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Monday 12 July 2010
Letters: Health policy
Keep markets out of the NHS
Andrew Grice's report "Don't let the NHS escape pain of cuts, Tories say" (7 July) reflects the long-held desire of Tories to privatise the NHS.
For the past 62 years, various political leaders have insisted the NHS is safe in their hands and that they can deliver health care more efficiently. In reality services have been continuously destabilised in order to establish a competitive market system with a plurality of for-profit providers, for the double-edged sword of patient choice. Now, the coalition intends once again to put commercial values at the heart of the NHS.
The previous administration already introduced charges for health care (co-payments and top-ups), altering the NHS funding base. New Health Secretary Andrew Lansley would like to extend that principle. The risk is that with continuing commercialisation and a cash squeeze, public support for the principles of the NHS could erode, opening the way to extending charges, introducing widespread top-up fees, co-payments and, by implication, private insurance. The danger is that this would see the NHS increasingly become an insurance system rather than a provider of health care.
If the founding principles of the NHS – universality, equity and quality – are to survive this financial crisis, we must abolish the purchaser-provider split and reintegrate services. This would save on transaction costs, marketing, billing and invoicing. The abolition of foundation trusts and the independent monitor would allow the reintegration of the health service and bring it back under direct parliamentary accountability.
The new Government has pledged to ring-fence NHS spending, although there will be cuts in real terms. We have an infinite demand for healthcare and a finite budget. An ageing population, escalating obesity and alcohol-related illnesses, and growing health inequalities will put increasing pressures on the health service. These will be difficult to overcome even without the future budgetary restraints.
Lansley should concentrate on transforming the NHS from being a sickness service that diagnoses and treats, into one that also promotes health and pre-empts illness. All the main political parties need to rethink their policies on the role of the market in the NHS in England. The universal healthcare provided by the NHS – once the envy of the world – is in serious danger of becoming unsustainable.
Dr Kailash Chand
Your leading article (10 July) fails to analyse what is behind the move to hand £80bn to GPs to spend. Labour and Conservative parties believe in the magic of the commercial "market". GPs will gradually be absorbed into larger units run by businesses for commercial profit. This plan is, in effect, the Government's way of paying businesses to run the NHS. Commercial healthcare costs 10-15 per cent more than present NHS healthcare.
Can we afford this extra £10bn to pay business people large salaries and bonuses – not to mention dividends to shareholders – out of our taxes for health care?
Dr Chris Burns-Cox
Co-Chair, NHS Consultants Association, Wotton-under-Edge, Gloucestershire
Isn't it interesting that successive Tory governments believe that the best way to save money in the English NHS is to give nearly all of it to the only people delivering NHS health care whose income depends on the profitability of their personally owned business and who are not actually employed by the NHS – ie GPs? Abolishing PCTs in England may turn out to be no bad thing, but effectively recreating them, run directly by local GPs, will not help.
GPs are neither trained nor experienced in managing whole-health economies, nor in understanding the impact of decisions on large institutions such as hospitals.
GPs may be bright, engaged, and understand their patients' needs, but their only managerial experience is of their own NHS franchise (their surgery). Burdening them with this extra responsibility is unfair, has not worked in the past and is likely to create a degree of chaos in the system that will be costly to correct and not necessarily good for patient care overall. Nor is it even clear that GPs want it.
To be more efficient we need a seamless system without duplication of effort or management. While far from perfect, the Scottish system of Health Boards that manage jointly primary- and secondary-care providers from a single budget seems a more sensible model to build on.
Of course, a third option would be to give the money for both community and hospital care to hospitals to manage. These institutions are also full of bright, engaged doctors who understand patient needs, are firmly rooted in (and usually loved by) their communities and, as a plus, they already employ high-quality professional managers used to the bigger scale.
And their staff are all employees of the NHS.
Dr Andrew A Jeffrey
Don't denigrate our diplomats
If David Cameron wants to downgrade Britain to an economy-class nation globally, then sneering at his (and our) ambassadors is the right way to start ("Do our ambassadors spoil themselves?" 8 July). The businessmen who sniggered at the Prime Minister's cheap insult should be ashamed. They are the first to demand a Rolls-Royce service from British diplomats and expect ambassadors, embassy staff, wives and partners to lay on red-carpet receptions to boost sales.
