In your leading article of 22 January you say that the increased demand for gastric-band operations means that people now have to be more obese before many NHS trusts will perform them. At the other extreme, the same dilemma occurs with anorexia. To obtain NHS treatment a sufferer has to be a very low weight, often only gaining adequate treatment once they have reached a critical level (a BMI of less than 15). By this time, the anorexic thoughts and habits have become so entrenched that treatment is more lengthy and expensive.
Why are more cost-effective options not used before people become critical?
It has been proven that the earlier a person with an eating disorder obtains treatment, the more likely they will recover. As with obesity, anorexia carries with it other medical conditions such as heart problems and osteoporosis which require further long-term care.
Our late daughter, and others I know who have had anorexia, have said “How ill do I have to be before I can get help?”
J MALLEN SHEFFIELD
It has been reported that the NHS could save millions by flying patients to India for operations. The spectre of the NHS paying for patients to travel to India, a country of immense poverty which seems incapable of sorting out its own desperate problems, for conditions which can betreated more than adequately locally, would be nothing more than criminal.
Is no one in the NHS taking the health aspects of climate change in the least bit seriously? The damage to the health of billions of people that even the current predictions of climate change will bring is well-researched.
There exist many professors – especially of ”health system economics” – who are among the most intelligent people on the planet, but seem devoid of any common sense. Are we saying that a country with grim levels of undernourishment should be tailoring their hospitals to deal with problems related to western obesity?
DR COLIN BANNON CRAPSTONE, DEVON
Government IT overspends
It was refreshing to see a sensible response from an ex-minister who has had to manage the interface between policy and execution, and suffer the consequences of failures in IT systems (letters, 21 January). But Mr Blunkett misses out one important group which, Macavity-like, normally avoids the consequences of failure, seamlessly moving on to the next contract. These are the third-party consultants who advise on the link between policy and implementation, develop requirements and “manage” their implementation.
Many of these organisations perform poorly, represent both sides (customer and provider) badly, and some are frankly incompetent. The sooner government, as an important customer, takes back control and invests in expertise, the more likely projects will begin to be delivered on time, on cost and meet expectations.
RICHARD TAYLOR BRISTOL
I am amazed by David Blunkett. Surely after 12 years in government, it is a bit naive to suggest there may be “arguments for much closer scrutiny” of procurement?
Ministers should propose, preferably with Parliamentary approval, what systems should be procured and set the budget. If not ministers, then whom? If ministers do not monitor effectiveness and control spending,what are they doing?
Mr Blunkett talks about putting the Government “in the driving seat”. If the Government is not now in the driving seat, who is and who is actually responsible for the specification and implementation of Government IT systems?
JOHN HENDERSON WINCHESTER
Mike O’Brien, the health minister, writing on the subject of payment to companies supplying IT to the NHS (letters, 21 January), states: “No money has been paid to suppliers for these systems until they are successfully working”.
This is not usual practice in payment for large contracts, where staged payments are made to ensure that suppliers do not go bankrupt in the middle of a project. Staged payments also make it possible for bids to be considered from companies which do not have access to large cash reserves.
Many IT projects take many years to complete and they are almost invariably innovative and high-risk. Few companies, even those on government lists of preferred suppliers, can afford to invest long-term the vast sums involved in the hope that they will receive payment only after the system is up and running.
CHRIS PAYNE LINCOLN
It would be easy to conclude that large government IT projects fail primarily for technical reasons (“Labour’s computer blunders cost £26bn”, 19 January).
Technical mistakes certainly are made, but the root cause of many failed projects seems to be the procurement process with which they begin.
The question which is asked of the suppliers is not one that allows for the kind of answer that leads to success.
It is well known in the private sector that very large monolithic projects have little chance of success, but this is the only kind for which the Civil Service seems to know how to ask.
I have no doubt that ministers are, as Michael Savage puts it, “too easily wooed by suppliers”. The suppliers which we see winning government contracts again and again might also find it too easy to woo a minister – particularly a minister and a department which would rather launch a high-profile, high-budget, highrisk project than adopt the smaller scale, incremental approach that creates few headlines when launched, but also has a much better chance of creating few headlines when it does not fail.
KEITH BRAITHWAITE LONDON W1
The role of race in unemployment
You say I made the assertion that “race has diminished as a factor when it comes to economic opportunities in modern Britain” (leading article, 21 January).
I did not. I said we must recognise that we will not succeed in tackling racism without tackling all forms of discrimination, prejudice and inequality.
The latest unemployment figures reenforce the need to tackle both racism and class; in a recession it is those who are most disadvantaged who suffer most. We recognise there is still an ethnic penalty and after 10 years of closing the gap the recession has opened it again.
Butwe should not neglect those white working-class young people who are also having a hard time in the labour market and also deserve fair treatment.
JOHN DENHAM SECRETARY OF STATE FOR COMMUNITIES AND LOCAL GOVERNMENT, LONDON SW1
Individual giving helps Haitians
Contrary to Adrian Hamilton’s opinion (21 January), the generosity of individuals is making a massive difference to the lives of people in Haiti.
