Sir: Hospital-acquired infections are receiving publicity. In the past 18 months I have spent two periods in hospital, one in England, the other in France.
I was admitted to the French hospital two days before surgery, not only for pre operation tests, but to prepare me for the surgical procedure. This included two compulsory showers on the day preceding and another shortly before the operation. I was required to use an anti bacterial shampoo. In the English hospital I asked if I could have a shower, a request met with surprise. The nurse reluctantly took me to the rather dirty shower, which was used as an auxiliary store, and after removing boxes I was allowed to use it.
In the French hospital all medical staff and cleaners changed from their private clothing on arrival into freshly laundered white trouser suits and before leaving for home deposited the white hospital clothing to be laundered. In England nursing staff travel to their hospital in their ward clothing, no doubt having completed chores at home, used public transport and perhaps visited shops.
No French nurse ever approached me in the hospital without putting on new disposable gloves and using a spirit gel. Most of the English nurses wore the same disposable gloves from patient to patient. And while there were dispensers of gel in the ward I never saw a nurse or doctor use one.
In te English ward there was a token clean each day, which consisted of a lone cleaner mopping the centre of the ward with a none-too-clean mop. In France cleaners were hospital employees under the direct supervision of the senior nurse. They worked in pairs. All of the floor was washed and dried; all surfaces were wiped, including lockers and my refrigerator. (Yes even a fridge to keep bed side drinks cool for infection safety).
In England it was the practice to allow children of all ages into the ward. In France young children were not admitted and visiting times were restricted. Flowers, which might bring infection, were also not allowed.
I was a keen observer in both hospitals, not only because my own well being was concerned, but also as a former nurse of many years. I asked my French surgeon about hospital-acquired infection and I believed him when he said it was not known in the hospital.
O L EDWARDS
Troops feel bitter sense of betrayal
Sir: Mr Blair missed the point in his speech on Friday; probably deliberately.
He is quite right to state that servicemen and women in a volunteer service should accept there is a danger that they might be killed or injured. Those of us who have been affected readily accept that. The real complaint is that troops are being sent into battle with inadequate equipment when better is available.
Moreover, if we become ill or injured we expect to be looked after by the MoD. It is the bitter sense of betrayal and disillusion when one realises that the MoD couldn't care less once one is of no use that really hurts.
Be assured there is little support or understanding in the NHS.
LIEUTENANT-COLONEL (RETIRED) CRYMYCH, PEMBROKESHIRE
Sir: Having opted not to settle for the defeat (or draw) his anti-war detractors might have preferred, President Bush appears at last to be aiming for an outright win against Iraq's Islamist insurgents and Iranian interlopers. Shouldn't we be welcoming this revised war plan, instead of snootily condemning a belated strategy for victory?
Sir: Tony Blair complains that his foreign policy is being hampered because public opinion is not behind his war. As Brecht wrote half a century ago, would it not be easier in that case for the Government to dissolve the people and elect another?
DR MERRYN WILLIAMS
More money for GP practices
Sir: Your report on GP salaries (12 January) inaccurately and unfairly criticises NHS Employers for its role in the GP contract.
The story did not reflect the fact that the GP contract that was introduced in April 2004 represented a radical modernisation of the General Medical Services contract, for the first time linking rewards for GPs to improvements in patient care. This was a major step forward that is recognised internationally as a pioneering approach to improving chronic disease management in UK.
Crucially, the contract allowed room for changes necessary to reflect patient needs and the development of general practice. It was always intended that the contract would be reviewed and refined as part of ongoing discussions with the BMA. Last year, we made significant changes to the contract, which resulted in greater value for money with efficiencies of more than 7 per cent and improvements to patient services with no extra reward for GPs. This year, we were hoping to continue the improvement of the contract, but have not yet been able to reach an agreement on change with the BMA, which wants to see even more money invested into general practice and GP income.
In terms of GP pay, recent data has showed that investment in the contract had resulted in significant increases in individual GP income. We had hoped that more of this money would be invested by practices in patient care and are disappointed that this has not been the case. We have already begun to address this.
DIRECTOR, NHS EMPLOYERS LONDON SW1
Sir: You quote GPs' income figures that have little to do with the reality I recognise.
You source figures from a group of accountants who deal with only the more financially savvy doctors and you then lump in private income with that from the NHS. Do that with consultants and see what wonderful headlines you can generate.
The new contract has been the best investment any country has ever made in public health and prevention. The Government may have thought we would only achieve 750 points, but we have done our patients proud, with an average of near the maximum 1050 points in the last year from practices small and large, from inner cities to leafy suburbs. Their miscalculation, not ours.
In the last two years, we have had no increase in practice gross income, yet we've had to give our staff a cost of living rise, leading to a reduction in GP income.
DR PETER SWINYARD
Trees can help to save the climate
Sir: Cahal Milmo's article on carbon offsetting (The Big Question, 11 January) dismisses forestation-based offsets. We agree that tree planting alone will not solve the problem of climate change, but we shouldn't lose sight of the fact that a quarter of global carbon dioxide emissions comes from the destruction of forests and grasslands, mostly in the tropics. Reversing this would be a major contribution to creating a sustainable environment and must be pursued in parallel with reducing the carbon emissions we create from fossil fuels.
