Letters: NHS

If the Tories and their increasingly craven Lib Dem allies really wish to put power in the hands of patients, then why is it that, under the proposed NHS changes (Steve Richards, 18 January), GPs and only GPs are put in charge? Why is it that surgeons or other doctors, even psychiatrists, can't be equally representative of how patients feel about the health services offered to them?

More than that, why are nurses, occupational therapists, and other key clinical professionals shoved out of the way when it comes to having a real stake in what the Government sees as the future for health services in this country?

Could it be that the GPs have never accepted the NHS and to this day remain independent contractors occupying a no-mans-land in which their generous fees and other sources of income, including mortgage payments for their surgeries in many cases, are picked up by the taxpayer, but the GPs like to think of themselves as outside the system when it suits them so to do.

The aim is clear – to privatise the health service and to make the case for change to insurance-led health care.

Tony Goss

Gloucester

Amid all the concern regarding the spiralling costs of health care, one wonders how increased commercialisation of the NHS is really going to help.

Most drug and equipment manufacturers employ patents to create a position from which they can monopolise supply. One of the great strengths of the NHS as (effectively) the sole supplier of healthcare in this country, is that it constitutes a client that is simply too prominent to ignore and too powerful to exploit, thus strengthening enormously its capacity to demand reduced prices in negotiations. Quite why the Government is so keen to deprive the NHS of this tremendous advantage is a mystery.

What sort of society looks at the sick, unfortunate and desperate and identifies an opportunity to profit from their misery?

Thomas Baker

Ely, Cambridgeshire

Steve Richards has confirmed what I have suspected all along: that David Cameron has been less than honest with us about his intended aims for the NHS. There seem to be a lot of questions that have not been addressed.

What happens if GPs run out of money before the end of the financial year? What happens if my GP will not refer me to the hospital of my choice because of cost? If I am referred to the cheapest provider will this be the best treatment? If hospitals cannot attract "business" from GPs, will the Government, by default, privatise them?

The people who are making these decisions do not have to rely on the NHS. I hope the Liberal Democrats will wake up and not support the Conservative Party in the forthcoming vote.

Lesley Cogan

Wickford, Essex

Reform of the National Health Service, combined with the savings local authorities are projected to have to make will once again put those individuals with mental illness and learning disability at increased risk.

This is happening just at the point when evidence shows the impact of needs-led care and treatment, working in partnership with patients and their families, has started to bring about real positive change.

History tells us that in times of economic restraint, when combined with major reform, those with mental health problems fare the worst. The Big Society cannot allow this to happen again.

Sue Bailey

Psychiatrist

Manchester

What a shame that David Cameron's response to health service reform has been so much faster than his earlier reaction to demands for reform of the banks.

Tony Brooke

Southampton

Tyrant's fall is a lesson for Blair

The revolution in Tunisia has given the world the most positive start to a New Year since the people of Romania shot their dictator, Nicolae Ceausescu, at the end of 1989.

At enormous risk to themselves, the people of Tunisia have risen up and overthrown the 23-year old dictatorship of Ben Ali – a monster to his own people but a long-time "friend" of the West.

I hope Tony Blair is watching the events in Tunisia even as he prepares to revisit the Chilcot inquiry on Friday to answer more questions on his role in the bloody invasion and occupation of Iraq. The Tunisian revolution has shown the world that the people of the region don't need the self-interested "help" of the West to overthrow their dictators. Actually western governments have, all too often, supported and armed the region's tyrants – Saddam Hussein and Ben Ali included.

In chasing Ben Ali out of the country, the people of Tunisia have provided others in the region with a model of how they might deal with their own dictators. Demonstrators in Cairo have been chanting the following refrain aimed at Hosni Mubarak, long-time dictator of Egypt and ally of the US: "Ben Ali, tell Mubarak a plane is waiting for him too!"

I hope all tyrants and oppressors are watching the events in Tunisia.

Sasha Simic

London N16

It is disturbing to find so many people concerned with the Iraq war inquiry. There are only two salient points.

One, the war was always going to be legal; Parliament voted for it. The real question is whether Tony Blair lied to Parliament – and whether Parliament failed to do its duty of holding the executive to account.

