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Its not the pay is it. That is simply a proxy for degree of responsibility and accountability allowed to an individual. The main criteria for an individual making a decision should be their experience and confidence in their judgement. Of course it also matters that your boss stands up for you if something goes wrong! The same examples are being used for arguments to support universal collering and to oppose this; the people who walk in with c spine injuries. A more useful piece of evidence would be patients who attend with injuries and deteriorate as a result of moving or other treatment. David O'Hagan Staff Grade A&E Alder Hey