Sir: Your report "Night shift surgeons will cut the wait", (29 September) implies that it is the trust hospitals that are struggling to meet waiting lists. While some trusts may indeed be behind on contract, the real root of the problem is the failure to provide adequate resources to enable NHS hospitals to meet their local needs.

This is because most purchasing authorities are themselves cash-strapped and many first wave GP fund-holders seem intent on diverting NHS resources away from NHS hospitals and into the private sector. The problem arose because the previous government chose to expend millions supporting an internal pseudo-market with all the attendant management costs, rather than spend it on direct patient care. While the new government is keen to cut "red tape", it will not achieve this by amalgamating trusts if it does not first amalgamate purchasing authorities and rationalise the waste of resources there.

A disproportionate number of staff appear to have been channelled into primary care. While some of these health prevention measures may take 30 years to take effect, people still need their hernias and gall-bladders operated on.

The Rapid Response Unit in Bradford last year showed the way forward. Vast numbers of patients can be processed, with all grades of staff being remunerated reasonably for use of their spare time. But at the end of the day creating additional capacity in the evenings or weekends costs extra money.

Is the Government equal to the task of reversing unnecessary consumption in managerial terms, halting the exodus of cash into the private sector and as a result giving all our NHS hospitals what they need to provide an effective, sustainable capacity to meet the growing long-term need?

Dr PETER KNAPPETT

Director of Critical Care

Bradford Royal Infirmary