Two, the idea that someone (Saddam) should be imprisoned, tried and executed and by association thousands of his citizens should be killed because he might commit a crime is, itself, a very serious crime. But current Conservative and previous Labour government policy has moved dramatically towards the direction of presuming people guilty and forcing them – at great expense and effort – to prove their innocence.

If Parliament cannot be bothered to investigate crimes committed in it and by it, I can see no point in these inquiries and reports – save for a little catharsis. The highest court in the land (and the seat of its executive and legislature) is itself committing criminal acts and is above the law. That is what needs an inquiry.

Robert Dobson

Seal, Kent

Care homes, an African view

Richard Lyon chides us for "packing off" our elderly into care homes, remarking that the culture in most African nations would prevent such cold-hearted behaviour (letter, 17 January).

I heard a very different opinion from Augusto, a Kenyan community worker I recently worked with abroad. Discussing care of the elderly, he remarked that in his culture elderly people are not put into care homes. I expected a lecture, but he added: "They remain in their family homes, where abuse and neglect is distressingly common. The sooner we have a network of well-run care homes, the better." He knew of one person with dementia who was kept tied to the village tree.

There is no simple answer to all this. My 94-year-old mother has been in a care home for a year, and her mental and physical health has hugely improved.

As a retired teacher, I offer a weekly poetry group for the residents; my brother assists them with Skype – perhaps one answer is for relatives to remain involved, as far as they can.

Heather Lister

Bristol

Thank you for devoting your front page to the article on care homes by Johann Hari (14 January). I too think this generation deserves better.

I cannot help hoping David Cameron will find time to visit a care home without notifying them in advance of his visit. Both David Cameron and I had parents who suffered strokes last year, and I felt extremely sorry when Mr Cameron's father died.

My mother is now in a nursing home and I now pray this is not a fate worse than death.

A J Griffin

Binfield, Berkshire

Each prison has a board of visitors, a group of volunteers who have access to the prison at any time of day or night, to monitor life in the prison and to give prisoners access to an independent body. Perhaps there should be a board of visitors for care homes, covering several homes.

Elizabeth Meanley

Briston Norfolk

Postal emblems under threat

With the recent uproar over the potential loss of the head of the Sovereign on UK postage stamps as a consequence of privatisation, how ironic that during the mid 1960s stamp assays were submitted to the then Postmaster General, Tony Benn, with exactly that idea in mind.

Specimen stamps were drawn up with no image of the Queen, replacing the head with either the royal coat of arms, the words "UK Postage" or "Great Britain". The final compromise was to show the Queen as a cameo on commemorative stamps, as is the case today.

Around the same time plans were under way to redesign and replace the effigy of the Queen used on UK decimal stamps. That final image is the one so familiar today, and depicts a young Queen wearing her diadem. Unlike Bank of England notes and United Kingdom coinage the image used on stamps has not changed in nearly 45 years.

However, we could now face one threat that did not present itself in the 1960s – the loss of the red post box, another British design classic. When Post Office Telecommunications was privatised during the early 1980s and became BT, it slowly brought about the demise of the red call box, replacing them with bland glass phone boxes emblazoned with their logo.

All post boxes carry the cypher of either the Queen or her predecessors. Therefore only one half of Royal patronage will be retained in the stamps; but the other, Royal Mail postboxes, will doubtless disappear from many street corners over the coming years with the forthcoming privatisation.

Richard Quinlan

London Sw2

Heaving mob in the art gallery

"Can galleries cope with crowds?" (Report, 17 January). Rather, can the art lover cope with the crowds which the galleries deliberately attract? I am an artist who gave up on these over-hyped exhibitions long ago. Trying to look at a small and sublime Vermeer in the midst of a heaving mob is not an elevating experience.

But does one need to go to the actual shows when one can buy the excellent and copiously informative catalogues instead? There the paintings are immaculately and truthfully reproduced, and can be studied peacefully, sitting at ease, without jostle, without heads in the way, without having to squint aslant to avoid seeing one's reflection in the glaze, without the guilt of obscuring other people's view, without the distraction of amateur art criticism being broadcast (often on mobile telephones) around one.

An exhibition is a brief, harrowing and frustrated experience. A catalogue is for ever.

