I am deeply saddened to see that the Health Bill is going forward into law. As an American living in London, I'm desperately disappointed to see that the Bill will introduce the worst of the American system into this country: commodification of health, a two-tier healthcare system, healthcare professionals looking after funding more than looking after the wellbeing of patients, and care (or lack of it) being driven by profit.
The former three-tier management structure is now replaced with a seven-tier system. How exactly is this going to make things more efficient?
GPs cannot do commissioning. This is a management function requiring many people working full-time. It's tedious and it's nothing to do with medicine. It is not something done in your spare time at the end of a busy day.
The Department of Health understands the complexity of commissioning and has now set up commissioning support organisations, which are private companies, to take this function from GPs. Public- sector NHS employees by and large were paid a lot less for commissioning support than the going rate for private consultants. How exactly will this new structure make things cheaper?
There were certainly huge inefficiencies in the former NHS. However, there were much simpler solutions which did not involve turbo-charged privatisation. The changes this government has introduced are very much ideological and have very little to do with patient choice or efficiency.
Sadly, you don't know what you had until you've lost it.
H B Ridgley
One million people marched in London against the Iraq war. But it made no difference. Restructuring the NHS was sworn against before the election. But it made no difference. The Bill has been opposed by virtually every professional body concerned. But it made no difference. And we think we can export democracy. We are fools if we think we even live in one.
Road tolls will only add to transport chaos
David Cameron has rediscovered road tolls as further way to turn the screw on the British public. After pumping up rail fares to pay price-gouging contractors in the hope that something will improve, the Government hopes do the same for the privilege of driving on busy roads.
Whether you travel by train, bus or tube, in the UK you already pay the highest prices in the world to do so. With walk-on rail fares already unaffordable for many people and some of the highest petrol prices, more road charges only add to the pressures we face. What impact will this have on our vital tourist industry as people think twice about going away for a long weekend?
Once in place, tolls, disguised as green policy, will inevitably rise – almost doubling on the M6 Toll since it was built. People don't drive on busy roads in the rush hour by choice. Far from reducing business costs, road tolling will add millions to freight costs, which will be passed on to customers.
Britain's transport policies are in chaos. The Government needs to think again and work with the grain of public need.
In determining future outsourcing contracts for the trunk road network, who will ensure that environmental impacts on local people are addressed?
The M40 is a toll road and has been privately maintained by its route operator under a 30-year PFI contract since 1996. It carries some 100,000 vehicles daily, their noise and pollution falling on communities close to it, especially the unimproved stretch through the Chilterns and south Oxfordshire.
M40 Chilterns Environmental Group was formed in 2004 to represent 13 communities close to this stretch of road. After eight years of unavailing pressure for action, it is apparent that environmental responsibility has fallen into a black hole.
DEFRA's noise maps for the road network identify 14 First Priority Locations for Action on this stretch of the road. The Highways Agency recommends, at most of these locations, quiet surface (to reduce tyre noise from cars) and improved noise barriers (to reduce engine noise from trucks). Although the Agency remains the design authority for the M40, it professes to have no control over the maintenance practices of its route operator, which can therefore reduce its costs by preserving existing noisy surfaces, merely patching holes. Since improvement of noise barriers is not a maintenance issue, their cost would fall on the Agency, which has no budget for a road it does not own.
We are advised that "subject to priority and availability of funding, improved barriers may be installed at some locations in the next financial year, 2013/14". As the Agency currently has no study programme to determine either priorities or funding, we have low expectations.
Will those who negotiate the next round of contracts learn from our experience?
Dr Ken Edwards
High Wycombe, Buckinghamshire
Every year I am asked to pay for my use of the roads in various forms.
I pay a tax on the price of a new vehicle; I then pay VAT on the tax as well as on the price of the car. I also pay the highest tax in Europe on the petrol (which pre-tax is the cheapest petrol in Europe). I even pay tax on the tax on petrol. After that I pay a road tax, purportedly to maintain the roads.
