As the forecasters duly proclaimed the end of the lingering summer weather, today saw downpours across Surrey. I was up before 6 a.m. to catch a ride with local paramedics (Aran Blunden and Katie Crabb, see below), and get a glimpse first-hand of the challenges they face on an ordinary shift. They responded to two people with respiratory problems and - no surprise - a traffic accident (thankfully not serious). This is, apparently, typical for the change in seasonal weather.

Paramedics, nurses and consultants all bemoan the distorting effect of paperwork and targets, and it is easy to see why. The form-filling is extraordinary. Much of it appears to be processed as a defence to litigation - the inevitable knock-on effect of the compensation culture. As a non-medic, one thing that interests me is the lack of discretion we give those on the frontline. If someone requests an ambulance to take them to hospital - no matter how trivial - standing orders are for paramedics to duly comply regardless of their judgement. In an increasingly consumeristic society - there are other words for it - this must absorb a significant amount of finite resources.

Aran and Katie demonstrated all the hallmarks of dedicated paramedics, with a true love of the job - come rain or shine - and an ardent commitment to helping those in need. They were far too professional to address the question of NHS reform or pay! But, it did get me thinking. According to Panorama, 6,500 NHS staff are paid more than the Prime Minister (i.e. above £142,500) and the highest paid NHS Chief Executive takes home almost double that, at £270,000 - but the highest paid paramedic earns just 10% of that amount. A recent report showed top NHS managers receiving a 7% pay rise in 2008/9, whilst nurses received a 3% uplift.

I have spent most of my career in public service. People drawn towards that kind of profession do it as a vocation. They know they will take a hit in salary compared to the private sector. I certainly did. It must rankle those on the frontline to see such discrepancies in pay compared to senior bureaucrats. The typcal rejoinder is that you need high salaries to compete for talent with the private sector. That is hard to stand up, when you actually look at the waste - and overall decline in productivity - in the NHS. Equally, the countervailing risk is that you undermine the ethos of public service and erode morale, when you penny-pinch the frontline to pay for a bloated and overpaid managerial class.