Health policy, Prince Charles and others

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Meeting government health targets does not benefit patients

Meeting government health targets does not benefit patients

Sir: Jeremy Laurance (Health Check, 16 November) has provided an explanation for the problems encountered by patients all over the UK, including my 85-year-old mother, in making appointments to see a GP. Appointments at her health centre can now only be made on a daily basis, by telephoning after 8.30am. The lines are constantly engaged, so that by the time she gets through there are no vacant appointments available for that day and she must try again the next day. No future appointments are permitted.

Last week my father, also 85 years old, had to drive my mother to the health centre at 8.30am in order to make an appointment. They had to return later in the day for her to see a doctor. If my father could not drive, my mother would have to take a taxi at 8am, not to see the doctor but to make an appointment to see one. The new system means that it is virtually impossible to see the same doctor twice. No doubt the practice will be able to claim that it is meeting government targets for appointment waiting times.

It is clear that GPs, primary care trusts, and hospital trusts are using what could be described as suspect means, all fully permitted within the Government's rules and guidelines, to appear to meet healthcare targets. The meeting of such targets is a primary focus since health service star rating depends on them. Large sums of NHS money are used to monitor the statistics by complicated and unwieldy tiers of administration, whilst patients continue to struggle with the reality of a service which frequently confuses them and hinders their access to prompt treatment.

London W5

Sir: Jeremy Laurance identifies the practical impossibilities GPs face in trying to implement the government's 48-hour access target for patient appointments. The new national GP contract introduced in April has not yet had time to overcome the severe shortage of family doctors. The BMA's GPs committee has consistently said that until we have more GPs, guaranteed instant access comes at a cost: in many practices this equates to being unable to offer patients forward appointment booking.

Until you have sorted out the underlying workforce problems, there is always going to have to be a compromise between trying to offer a same or next day appointment, and allowing patients to book routine appointments further in advance. Practices have in the past tried to implement that compromise as best they could, but the government's fixation on 24-48 hour access for all, irrespective of the urgency of their condition, has skewed the balance.

The aim of family doctors is still to see any patient who needs to be seen the same day. But we recognise, as patients do, that not every request for an appointment is urgent. The GP contract will encourage more doctors to become GPs. Until then we will struggle on. But, in the meantime, politically-driven targets do not help us to run our practices in the best way to serve our patients.

Chairman, General Practitioners Committee
British Medical Association
London W1

Charles has chosen the path of caring

Sir: Johann Hari's profile of Charles Windsor should have been called "The Saturday Caricature". Whilst some of the details of Charles's upbringing may have been illuminating, the well-trodden path of his failed marriage surely has been covered by enough articles and books. Not to discuss his work for this country other than some snide comments that he may just work for one and a half days a week is outrageous.

For all the thanks he is getting Charles could have chosen to be a colourless figure, involved in country pursuits, and the patron of a few charities. He could shake a lot of hands and remain silent. That would suit our government and the corporate lobby. He would not have to deal with the spun stories about him in the press every few months. He would be left in peace.

Instead he has chosen a very onerous path, one of caring for his country, its people and this planet. I do not agree with everything he says, but I admire the fact that the Prince is not just a talker. He is a doer. He does not simply become patron of a charity, he starts one himself. He has boosted the organic movement, complementary medicine, tolerance towards other cultures and faiths. He does not just open seminars and conferences, he instigates them.

New Malden, Surrey

Sir: The Prince of Wales may have been misquoted. However, others have sought to revive two very old arguments: first, the "all-must-have-prizes" view of modern education, and second the idea that schools tell students that, provided they work hard and pass their exams, the world is their oyster.

In 33 years of teaching in state schools I have never once sought to give praise or credit for a performance that didn't merit it, nor have I peddled the deception that you can be a brain surgeon just so long as you pass the relevant A-levels; more to the point, I can think of very few teachers I have known who would. The disciplines of league tables, SATs and performance management have long since driven these attitudes out of the system. We do encourage students to aim high, but I fail to see what can be wrong with that.

If some people are concerned that young people these days think that they can get things without working for them then I suggest they look elsewhere for the causes.

Dudley, West Midlands

Sir: Johann Hari's accuses the Prince of hating meritocracy. In his contentious memo the Prince expressed the belief that the highest posts should be held by those who have natural abilities, have qualifications and who have put in the necessary effort. Contrary to hating meritocracy, the Prince appears to be putting forward a manifesto for a meritocratic society.


Sir: Andrew Papworth (letter, 19 November) states that if we had a proper, grown-up democracy every citizen could be born with the opportunity to become the elected head of state. Well, not quite: perhaps if we had a proper, grown-up democracy we might not see the need for a head of state, elected or otherwise. The powers and responsibilities of a head of state could be devolved variously to a supreme court (with a proper written constitution to apply), the Speaker of the House of Commons, parliament, and the people themselves, with no role left for any presidential monarch-substitute to fill.

Worthing, West Sussex

Sir: Johann Hari believes that Prince Charles's 2:2 was a "polite" degree for a future monarch. An urban legend, I think. Some years ago his former tutor at Cambridge told me that she thought the Prince deserved a 2:1, but dropped a grade through going off to learn Welsh at Aberystwyth.