Should I be foolish enough to break the speed limit or run a red light where there is a camera I am punished by what, to many, is a tax in all but name. To legally drive a car I need to have car insurance, which is itself taxed. If I wish to drive in London I am taxed. Various studies have shown that the vast majority of road tax is not spent on roads.
I know this may be a radical suggestion, but can the Government please spend the majority of road taxes on the roads before passing the begging bowl round asking for more money and suggesting tolls or other methods of getting more money out of the motorist?
Stockport, Greater Manchester
With the Government predicting 40 per cent more traffic by 2025, there is a clear need for new investment and capacity on England's roads. With no strategy currently in place to deal with this, action is urgently needed. Technology will be paramount in allowing an increase in capacity, particularly in relation to hard-shoulder running and managed motorways.
We are also concerned that companies could potentially charge any fee they wish to road users. The toll company on the M6 can charge any fee it wishes, and in future this could prove problematic. I think the Government needs to be careful that future toll charge mechanisms are authorised by the Department for Transport.
Professor Phil Blythe
Institution of Engineering and Technology
Women still face a jobs chasm
Employers must resist self-congratulation following the sharp rise in female FTSE-100 board appointments last year.
Despite the progress of 2011, in the FTSE-250, only 9.4 per cent of directorships are held by women. In the legal industry, our own research shows UK law firms still have plenty of work to do too. Although it's the highest proportion in Europe, just 16 per cent of magic circle firms' partners in the UK are female. The research also showed that two thirds of female lawyers considered their gender to be a barrier to career success.
Over-hyping the so far modest - though certainly very creditable - achievements of UK employers in ensuring women have equal access to the top is a dangerous business. There is still a chasm between men's and women's chances of making it to the top. To trumpet too loudly the fact women are now only a third as likely as men to become board members will do nothing to bridge it.
Laurence Simons, London WC1
Tax statement raises questions
The taxation system can be a minefield. I am pleased to see that the Government has announced plans to introduce an annual statement for taxpayers, showing them what proportion of their money has been spent where.
But choosing what is represented on the statement is a quite political decision. First, there's the interaction with benefits to consider: how much the taxpayer gets back from the Government in the form of benefits or tax credits.Then there's the tax gap, the difference between how much HMRC expects to get in, and how much it does actually get in. Will the statements reflect this? If we want a proper public debate about taxes, making clear the impact of cash-in-hand or tax evasion needs to be part of that.
Another concern is whether HMRC can cope with any questions from recipients who may not understand this annual statement. The department is overstretched as it is.
Head of Taxation
Association of Chartered Certified Accountants
Yes, England did expect
The article in the Italian magazine quoted by John Laird (letter 19 March) was correct in referring to the "English fleet" at the Battle of Trafalgar. The crew and marines on board Nelson's ship, HMS Victory, numbered some 880. Of this number nearly 600 were English compared with some 170 other British citizens: Irish (80), Scottish (60) and Welsh (30). The crew also contained some 70 men from 18 different countries, including four Frenchmen, and some 40 men of unknown origin.
I found Chris Killip's photographs of "Northern working life in the 1970s and 80s"fascinating (17 March), but I was surprised by his contention that "shipbuilding was dominated by Protestants and the Orange order in Newcastle, as it was in Belfast, Glasgow and Liverpool." I have consulted several members of my family who spent their entire working life on the river Tyne, and they were as mystified as I was by this statement.
North Shields, Tyne & Wear
If America does get into war with Iran, what will happen here, with the Coalition Government? All the Conservatives' instincts will be to join in on America's side. Labour will support them. That leaves the Liberal Democrats. Can they be the ones who keep Britain out of it? Will they be prepared to end the Coalition over it? This could be their historic opportunity – and possibly their salvation at the next election. But they'll probably blow it.
Rest for some
Presumably the readers who think Sunday is a day of rest (letters, 21 March) have never been to the pub on a Sunday or into a restaurant or a newsagent or travelled on public transport.
Bowness on Windermere, Cumbria
A syndicate of bus drivers wins a lottery. People say it is what we all want. Millions do the lottery. So why are we against hard working capitalists earning their salaries and bonuses? It is fine to get it for nothing but not through hard graft.
Robert Duncan Martin