The Bill creates two particular problems for doctors in training which we would like addressed. Fragmentation of clinical services will make it much harder for doctors to arrange training programmes. We expect to see a lessening of the role of Deaneries, who have always been fatally compromised by their internal conflicts between their educational goals and their SHA Paymasters. We are keen to see the Royal Colleges given a stronger voice in maintaining professional standards, and we consider that they can best ensure that doctors-in-training are sent to the most appropriate training units.

We firmly believe that the most effective way to manage staff, improve services and raise morale is to give more power to local staff. We would like to see an end to the central management ideology that has been a professional blight in recent years. And we also hope that transferring decision-making into the hands of practicing clinicians will reduce the dominance of the administroids whose perspectives are often divorced from clinical realities.

We strongly support the principle of an NHS that is free at the point of use, based on need rather than the ability to pay. But if we want to sustain the NHS for future generations then we need to improve the way care is evaluated administered and delivered.

We therefore support the idea that improved results for patients can come from giving clinicians the power to shape services around their patients needs - provided that appropriate checks and balances are in place to minimize health inequalities.

For the past decade we have had a tick-box system, based far too heavily on volumes of work and waiting times. This has not worked, has introduced perverse incentives such as those for private providers of independent sector treatment centres, and has led to a management-driven form-filling agenda, rather than one focused on patient care.

Matthew Shaw, co-founder of RemedyUK, says ‘We believe that by returning leadership to the hands of clinicians the NHS can improve decision making in the tough climate that we face. And we believe that, whilst not abandoning the fight over individual areas of concern, it is important to consider the overall shape of these proposals. The wood is important as well as the trees.’

Meanwhile we remain concerned that the budgetary constraints - Nicholson’s Challenge of £15billion efficiency savings by 2015 - are receiving insufficient attention. Consideration of the budget and the direction of the new health reforms are separate issues and must be approached in different lights.

Remedy wants to find out what surgeons in training really think. The survey should take less than five minutes to complete.

Please pass this on to friends or colleagues in a surgical training post.

Click here to take part

"Darling, whatever do you mean?"

"Well Mummy you remember that really good Essay I wrote."

"Oh yes dear, that one was very good"

"Well look - THEY'VE COPIED MY JOKE!!!!! ALLOW THAT!!! "

"Nonsense darling, lots of people make jokes like that."

"But Mummy its not fair, people are ALWAYS copying..."

"Stop it at once. Did they copy that nice letter you wrote to Mr Mandelson?

"Well not that one, but ..."

"Then stop complaining and say sorry."

"Sorry"

"Now come on, say it like you really mean it. You don't want them to get all cross and pompous, do you"

"SORRY MUMMY, I REALLY MEAN IT"