Middleton Stoney, Oxfordshire

Rural history

Sir: I agree with Patrick Reade (Obituary, 16 November) that Marjorie Baker's images of Sussex would be of great interest to historians, including clothing historians. I wish to point out however, that in her wonderful 1947 photograph Mr Browning's Winning Team, Mrs Dale is not "aproned" but wearing what look exactly like a pair of issue Women's Land Army dungarees and jumper.

Her clothing alone sets this picture in its historical context (the WLA being disbanded in 1950) far more accurately than the men's and yet she has been rather overlooked. For me, she is the one who raises the most questions, for she is older than the stereotypical land girl and she is also in the company of her agricultural family. Clearly she didn't begin her wartime duties as a fresh-faced hairdresser from Balham!

I look forward to seeing more of Baker's work at Henfield and Horsham museums.



Sir: Why does Yasmin Alibhai-Brown persist in peddling the notion that Fathers4Justice is a misogynistic organisation (Opinion, 22 November)? As a woman who has been involved in F4J since the early days of the campaign, I find the proposition not only laughable, but profoundly offensive. While F4J is, by the very nature of the injustices it seeks to redress, male-dominated, it is not remotely anti- women in either its intent, expression or internal culture.

Wives, partners, grandmothers and other female relatives and friends constitute a substantial proportion of F4J's active supporter base and are engaged at at every level within the organisation, in fundraising, in administration and in protest. We are not involved because we are the unwilling or unwitting dupes of our overbearing menfolk, but because we too are victims of a cruel and institutionally prejudiced family law system which abuses thousands of children every year by depriving them of perfectly decent, loving parents and their extended families.

The media and the public in general have no difficulty in recognising that F4J is not anti-women, but simply pro-equality. By implication equality in parenting will curtail certain privileges unfairly enjoyed by women under the current family court regime. I suspect that it is this which really alarms Alibhai-Brown.


Lenin was right

Dear Comrade Editor: On reflection, rather than expressing outrage at Robert Fisk's libel that I was an "old Trot" (letter, 16 November), I should express my gratitude. For it has taken the correspondence this sparked to remind me that among the many other objections to Trotskyists, which include revanchism, false consciousness and objectively counter-revolutionary tendencies, they are such a humourless bunch.

Two of your correspondents (Mr Kelly and Mr Ovenden, letters 17 November) claim that because Lenin hardly mentioned Trotsky in his polemic Left Wing Communism: An Infantile Disorder, this tract could not have contained the "prescient warning" against Trotskyism, as I had asserted.

Fortunately, the Foreign Office library still has Lenin's complete works (and well marked they are too). Yes, at the time that Lenin wrote - 1919 - Trotsky was part of the collective Soviet leadership. But Lenin had already spotted that Trotsky was indeed a Trot. For example, in his 1914 article Disruption of unity under the cover of outcries for unity, Lenin wrote " ... we were right in calling Trotskyism a representation and the worst remnants of factionalism" (Collected Works, Vol 17 pp 242-44). Lenin's observations in Left Wing Communism were prescient, with his warnings of "splitism", "ultra leftism" and "wider infantile disorders", which have so characterised Trotskyist groups throughout their history.

Foreign Secretary
House of Commons

PS. Quiz question: Name a successful Trotskyist government (or revolution, for that matter).

Climate change war

Sir: Friends of the Earth has not yet declared war on Tony Blair over climate change ("Greens declare war on Blair for 'failures' over climate change", 19 November). Your article rightly highlights several appalling decisions made by the Government during the last year, for example on emissions trading for industry, road transport and aviation. Friends of the Earth has been critical on all of these. But we have not given up hope.

The Government will soon launch a consultation on its climate change programme. If the Prime Minister really means business he must use this opportunity to deliver policies which will result in year-on-year reductions in greenhouse gases. He must also reiterate in his next manifesto the promise to cut carbon dioxide emissions by 20 per cent by 2010.

Gordon Brown also has an important role to play. The Chancellor must put the battle against climate change at the heart of next month's pre-Budget statement, and make it easier and cheaper for people to reduce their climate-changing emissions.

If the Government delivers on these, then Mr Blair's claim of world leadership on climate change will have some credibility. If it fails, he will very clearly be exposed as a hypocrite.

Executive Director
Friends of the Earth
London N1

Talentless voters

Sir: It must be very annoying for Dr William Bedford (letter, 22 November) to think that every "talentless cretin" in our democracy has a vote exactly equal to his.

Ripon, North Yorkshire

Out of the box

Sir: Howard Jacobson ("Seeing is disbelieving", 19 November) has clearly not been attending to his television obediently enough otherwise he would have received adequate education to be familiar with the axiomatic principles of "ignorance = intelligence" and "stupidity = sophistication". In time and with supervision his spirit can be broken.


Answer to nits

Sir: It is sad to think that each week, E Jane Dickson's daughter Clara has to suffer the nit comb and the pesticidal conditioner (Review, 18 November). The glue which fixes the nits (which are eggs) to the hair shaft can easily be unstuck by washing Clara's hair in a bowl of water to which vinegar has been added. The glue dissolves and the nits float off. No more nits, no more nit comb, no more pesticides on Clara's scalp and no more tears.


Pronouncing 'ough'

Sir: Inserting "tough" before "dough-faced" in Mr Courtney's letter (22 November) makes eight different ways of pronouncing "ough".