Letters: Collapse of morale at all levels of NHS

Dramatic collapse of medical morale at all levels of the NHS

Sir: Johann Hari's assessment of the NHS and government policy is perceptive (29 September). The present policy mirrors in many ways that which Kenneth Clarke and Margaret Thatcher considered in the early 1990s, but lacked the political will to carry through: separation of purchasers and providers and money following patients.

Proper choice depends on spare capacity and adequate information to make choices. Significant efforts are being made in the NHS in England to increase capacity in specific areas which can be measured, mainly routine surgery and diagnostics. These efforts might have been more effective if they had engaged the professions in the process. Choice requires the information and the time of professionals to explain those choices.

The most successful reforms fully engage those involved in carrying them through. A striking aspect of this government's stewardship of the NHS has been failure to engage the professionals, particularly doctors, in the planning and implementation of change. There seems to have been an active agenda to undermine and exclude the profession on whom they largely rely to deliver the improvements they seek. This has resulted in the most dramatic collapse in medical morale at all levels of the NHS, from senior consultants to newly qualified house officers. An alarming number the latter are actively considering leaving the profession to do something else. The motivation behind this agenda is baffling.

"Choice", "Payment by results", "Money following patients", all mean the same thing: that funds must move to where the patients is treated. The NHS is one of the last three command economies in the world, North Korea and Cuba being the other two. The change towards an NHS economy which links demand to the revenue to meet such demand is logical and welcome, but taken to its logical conclusion it means a National Insurance based system where the premiums rise when demand increases, just as they do with car insurance. Could this even have advantages for politicians? If seen as separate from overall taxation, it would not be seen by the public as just another tax increase. Unfortunately I doubt the Treasury would contemplate such hypothecation: it dilutes their power.

ANDREW J MOLYNEUX

CONSULTANT RADIOLOGIST, OXFORD

Europe has no right to preach to Turkey

Sir: People from so-called Christian European countries should not be so quick to look down their noses at the past human rights abuses of countries like Turkey (Letters, 3 October).

The enslaving of Africans and the raping of the wealth of that continent more than 400 years ago, so that the Gold Coast became the dust coast, is such a crime that is still not fully faced up to by Europe today. Among the endless programmes on TV, and the monuments in honour of Second World War heroes and enemies of the Nazis, there are precious few reminders of a period in history when the square mile in London was built with the stolen blood-stained property of others. Yet here we are today, on one hand continuing injustice in the form of restricted trade while the children of those slaves starve to death, and on the other hand, shaking the finger and tutting at Turkey, blaming it for an empire that is no longer in existence, even in token form.

Let us not kid ourselves, the problem with Turkey is that it's Muslim and not only that it represents confident Islam in the same position globally during the time of the Ottomans as we find Christianity today. Islamophobia, racism, call it what you like, but the reasons for raising eyebrows at the prospect of Turkey joining the EU lie in the arena of those sorts of words rather than any legitimate concerns.

MICHAEL BADU

NORWICH

Sir: "Turkey has never been European in either tradition, history or culture," writes David Westbury (letter, 5 October). Such a selective view of history is seriously misleading, and reveals a myopic definition of "European".

True, "Europe" has never included Asia Minor geographically, but the Aegean region, comprising all its coasts and islands, was a religious, cultural and ethnic unity prior to the 5th century BC. That Greek culture, seen by most as the foundation of all things "European", spread from that basin west to Marseille and east to the borders of Persia and briefly beyond. The superb mosaics from Zeugma on the Euphrates, eastern Turkey, are a brilliant example of that enduring culture across Asia Minor. There are more "classical" remains in Turkey today than in Greece.

The incoming Turks from the late 11th century did not massacre the indigenous population, but were absorbed by it. The facial features of the young receptionist at my hotel in western Turkey last Sunday were extraordinarily similar to many a Greek girl - and to the profiles on classical Greek vases.

