Letters: Private companies in public healthcare

Commercial companies poised to take over family surgeries

Sir: Your leading article (5 June) on "polyclinics" misses a number of important points. There is huge confusion about what a polyclinic is. Even the health minister Ben Bradshaw doesn't seem to know; I have seen two letters from him, sent in the last few weeks, in one of which he describes polyclinics as synonymous with the GP-led health centres that are to be procured in each Primary Care Trust and in the other he describes polyclinics as synonymous with existing community hospitals.

It is the introduction of large commercial companies into general practice that GPs and patients object to. One of the great strengths of the existing model of general practice is its localness. Your practice is run by its partners, who are also front-line workers in the business; they have day-to-day contact with you, the patients, and can make swift decisions about change in response to consumers' suggestions.

The new arrangements for general practice contracts are weighted in favour of the large commercial organisations, whose board members take decisions at a distance. They can afford to employ people to complete the 100-page pre-qualification questionnaire and keep it on file ready to apply for any practice anywhere in the country. A local practice may, however, only be interested in the once-in-a-lifetime event of rescuing the practice down the road which has got into difficulties.

Finally, GPs are suspicious that the excellent idea of encouraging integrated multidisciplinary working is, once more, just a political fad. During the 27 years that I have worked in my inner-city practice we have had in our building, and have had withdrawn as the political fancy dictates, health visitors, midwives, consultant psychiatrists, psychotherapists, community psychiatric nurses, community mental health workers, social workers and specialist nurses. We currently retain district nurses, a counsellor, a dietitian, a pharmacist and a smoking cessation adviser.

Dr John Grenville

Derby

Free markets push farmers into poverty

Sir: In his critique of my comments on the global food crisis (Opinion, 6 June), Dominic Lawson is left wondering why market liberalisation is "such a terrible idea" for developing countries. Let me explain.

Opening up developing countries to competition from cheap foreign imports means that farmers are no longer able to produce viably for their own local markets. Like British village shops exposed to competition from out-of-town supermarkets, vast numbers are forced out of business. Unlike here, there are no safety nets to catch them when they fall.

While free-market economists like Lawson may applaud this social Darwinism, the reality is that entire local economies collapse and vast increases in poverty ensue. Millions of farmers and agricultural labourers are forced to migrate to the slums of mega-cities in search of non-existent work, joining the millions already eking out a precarious living on the margins of society. Rural poverty meets urban poverty, and both plunge deeper into despair.

So what about the argument that cheap imports are to be applauded since they make food more affordable for the poor? On first sight this is a persuasive thesis, especially for those of us who live with the luxury of guaranteed basic incomes. Yet it has long been established that the impact of prices on the poor's sources of income, not on their consumption levels, is the key determinant as to whether market liberalisation will be a force for good or for harm in developing countries. Put simply, even cheap food is unaffordable when you have no job and no money with which to buy it.

Finally, it is important to debunk Lawson's claim that "food sovereignty" means rich land-owners extorting monopoly rents at the expense of the poor. Nothing could be farther from the truth. Food sovereignty entails the redistribution of land from the rich to the poor and landless so that they can exercise their right to food. This, not market liberalisation, offers the prospect of a fairer future for developing countries, and we should support it.

John Hilary

Executive Director War on Want, London EC2

Refuse to pay that service charge

Sir: Johann Hari (Comment, 9 June) highlights the problem of tipping in restaurants and the failure of management to pass on the tips to staff.

We sometimes eat out in London but, unlike here in Sussex, a service charge of 12.5 per cent is often applied to the bill. I know from the experience of my daughter at a London restaurant that these charges are often not always distributed to the waiters. Recently, at a restaurant in Docklands, the waiter had to ask the manager permission to remove the charge from my bill, as though there was some obligation to pay.

I always refuse to include the service charge in my payments, because I am unsure that any of it will go to the waiter, preferring instead to leave a cash tip. Would any diner willingly pay these bogus charges if they knew they were going into the pockets of a greedy management? Of course not. The service charge removes the privilege of diners to make their own judgment upon the service they have received, and undermines a noble intention to supplement meagre wages.

It is a con, and hardly better than simple theft. The Government should address the problem without delay.

Paul Madeley

Arundel, West Sussex

No TV? You are presumed guilty

Sir: A fundamental point has been overlooked in the recent correspondence regarding TV licensing. There is no requirement under the law for TV-less householders to do anything. TV "refuseniks" have no obligation to contact TV Licensing, no obligation to talk to their enforcement officers, no obligation to notify them of a change of address and certainly no obligation to allow them into their homes.

This is inconvenient for TV Licensing and so, unsurprisingly, this position is not mentioned on their website, in any of their literature or in their "official warning" letters. More seriously, they persist in the harassment of those living at unlicensed addresses, despite the fact that, according to TV Licensing's own statistics, the majority of these householders have not committed an offence. By some perverse twist of logic, TV Licensing claims that the pursuit of these householders is "fair" because of the people who actually pay the TV licence.

Given that it is a tenet of a free and just society that the innocent and law-abiding do not have to affirm or prove their innocence and should be able to lead a life free from harassment, why is this behaviour by TV Licensing tolerated or even legal?

Rob Hatcher

Northampton

MPs cushioned from reality

Sir: Allowing MPs to claim for childcare, as suggested by Mary Dejevsky (Opinion, 9 June) would be highly detrimental to the interests of the population as a whole, as it would further increase the existing gulf between the governing and the governed in modern Britain .

While there is a case to be made for more help with childcare for working parents throughout the population, the idea that MPs should uniquely not be required to fund their childcare from salaries of approximately three times the mode average salary among the general population will simply reduce the awareness of the issue within the strange alternative universe that they inhabit.

