Letters

It is becoming increasingly obvious that the substantial increase in NHS funding announced by chancellor Gordon Brown last year is not enough. However efficient and effective NHS staff are, there are simply not enough of them in many parts of the service.

Many acres of newsprint are spent on the medical and acute nursing shortages. Unfortunately, only a few square yards are spent on other, equally crucial, staff groups. The examples are legion.

The Audit Commission report on mental health services for children highlighted acute shortages of clinical psychologists and child psychotherapists - almost one in five posts vacant in London, for example - and this in a priority service.

Health secretary Alan Milburn's welcome new initiative on cancer services will place even greater pressure on laboratory services at a time when it is widely recognised that pay is so low it is impossible to attract enough scientific and technical staff into the NHS.

There is an expanding role for pharmacists in the NHS, yet the staffing crisis gets worse. Not only are pay scales for pharmacists inadequate to attract and retain staff, but pay rates for technicians are so poor that the bottom end of the pay scale is creaking, too.

A major independent survey of health visitors in London commissioned by the Community Practitioners' and Health Visitors' Association revealed that many health visiting services are stretched to the limit and beyond, even before the excellent new initiatives on public health and social exclusion requiring a health visiting input begin.

This at a time when the age profile of health visiting means large numbers will retire in the near future, with no sign of training plans recognising this. The same goes for school nursing.

The survey revealed alarming delays in referrals for speech and language therapy in many parts of London - with up to 12 months' wait to see a specialist.

In any discussion of service and workforce planning it is essential that key professionals who may not always be as glamorous as the cast of Casualty are also planned for.

Second, despite the much more honest and sharp approach of the Department of Health to workforce planning, too little too late still seems to be the motto of those responsible for commissioning training places for key groups of staff.

Third, pay is a crucial factor. The NHS Confederation and ministers are right when they say pay is not the only factor in recruitment and retention. But it is the single most important factor, and for many of the groups listed here it is crucial. Many will be outside the pay review body for another year before Agenda for Change is implemented. Another year with a pay offer insultingly lower than that to pay review body professionals will be disastrous.

This all costs money. There is not enough to go round. If we are to avoid robbing Peter to pay Paul, while recognising the cash injection already put in, we will all need to lobby. Here is a basis for real social partnership.

Roger Kline National secretary (health) MSF London SE1