William Hague is downgrading the Foreign Office to Primark diplomacy. Bring back Lord Carrington, Douglas Hurd, Geoffrey Howe and Malcolm Rifkind. At least they protected the Foreign Office, appreciated the work of ambassadors, and did not expect them to arrive exhausted from long flights.
And they also might have had words to say to a Prime Minister who openly denigrated the public servants who defend and promote the nation beyond our shores.
Denis MacShane MP
House of Commons
I am an international officer at a leading Czech university, and have twice recently been kindly invited by the British Embassy to go to a garden party and a croquet and Pimms' party on the ambassador's splendid lawn beneath Prague Castle.
Is it churlish of me to have turned down the invitations, irritated that an old-fashioned image of my country is yet again being presented? Should I not perhaps relax, enjoy the strawberries and cream, and smile? Or should I write to The Independent and see who else is fed up with seeing her or his country presented as tea-partying its way into the second decade of the 21st century?
Czech Technical University, Prague
Media's role in Moat stand-off
It is time seriously to curtail the role of the 24-hour news channels in developing crime situations. The other night I happened upon Sky News just as they had various reporters and camera crews standing at the police cordon, using powerful microphones and lenses in their attempt to eavesdrop on a senior police officer as he briefed his team, and to view the developing stand-off with Raoul Moat, a man who was, inevitably, about to commit suicide.
Leaving aside the lack of ethics and morals, the possible negative impact on the police operation is obvious. Senior police officers should be given strengthened powers immediately to apply to the courts for a swift decision to bar the press from a sufficiently large area of land, sky and sea – with punitive sanctions against those who ignore the order.
And, at the same time, let's try to provoke a debate in news editors' offices about the real meaning of news: namely something that has happened and not endless speculation about, and interference in, developing dangerous situations.
In seeking to blame media coverage for copycat mass killings, Dr Kate Painter only manages to reveal her own irresponsibility (Letters, 10 July). If there are plenty more "mentally abnormal" people out there as she writes, perhaps some would not take kindly to being glibly branded a "loser", a most belittling and derogatory label. They might even resort to massacring a few innocent "winners".
The level of "sensationalist, tabloid reporting" of certain crimes in the UK is linked directly to media laws in this country. As all journalists know, once suspects are charged, a blanket ban comes into force until trial. Flouting this ban brings with it the risk of being in contempt of court.
Therefore the media will grab hold of any story where the suspect is either as yet unknown (the Suffolk murderer), known and on the run (the two recent mass shootings), or otherwise occurring outside the UK (the Knox case, Madeleine McCann).
The lesson is clear: for those seeking media notoriety, commit a gruesome crime and stay on the run as long as you can; for those wishing to remain anonymous – no matter how "sensational" the crime – hand yourself in straightaway.
If the warning that the Prison Service apparently passed to the police about the danger posed by Mr Moat to his girlfriend was substantive, then why was he let out in the first place? Or am I just joining all those who have 20/20 hindsight?
The welfare of game birds
You report "Gun lobby persuades Government to kill off game bird welfare law" (5 July), but I would like to point out that the UK's largest shooting organisation, the British Association for Shooting and Conservation (BASC) has opposed the use of small cages for the production of game-bird eggs since 2005 and continues to do so.
BASC, which represents more than 130,000 members, supported the code of practice laid down under the last government, which specified minimum spaces for pheasants and partridge kept to produce eggs. It should be noted that only a small percentage of game farms operate small-cage laying systems, and that the majority use extensive reproduction and rearing systems. Eggs are taken from both systems, hatched and reared on until the birds are released from late June onwards.
Game birds are defined as wild in practice and under the law when, months before the start of the shooting season, they are able to independently move in and out of large release pens, usually situated in woodland or on farmland – not "moorland" as you stated.
Head of Game & Gamekeeping, BASC, Wrexham
Abuse survivor's hopes for Church
The Pope apparently hopes to meet victims of clerical abuse on his trip to the UK (report, 5 July). Having been sexually abused by a Catholic priest 63 years ago, I feel real sorrow for more recent sufferers. They need to be reassured that, although abuse is damaging and devastating, recovery is possible. I am thankful to say that I have been happily married for more than 45 years, and am leading an active and satisfying life. I have also returned to the Catholic Church.