Peter Forster

London N4

Honoured for rescue

You mentioned in your article on the New Year Honours list (31 December) the MBEs awarded to Joel Harri and myself for the evacuation of foreigners from Osh in June 2010, but not that received by Mrs Claire Harri for the same reason.

Although I led the group of 93 who were evacuated and Joel took the most risks in rescuing people, it was Claire's diligence and foresight in networking and in liaison with the embassy which provided the basis for such a large operation. More credit still goes to the team at the embassy end, under HMA David Moran, who actually arranged getting us out, but, of course, they were "just doing their jobs".

Chris Duff

Osh, Kyrgyzstan

Gaudy cruelty

Dylan Jones glorifies the sordid practice of stag hunting and inculcates his children in the culture of violence and cruelty, while waxing lyrical about the attendant "pomp and ceremony", "bright pink tunics" and "tight green quilted vests" ("Man about town", 15 January). As with bullfighting, the callous and thoughtless seem mesmerised by the gaudy costumes involved in these gruesome rituals. Grand Guignol indeed.

Adrian Maton

London SE1

Perspectives on coalition politics

Why some Tories will vote Lib Dem

It has hitherto been the conventional wisdom that a coalition was electorally dangerous for the smaller party because, at the next general election, the perceived choice would be either to retain the Government (so vote for the larger coalition party) or throw out the Government (so vote for the opposition). This is why Liberal Democrats have always taken the view that the certainty of electoral reform was a prerequisite for participation in a coalition government.

The outcome of the Oldham East and Saddleworth by-election challenges that conventional wisdom, and demonstrates that electors are more intelligent than some politicians give them credit for. What clearly happened was that hard-line Tory voters voted Conservative, and moderate Conservatives supported the Coalition Government in the most efficacious way available, namely by supporting the Lib Dem candidate. Under the alternative vote, the Lib Dems would have won. But, even without that, voters are manifestly adept at using the present electoral system to achieve their desired outcome.

So expect a significant proportion of moderate Conservatives to empower themselves by voting Yes in the AV referendum. And expect a significant proportion of moderate Conservatives to vote at the next general election in the way best calculated to perpetuate the Coalition Government. No wonder the right wing of the Conservative Party are the unhappiest people in politics today.

Philip Goldenberg

Woking, Surrey

Clegg lost his chance of real influence

Emilie Lamplough (letter, 8 January) believes "Nick Clegg shouldn't be written off yet ... People may be angry now, but it's very difficult to argue that the Lib Dems had any other realistic and sensible option than to coalesce with the Tories."

Well it's not too difficult; Clegg was not forced into coalition at gunpoint. Foreseeing the future subservient role for his party wasn't too difficult either, and he could have allowed the Tories to attempt to form a minority government. But the lure of ministerial cars seemingly proved irresistible.

Had Clegg taken this "other realistic and sensible option" then the potential for the opposition parties to prevent destructive and divisive policies on the NHS and education would have been real instead of illusory.

Eddie Dougall

Bury St Edmunds, Suffolk

Only way to sort out financial crisis

For a third party in British politics, the only realistic possibility of exerting influence on government was always to form a junior partnership with another party. Despite this fact, which was surely understood by all Lib Dem voters, it seems the practicalities of such a partnership were never properly considered by some.

The general election result left the Lib Dems with a stark choice. Should they abandon the only realistic possibility they would have to exert influence, because some of their supporters had never envisaged any alliance with the right, or should they do what was so clearly necessary in the face of a most dangerous combination of financial threats? The practical requirements of the hour ensured that the right choice had to be made.

But in making the choice, the party faced an inevitable loss of support from those who never considered that a Lib Dem leader could align with a Tory.

The question Lib Dem voters must ask themselves now is whether Clegg, Cable et al did the right thing in joining the Coalition, just at that crisis point. Once the answer to that is clear, Lib Dems should acknowledge that even the most important of policy aspirations (and until you're elected, all manifesto promises can only be aspirations) are, and must be, subject to negotiation.

If any Lib Dem voter believes it was fundamentally wrong to align with Cameron and thus secure a viable Government to address the crisis, then I believe they never understood the essential reality of the position of the third party in British politics under the current electoral system.

Martin Callaghan

London W5