. Nothing would surprise me. This government badly needs money, especially in view of the cost of conflicts around the world, and our involvement, plus the ongoing banking crisis.

What I find the most disturbing though is, that the proposals are for the job cuts to include front-line staff. The last few years has seen a frightening increase again in overpaid administration posts in the NHS. I do not mean lowly paid clerical jobs, and the like, but those posts that are higher managerial and are vastly over-rated.

Will Jobs be cut?

As many hospital trusts vie for Foundation Trust status they are attempting to streamline their services and become more competitive. However this breaking down into smaller business units has seen a massive increase in newly created executive costly posts. Manager and assistant manager posts seem to be on the increase. If front-line posts are cut in the NHS, in some areas of the country there will be a severe shortage of front-line staff and a glut of managers.

Of course the agenda for change, as well as rectifying the pay of those who were underpaid, has upped the salaries of all these managers. The managerial staff figures must be ridiculous by now. The NHS is in danger of having far to few Indians and far too many Chiefs. Yes, some bosses are needed, but just how many?

With ever changing targets and criteria to be met, there is a need for managers. However, to my mind the meetings, rules, regulations, ever changing procedures and more have done nothing really to improve the lot of the humble patient.

Waiting times are shorter but at what price?

In order to meet targets there are patients whose surgery, for example, is not urgent being attended to before a patient's who's need is dire. All of this is so that the patient's meet the waiting time criteria, which in this context is crazy.

So Gordon, or should I say MR Brown,-

If money is tight for the NHS look to your laurels. Stop changing the goalposts and making excessive amounts of overpaid managers essential for the running of the NHS. Get back to basics and invest in front line staff. As those in the front line become demoralised, and perhaps down hearted, as they consider the possibility of redundancy, patient care will suffer.

If job cuts are not on the cards make sure that NHS staff are fully informed and keep your promise. If job cuts may be on the cards have the guts to come out straight and say it.

However if jobs are to go for the sake of the patients get it right and make sure that those supernumerary staff are the first go.

The NHS is still a great institution and something to be proud off, so let's keep it that way.