Although our Church is taking steps to deal with this issue, more needs to be done: paedophile priests must be removed promptly and handed over to the police. According to a good Catholic priest friend of mine, this is already the case in the UK. But ordinary Catholic folk do not know this. The recently introduced tough regulations by Bishops of England and Wales need to be stated in clear and simple language and used as a model worldwide. This would do much to restore the trust of Catholics, and also deter those with paedophile tendencies from becoming priests. Never again must scandals be hushed up and offenders moved from post to post.
In addition, the Celibacy Law for priests must be ended. It is no longer appropriate and it deters good men from becoming priests, besides forcing priests who later fall in love and wish to marry, to leave – a terrible waste of priestly talent. The law is also illogical and unfair because Anglican priests with families are able to become Catholic priests.
Were married and unmarried priests able to work side by side, married priests might more quickly detect suspicious behaviour by a paedophile colleague with youth groups, choir members, altar servers etc, and take appropriate action.
We must protect our young, besides developing our Church in a wise and sensible fashion. Our Holy Father can easily undertake the reforms and I am sure other Catholic readers will join me in pressing for these changes.
I have just taken the first cohort through to completion of the new specification A-levels, started two years ago. Now I hear (report, 5 July) that Michael Gove intends to rip up all my and other people's hard work by changing them yet again. Can they not let us get on with it for at least a few years before another ill-thought-out change?
Glenn Moore says (Sport, 10 July) that the Spanish goalkeeper Iker Casillas is "one of the few leading keepers in South Africa yet to make an error". Yet every schoolboy knows that he made a howler against Switzerland. I should know. I am only 11.
Perspectives on police practices : The Met is bloated and complacent
We have heard about the problems that budget cuts will cause the Metropolitan Police, and assorted scare stories about their ability to tackle terrorism as a result. I appreciate that policing in the capital is a very complex and challenging task, but a quick read of the policing plan throws up some interesting questions.
To cite a single example, the Met spends over £150m on Human Resources (HR), employing nearly 2,500 staff (including 567 Police Officers) in this function. That's one HR worker for every 23 employees. And despite investing £48m in a new Human Resources IT system, future HR budgets suggest a direct staff saving of only 25.
By comparison, my local force, West Mercia, repeatedly judged as excellent by HMI inspectors, has an HR-worker to employee ratio of one to 177.
Overall, civilian staff numbers in the Met are around 25 per cent of the total workforce; West Mercia has a 40 per cent civilian component, which makes it a fundamentally less expensive and more efficient organisation.
This streamlining in West Mercia took place over many years, mainly as a result of inadequate settlements from the Home Office, so they could shovel more money into metropolitan forces.
And while we are obviously comparing chalk and cheese, it's worth pointing out that West Mercia is policing an area nearly five times the size of the Met, with only 8 per cent of the staff, and still delivering a crime rate less than half of the Met.
Over time we have come to view the Met as a gold standard against which all forces should be measured. But the most cursory read of the Met Policing Plan suggests a complacent and bloated organisation that would benefit from a few lean years.
Pay perks for minority officers
It has been suggested that minority recruits should join the Met at a higher rank (report, 8 July). When I joined the Met in the mid-1960s there was not only a dearth of ethnic-minority officers, but also of graduates.
I suggested in the correspondence columns of Police Review magazine that perhaps an increment of £500pa for good graduates should be paid. The idea was rejected on the grounds that they might not become proficient officers; in fact, such rejects probably form as small a percentage as those who fail teaching probation.
Instead, it was decided that certain inspectors should be sent on full pay on three-year degree courses. Some of these home-made graduates resigned from the force for better jobs after graduation, and others were never promoted any further.
I read recently that Norfolk Constabulary was sending inspectors and sergeants on courses to study for degree-level management qualifications. It seems that the police would rather spend public money on people who have failed to make use of our educational system prior to joining, rather than reward those who have. So perhaps increments should be awarded to high-quality ethnic recruits.
It's time, too, to challenge the idea that two years on the beat is vital to become a competent officer; some beats offer far higher learning curves than others, and some supervisors far better tuition.
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