From the 10p tax rate, to the invasion of Iraq, to being held without trial or even charge for 42 (or 90) days, a significant proportion of our governing class have proven themselves unable to empathise with those people whose experiences they do not directly share. Let's not add to that by removing the problems of funding of childcare from their immediate field of experience.

Qasim Salimi

London N22

No bar on pictures of naked children

Sir: With regard to the article entitled "Painter sees red" by Andy McSmith (5 June), both your journalist and Mr Hockney are mistaken. If a painting can lawfully be sold in the UK (in that it does not fall foul of the Obscene Publication Act) it will be unaffected by the proposals to outlaw non-photographic images of child sexual abuse.

Simply depicting a naked child will not meet the requirements of the proposed offence – that an image 1) is pornographic, 2) portrays a child involved in a sexual act, and 3) is of an obscene nature.

Maria Eagle MP

Parliamentary Under-Secretary of State, Ministry of JusticeLondon SW1

EU must act over Palestinian taxes

Sir: Israel has again violated its legal obligations to hand over Palestinian tax funds, on which hundreds of thousands of needy Palestinians depend. This time it is because the Palestinian authority has complained to the EU about Israeli settlement expansion, illegal in international law. Israel commits an illegal action, and then penalises the victims for complaining.

The EU, including the UK, so far has been silent, while forking out hundreds of millions of taxpayers' money to subsidise this situation. The only proper reaction to this is for all EU leaders to give a greater hearing for Palestinian objections to settlement expansion, and to make clear that an upgrading of EU-Israel ties might be under threat.

Chris Doyle

Director, Council for Arab-British Understanding, London EC4

Onward march of the health puritans

Sir: As a smoker, I agree with everything Joan Bakewell said in her article of 6 June. Even now, she is probably being bombarded with letters from the "health lobby" and other puritans who are outraged that she dares to defend the rights of smokers.

John Reid wasn't give a chance when he proposed a partial ban, and the hysterical anti-smoking mob made him out to be an extremist, merely for sticking up for the civil rights of smokers, as well as non-smokers.

Since then we've seen even the ridiculous, uncivilised situation of smokers being denied a proper social life, and the sight of them having to have a night out in the middle of the road has not been enough to appease these people, who have made it their business what other people choose to do. Unless the Government stops interfering with people's private lives, the UK will continue its slide into a totalitarian nanny state.

Stephen Lustig

London NW2

Sir: Adrian Durrant (letter, 9 June) says that condemning smokers for the harm they do is a redundant argument as we have a ban on smoking in public places. He seems to have forgotten the terrible effect of smoking in the home. Children are still subject to passive smoking as well as being shown a model to follow.

His other arguments tend to the ridiculous – can smoking be included in recreational activities? Also, where is his evidence that the campaign against smoking is making non-smokers uneasy? I see no sign of non-smokers siding with smokers. The desperation is all on the other side.

John Smith

Dorchester, Dorset

Keep RE out of the fairground

Sir: E Jane Dickson ("The funfair is no place to teach religion", 6 June) rightly appreciates the very British horror of a religious theme park. It's hard to picture Alton Towers punters queuing for a ride called "Hell", and even less likely they'd strap in for one called "Heaven"'. But she's wrong about religious education in schools.

Faith schools do provide RE in line with their traditions. All community schools provide RE for all pupils as well. The subject is the fastest growing GCSE over the last decade – entrants have trebled, and more than doubled for A-level too. The reason for this is that RE lessons now are the opposite of indoctrination: an open-minded, open-hearted space on the timetable for atheists, Pagans, Christians and Muslims to explore life's big issues together. I think E Jane Dickson should keep off the fairground: she ought to do some RE lessons.

Lat Blaylock

Project officer, National Association of RE Teachers, Leicester

Gracious loser

Sir: I think we should make Hillary Clinton an honorary Brit. She has demonstrated an outstanding ability at something we Brits hold particularly praiseworthy – and of which we have plenty of experience – coming second with grace.

Sean Maffett

Bourton-on-the-Water, Gloucestershire

Bring the troops home

Sir: A hundred British troops have now needlessly lost their lives in Afghanistan, together with others horribly injured. The Afghan war is unwinnable. Its government is weak and warlords hold positions within it who control the opium trade. The lot of ordinary Afghans has if anything worsened during this conflict, so we cannot win hearts and minds. It is time for Gordon Brown to bring our troops home from Afghanistan before other lives are lost in vain, together with our troops in Iraq holed up in Basra airport serving no military purpose.

Valerie Crews

Beckenham, Kent

Mathematical brains

Sir: I am happy to say that falling standards in maths are not universal. I gave your maths test (7 June) to my primary school maths group of 10- and 11-year-olds. Of the 31, 25 scored more than half marks and nine scored over 70 per cent.

Tim Silk

Lichfield, Staffordshire

Down from the heavens

Sir: Where archbishops dive, Canon Missioners have dived before. (leading article, 6 June) Canon Ivor Smith-Cameron, Canon Missioner of the Diocese of Southwark, 1972-1994, Chaplain to HM the Queen 1994-1999, sky-dived at the age of 60 and 65 to raise awareness and money for small-scale but vital projects in India. The Church of England, for all her faults, has always produced people of courage and vision to proclaim the message of the Incarnation – God with us.

Tini Brodie

London SW12

Progressive taxation

Sir: In the bad old days, it used to take me a week to complete my tax return. This year, thanks to the improved, simplified, form I managed it in 10 days.

Dr Vernon Coleman

Barnstaple, Devon