LETTERS: Morale sags in struggling health service

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Sir: You write: "Professionally, organisationally and morally, the health service is in remarkably fine fettle," (leading article, 21 June). This is in contrast to the letter I received the same day from the President of the Royal College of Physicians. One sentence from this reads: "I thought you should be aware of the frustration and despondency which are beginning to reduce the sense of commitment which physicians have seen as the quality and standard of their care as being compromised."

I have just returned home from a round of emergency admissions to the medical wards under my care in a large teaching hospital in the North- west. Despite it being mid-summer every medical (as compared with surgical) bed in the hospital was full, with most of the weekend still to run. Patients were in extra beds put up in rooms which lacked necessary safety equipment. Some wards were running with a shortage of nursing staff.

It is easy to predict the situation as winter approaches. As happened last winter, more and more surgical beds will be occupied by medical patients until "cold" surgery virtually ceases. Physicians, already working at capacity, will be further stretched as they cover the extra patients on surgical wards. Corners will be cut and consultation with patients rushed through.

Health-service reorganisation has, at best, been an irrelevance and, at worst, a compounding influence to the current crisis, as it was basically aimed at reducing surgical waiting lists and took little account of the greater complexity of medical diseases. The new generation of business- style managers are out of their depth when helping medical staff cope with the steady increase in work load resulting mainly from the medical emergencies we are experiencing.

Only an immediate increase of medical beds and staffing of about 10 per cent is likely to improve both patient care and "the professional, organisational and moral" aspects of the health service of which you are such a fervent admirer.

Dr P D O DAVIES FRCP

Consultant Physician

Caldy, Merseyside

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