Christianity, claimed by too many as a "Western" religion, began its outward spread first to Antioch (eastern Turkey), then, with St Paul's journeys, across much of the rest of this area. It is at Constantinople that government and the Christian religion begin their difficult relationship. The Patriarchate of Constantinople remains the only office from the Graeco-Roman empire to survive to this day. It is in Asia Minor that all seven Ecumenical Councils sat which defined the basics of Christian belief.

The ability of Turkey to inform us of our cultural and religious heritage cannot be ignored in the current debate. That heritage should also instruct modern Turkish politicians on the benefits of multiculturalism, and assist them to come to terms with their responsibilities to the Greeks, Kurds and Armenians within their boundaries.

NICHOLAS CRAMPTON

MUNDFORD, NORFOLK

How children learn to read

Sir: Your discussion of Ofsted's report on reading, English 2000-2005, is remarkable for its omission of one key word - parents ("Tests blamed for decline of reading for pleasure," 5 October).

With a phenomenon as complex as learning to read, it is foolish to focus, as the Government and the media repeatedly do, on single factors such as tests or teachers or phonics. We need to start instead from a far more multi-faceted and integrated view of how children learn to read, giving full recognition to the role of the family as equal partners in the process. We are all responsible for our children's learning, and must all play our part.

This means that if Ofsted keeps picking on individual factors in a narrow way, blaming teachers or experimenting with magic pills such as phonics, instead of looking at all the factors and helping them to work together, we will never make the progress our children deserve.

DR STEPHEN BAX

PRINCIPAL LECTURER, DEPARTMENT OF LANGUAGE STUDIES CANTERBURY CHRIST CHURCH UNIVERSITY, KENT

Sir: The cause of spelling reform would probably have advanced much further by now if all American spelling changes (as mentioned by Dr Coleman in his letter of 29 September) had been aimed at making spelling more consistent and learner-friendly. Webster originally had such aims, but in the spirit of American independence he was persuaded to advocate changes which would make American spelling just slightly different from the British variety, irrespective of their benefit to learners.

He minimally improved spelling consistency with the -er endings for "center" and "theater" and the single -l- in "traveled" and "marveled", but introducing the -ize ending for some verbs only, while still keeping the -se for the final Z-sound in most others (such as "rise", "rose", "wise") has merely complicated American spelling rather than made it better.

Having "defense" depart from the pattern of "fence", "hence", "pence" does not improve regularity either. "Harbor" and "labor" are shorter than "harbour" and "labour" but they still have to be learnt as exceptions from the main pattern of "father", "mother", "sister". "Wagon" breaks the consonant doubling rule as exemplified in "maggot" or "waggish".

Such pointless, jingoistic fiddlings have merely helped to give some people the impression that no spelling change is worth the trouble. What reform needs to address are the spelling inconsistencies which give learners most trouble and make the heaviest demands on teacher time.

MASHA BELL

WAREHAM, DORSET

Poor rewards for teachers

Sir: So, by undertaking a training course lasting from six to 12 months, I can secure a starting salary of £30,000 with reasonable hours ("Women prefer gas as trade proves fitting job alternative", 1 October).

Whereas a teacher who has spent three years acquiring a degree in one of the more demanding disciplines, (mathematics, say), followed by another year training for a post-graduate certificate in education has a starting salary of £18,000, unreasonable hours, and more heckling in a day than Jack Straw will get in a lifetime.

Have I missed something, or is that why there is such a dearth of good teachers, despite the (rather ignorant) view of the gas fitter who you quote as saying "Degrees are a dime a dozen". More proof (if proof were needed) of the dumbing down in Britain under Blair's government.

JAMES ENGLAND

FORNCETT ST MARY, NORFOLK

Nanny-state assault on packed lunches

Sir: Janet Street-Porter wrote a great piece on British eating habits (6 October) and mentioned the overdue changes to school dinners. However I must disagree with her opinion that parents shouldn't be allowed to pack their own children's lunch.

