A week is a long time in politics and so too can it be for the NHS.

In between listening to a medical director lecture a consultant that whatever his employment contract might say if he did not work all the hours required to satisfy the accountants his job would be on the line, and wondering just how the NHS would really benefit from levying a hefty fine on, or even closing, the Royal Cornwall Hospital, it dawned on me how brilliant Sir Thomas Legg has been.

Sir Thomas has reviewed all expenses submitted by our MP’s. He has concluded that whatever the rules may have been at the time they were inadequate and should not have been followed. So MPs who claimed their entitlement now have to pay some of the money back. The brilliance of this approach is that Legg has not only recovered money for the Treasury but has succeeded in changing the relationship between the public and its MPs.

Before the summer recess the public was in hanging mood, ready then to draw and quarter MPs who had abused the system; and, as we know, shares in duck house manufacturers and moat cleaning firms took a nosedive.

But now even the public is beginning to realise that changing the rules retrospectively to suit political ends is unfair. MPs may not be held in the highest esteem but our tendency to fair play offers at least a modicum of sympathy for people who acted within the rules but find, years later, that those rules should not apply.

I wonder if Sir Thomas came to this view after close study of the NHS? Too many trusts are saying that they simply do not care what was agreed between the Department of Health and the BMA in 2003.

Even though they were hailed and endorsed by the government, too many trusts are adopting the ‘Sir Thomas’ approach. “We don’t like the rules and as the game is played on our pitch we will decide how the game is to be played.” Like MPs doctors are entitled to ask whether this is fair.

Perhaps we should agree a new set of rules. My rules would not result in consultants being paid in units of Programmed Activities of four hours each, calculated to the third or fourth decimal point. My rules would recognise that doctors are professionals who resent this time sheet approach. My rules would recognise the value consultants bring. My rules would be work sensitive; not time sensitive.

Who wants to play?