Thanks to the remarkable response by the UK public, the Disaster Emergency Committee is able to provide financial support for 13 of the biggest aid agencies in the UK to deliver emergency help and begin to plan to help Haitians rebuild their lives from the rubble.
Comparatively small sums can make a big difference: £50 feeds a family for a fortnight; £100 could provide temporary shelter for two families.
Despite Hamilton’s view that money for previous disasters has been lost “in the great swirl of tragedy and rescue”, the money raised by the DEC after the tsunami five years ago has had a massive long-term impact, leaving communities stronger and more resilient to future emergencies. After the immediate relief operations, money raised was used for a variety of DEC agencies’ recovery programmes, including education, construction, work and health projects.
Delivering aid to Haiti is not a competition. Countries and organisations must work together to make sure the huge coordinated effort needed to save lives is as effective as possible. It is vital that people keep donating to make sure aid continues to reach those who need it most.
BRENDAN GORMLEY CHIEF EXECUTIVE, DISASTER EMERGENCY COMMITTEE, LONDON NW11
GPs’ abdication of 24-hour care
I heartily agree with Mary Dejevsky in wondering why GPs are not contractually required to work shifts, ensuring care around the clock (15 January).
Towards the end of my nonagenarian father’s life, I arrived one Sunday for a visit to find he had not been to bed all night, that he did not recognise me, and that he was going around to various places trying to urinate.
After ringing for an emergency doctor, a charming young man arrived who diagnosed my father as having gone out of his mind. He called for a psycho-geriatrician who eventually arrived and came to the same conclusion. An ambulance was summoned to take my father to a psychiatric hospital 18 miles away. The next day the charge nurse of the admissions ward told me that my father should not have been taken to this hospital, but to the local general hospital in his town, as his condition was not a mental one but a physical one, a dangerously high fever.
Had there been a shift scheme at my father’s doctors’ surgery, this would probably have been recognised straightaway as he had been prescribed a medicament for a urinary infection only two days before. Whether he had taken it or not we do not know as he lived alone.
We cannot arrange for human crises to occur within certain hours. I write with some feeling as I am a retired deaconess, a member of a profession without fixed working hours and ready to respond to human need whenever it arises.
MARY WRIGHT HARROW, MIDDLESEX
The temperature of the oceans
Steve Connor quite rightly points out that we cannot look for long-term climate trends by examining short-term regional events (Science Notebook, 19 January). However there is one medium-term cycle which I believe he has not yet mentioned: namely the deep ocean cycles, otherwise known as Multi-Decadal Oscillations (MDOs).
These are cyclical variations in the temperature of the deep Atlantic and Pacific Oceans, of roughly 30-year duration. This theory accords well with all the major variations over the past century, whereby (roughly) the 1910s to the 1940s and 1970s to the 2000s were warmer. Therefore we may be now entering a 30-year colder period, which doesn’t mean we should stop worrying about CO2 emissions, but it does mean that stocks of grit should be kept high on the list of council priorities.
STEPHEN NASH MIDDLE BARTON, OXFORDSHIRE
Mr Penn(letters, 25 January) might well be right to believe that it is the kind of people who marry who keep families together, not the institution itself – but surely Cameron’s point is to reward good behaviour in the hope of encouraging others to emulate it. Surely this is more desirable than rewarding bad behaviour,whichisoneofthe unintended consequences of the current approach?
R S FOSTER SHEFFIELD
Gay blood donors
It was instructive to have Dr Susan Barnes (letters, 23 January) clarify the situation as to who may donate blood.
So a gay man of 60 who once had sex with a man when he was 16 may not; a straight man of 26 who has spent the past six years getting drunk and having unprotected sex several times a week with women whom he does not even know at the beginning of the evening may.
MICHAEL J J DAY SETTLE, NORTH YORKSHIRE
Not wishing to be a pedant or to denigrate the contribution of the people of Birmingham to the war effort, Dr Dawson (letters, 25 January) is wrong. The second most bombed British city during the Second World War was Liverpool. More than 4,000 people were killed there, 6,500 homes were destroyed and 190,000 were damaged.
Like Birmingham, the Government kept quiet about the amount of bombing the city suffered because of the strategic importance of the port.
DAVID JONES SKELMERSDALE, LANCASHIRE
Your Big Question of 22 Januaryabout the Tea Party movement in the US recalls the Poujadist movement in France in the 1950s. The Poujadists, who were against everything to do with government, gained 53 seats in the French Assembly, but within a short period the electorate realised that they had been taken for donkeys and kicked them out. The citizens of the USshould think very carefullybeforegoingdownthis road.
ROBERT G BEECH STANFORD LE HOPE, ESSEX
The managing director of the company that sells bogus bomb detectors (report, 23 January) describes the device as being capable of detecting anything “from explosives to elephants”. Every efficient household needs an elephant detector. No more backbreaking searches under the beds with a torch.
PETER FORSTER LONDON N4