I am quite capable of providing a healthy lunch for my child and actually look forward to doing this. Not every aspect of our children's lives is the responsibility of government and it is high time parents took more time in raising their children, and particularly providing healthy food. I would hate there to be a time when we "weren't allowed" to provide their lunch.

The solution to childhood obesity and other youth issues is not an overbearing government imposing ridiculous restrictions. Ultimately we are all responsible for our own children.

APRIL-TUI BUCKLEY

LONDON SW6

Brontosaurus with a massive thirst

Sir: Is it too much to hope for that your motoring writers might learn to judge something about a vehicle other than its attractions to drivers hungry for status symbols?

The Verdict page in your Motoring section (4 October) slobbered about the "beefed-up design" of a motorised brontosaurus called the Mercedes ML-500 Sport. This is a huge SUV, not just a Chelsea tractor but a Chelsea combine harvester, with a grotesque five-litre petrol engine.

Such a machine is wrong for a time of global warming and coming fuel shortages. David Wilkins glibly says: "Fuel bills for the huge petrol engine are the only real drawback." But what about its huge CO2 output? Its ludicrous thirst of a gallon for every 15 miles in town? Could petrol-headed motoring writers just look beyond the bonnet?

JEREMY BUGLER

BLAKEMERE, HEREFORDSHIRE

European flag and planning rules

Sir: Captain Kent (Letters, 4 October) is correct that the Deputy Prime Minister stated that the EU flag should be treated as a national flag for planning purposes. However, he failed to enact legislation to make it so.

Despite the best efforts of New Labour to replace parliamentary democracy with ministerial decree, the words of John Prescott do not carry the force of law; I suspect that if they did the legal process would prove even more impenetrable than at present. As for the European Parliament office in London, it continues to fly a tawdry advertisement in flagrant breach of planning law.

MARK CROUCHER

UK INDEPENDENCE PARTY LONDON SW1

Next on the list

Sir: Now that our leaders have let it be known that Iran has WMD intent and poses a current and serious threat to British interests, can we assume a secret deal has already been struck between Bush and Blair and - crucially - can we depend on a Tory party led by Kenneth Clarke to oppose what might follow?

RICHARD NEWSON

WHITTON, MIDDLESEX

Olympic coach park

Sir: The 170 East London businesses who are being forced out by the temporary Olympic car park on Fish Island are right to be angry - the site will mostly be used by 500 coaches belonging to Olympic sponsors and their guests ("Up in Smoke", 6 October). I can't believe that the Mayor of London will let 170 businesses be concreted over so that the world's super-rich have somewhere to park while they have a 17-day party. Ken uses public transport and so will all the sports enthusiasts watching the games.

JENNY JONES

GREEN PARTY MEMBER OF THE LONDON ASSEMBLY, CITY HALL LONDON SE1

Boots the library

Sir: I am sorry to learn of the troubles of Boots. In the 1930s I would accompany my mother to Boots in Southend on her weekly visit to change her library books (a small green paper shield was stuck on the front covers). Then we would proceed to the tearoom upstairs where, surrounded by potted palms, we would be serenaded by a quartet playing light music. Oh yes, there were some medicines, sticking plaster etc, downstairs.

MARY WILLIAMS

LONDON N6

Gourmet pest control

Sir: I was interested to read Judith Price's complaint about marauding pheasants in her garden (Letters, 6 October). It strikes me that the most elegant solution to the problem would be for Ms Price to buy herself an air rifle and a decent recipe book. Once released from their pens, the birds are legally regarded as wild animals. During the season (1 October to 1 February), any that stray on to neighbouring property are fair game.

SAM LITTLE

HALE, CHESHIRE

Tax avoidance

Sir: Presumably a sole remaining householder on the imprisonment of a council-tax non-payer can claim the 25 per cent discount for single occupancy

GEOFFREY SILMAN

LONDON NW3