The Kyoto Protocol recognises the importance of projects to restore forest habitats, which, through the clean development mechanism, can attract certified emissions reductions (carbon offsets). Future development of the Kyoto Protocol will, we hope, provide additional measures to avoid deforestation in the first place.
While no offsets should be an excuse for not reducing the emissions we create, forest restoration in the tropics can stably trap carbon and recreates some of the world's most biodiverse and fast-disappearing habitats.
CHAIRMAN, WORLD LAND TRUST HALESWORTH, SUFFOLK
Sir: I spotted a hummingbird hawkmoth in May, a common butterfly (unknown here) in July, a fully active wasps' nest on 2 December and a pheasant with young in mid-December. Something rather strange seems to be going on.
ENNISKILLEN, CO FERMANAGH
Iraq's bungling executioners
Sir: During the course of executing Barzan Ibrahim, Saddam Hussein's half-brother, his head was ripped from his body. The last time this happened during an execution in the UK was in the late 19th century, at Norwich prison, following which procedures were improved.
While the British government's opposition to the death penalty in Iraq is unlikely to prevail, officials could at least attempt to persuade the Iraqi authorities to adopt the more sophisticated (and humane) British method of hanging, with differential drops and a sheathed rope with an eye-ring instead of a cowboy noose. The Home Office, or the Public Record Office, must still have a copy of its tables for use in executions and some specimen equipment.
Ends and means in the Orwellian state
Sir: One thing you can't accuse this nightmarish government of is inconsistency.
They justify the illegal invasion of a sovereign country on the grounds that it led to the removal of a sadistic dictator. Now we have the Orwellian argument that ubiquitous surveillance and national databases for all our personal records and DNA are justified because they will make us safer or lead to more efficient public services. The devious and dangerous assumption that a good end will justify undesirable or even unlawful means is what we all have to challenge, not just the measures themselves.
However, the most chilling aspect of all this is the sight of essentially good and reasonable people such as John Hutton and Charles Falconer getting caught up in Blair's messianic madness. We should be very afraid.
Sir: I'm afraid your piece on government databases ("Big Brother", 15 January) contained a number of significant errors about the NHS electronic care records.
It is not true to say that "staff anywhere" will be able to access patients' information or that hospital managers, IT departments, high-street pharmacists and civil servants will all have access. Only staff directly involved in a patient's treatment will be able to see the record.
It is not true to say that people will not be able to opt out. The Government has already accepted the recommendations of the taskforce we set up to examine this issue, which acknowledged that some people may not want their summary care record to be shared or their information put on to the system. How this might be achieved will be considered by an advisory group drawn from patient, clinical and managerial stakeholders.
However, the Government believes that electronic records will significantly improve the safety and efficiency of patient care and will encourage everyone to opt in to the new database.
LORD HUNT OF KINGS HEATH
MINISTER OF STATE FOR QUALITY DEPARTMENT OF HEALTH LONDON SW1
Sir: You criticise the proposal to develop a super database in Whitehall that would enable government departments to share information on individuals.
I suspect that if such a measure had it been available now would prove helpful at monitoring British nationals who had been convicted of crimes whilst abroad. Furthermore, your article objects to the possibility of satellite monitoring of motorists. Might this not prove a useful measure should we wish to restrict motoring in Britain in order to minimise carbon emissions?
Sir: I wait in excited anticipation of the press infiltration of noted left-wing groups and its intrepid exposure of one of their morris-dancing participants as a card-carrying "leftie" of the George Blake persuasion, since the political left has been the historical threat to the security of the realm; but I fear I will be waiting in vain.
Flying to ruin
Sir: Limiting emissions from aviation is a political not a technological problem. Jenny Goodman (letter, 13 January) is mistaken if she thinks technical improvements that lead to better fuel efficiency in aircraft will solve the problem: more fuel-efficient aircraft could make flying cheaper still, thereby encouraging more people to switch from other (lower carbon) modes of transport. The only way we can limit emissions from aviation is by restricting its growth.
Sir: The suggestion that, for the sake of the climate, Tony Blair would do better to sail to the States with Cherie and undertake his lecture tours in an old Chevrolet (Letters, 12 January) repeats common misconceptions about air travel. By sailing in the QE2, he and Cherie would be responsible for about eight times the CO2 emissions they would contribute by flying. The most environmentally friendly thing to do, if Tony really must give the lectures, would be to do the journeys by air but leave Cherie at home.
J E GREEN
House of wisdom
Sir: Given the low esteem in which politicians seem to be held, is there not a case for excluding politicians from the House of Lords, and filling it with a "jury" of the nation's wise men and women who have not been influenced by a life in politics. Such a notion may entail an all-appointed house; many who might contribute most to the Lords would never contemplate putting themselves forward for election. Philosopher kings - and queens - may need to be persuaded to serve the state. So much the better for restoring trust in politics.
Sir: I enjoyed Thomas Sutcliffe's observations about the Ominous Object in film (12 January). The phenomenon can be found TV sport. Football fans can't have failed to feel foreboding as Bobby Zamora was shown a yellow card during Match of the Day at the weekend. Why was such a run-of-the-mill incident deemed worthy of inclusion? Zamora's sending off for a second yellow would have made no sense without the earlier incident, but its ominous inclusion did give the game away.