Letters: Skills crisis in NHS chemotherapy

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This Government has frequently denied planning to privatise the NHS (letters, 5 January). There are many examples that disprove their view, including the arrangements for the provision of chemotherapy.

If an NHS hospital needs to dispense the breast cancer drug, Herceptin, that hospital Trust will have to pay 20 per cent VAT on the drug. If the hospital were to contract out the provision of Herceptin to a private provider, who administers the drug to patients in their homes, that company would not have to pay VAT.

The policy guideline published by the NHS, Chemotherapy Services in the Community – A Guide for PCTs, states: "The development of community chemotherapy services outsourced to non-NHS providers could result in senior nurses being recruited from the main oncology units to undertake the community chemotherapy and could result in problems with staffing in the main oncology units.

"A community-based nurse specialist delivering chemotherapy at different locations during the course of a shift will not be able to treat as many patients as one working at a single unit.

"For example, when the chemotherapy infusion has been commenced, this is a time when the chemotherapy nurse at an oncology day-unit could leave the patient and undertake other tasks such as treating other patients or administration".

The loss of NHS-qualified chemotherapy nurses to the less productive private sector, where they enjoy a reduced workload for higher wages, is resulting in the de-skilling of NHS chemotherapy units.

Instead of unfairly favouring the private sector, the government should treat the NHS fairly by removing their burden of having to pay 20 per cent VAT on drugs.

Marcus Lapthorn

Faringdon, Oxfordshire

Dr Adrian Canale-Parola claims that privatising hospital services will help to plug the gap in NHS funding by attracting private-sector income. This argument is flawed because present financial conditions are unlikely to encourage a wave of wealthy private patients to buy in to deluxe, privatised NHS in-patient services.

It also places pressure on NHS hospitals to compete with local private hospitals by undercutting on price and quality of treatment, which is bad for all concerned.

As Dr Canale-Parola noted, community-based medicine and improved out-patient treatments have reduced admissions to wards for many common chronic ailments and even acute cases. So the "marketplace" in beds will also decline, reducing this income stream year-on-year.

Few would argue with reducing our dependency on pills, scalpels and beds. Better integration between primary care and NHS Foundation Trusts is also welcome.

Throwing the NHS open to the chaos of "market forces" is not. It failed previously and will fail again under the current reforms.

Anthony Rodriguez

Staines, Middlesex

Unionist chickens home to roost in a shameful Britain

The Scots have always acquired an understanding and appreciation of England, its culture, politics and history to consider themselves fully British and engage wholeheartedly in Britain, as they have amply demonstrated over 300 years in support of what they considered their Union (letters, 10 January). A now precarious majority still possibly feel the same way.

At the same time, England's people have never reciprocated this commitment (David Hume understood this 250 years ago), and never understood (or cared about) "the Union", still less, the nature of Scotland.

In the 21st century, all the long-postponed Unionist chickens are coming home to roost. This "Britain" has become a small, demeaning, selfish, unsuccessful, anti-European and obviously Anglo-centric Union, the well-earned and thorough legacy of Thatcherism.

This is a Britain identifiable as the home of a greedy, pernicious and failed City that is still not under control, an economy that is less free-enterprise than scam-ridden functioning in London's insatiable interest alone, a country endlessly given to ill-considered military adventures.

We have a press that is a public shame, MPs and a political class proven institutionally to have let down the electorate at the most basic level of fair play and personal morality, and a culture that has been entirely given over to a meretricious and vulgar celebrity.

The Scots are a self-deprecating people, brutally down-to-earth, suspicious of success ("I kent his faither"), and sceptical of ambitious or lofty claims.

But this Britain has become cold-hearted, hapless, mean-spirited, shameful and shoddy and, perhaps by 2014-15, a majority in Scotland will decide that their modest little country, with its long history and able intellectual culture, can do better than that.

John S Warren

Callander, Perthshire

Why is Cameron gambling with the future of the United Kingdom? Cameron and Alec Salmond both know that the Scots would choose maximum devolution (devomax) short of full independence, if the question were put.

Salmond wants that option to be on the ballot paper, Cameron does not. So, why would Cameron rather see Scotland leave the UK than offer the option of maximum devolution?

The reason is that Cameron is more opposed to devolution to an English parliament and a South Country assembly than to independence for Scotland. Conceding "devomax" to Scotland would inevitably mean the UK becoming a federation in which the South Country (South West, South East and East Anglia) and England would have as much say as Scotland, Wales and Northern Ireland. That is what Cameron fears.

Robert Craig

All The South Party, Weston-super-Mare, North Somerset

In your leading article, you state that "the Conservative Party [has never been] terribly successful in Scotland". In fact, only one party has ever secured a clear majority of the entire Scottish vote, and that was the Conservative party, in 1951.

The Tories continued to be a considerable political force north of the border until 1979, with the arrival of Mrs Thatcher, who knew little and cared less about the differentness of Scotland.

Her narrow and little Englander policies started the Scottish Tories' decline, which now seems irreversible, and which Mr Cameron's tactics seem unlikely to change.

James Cox

Twickenham, Middlesex

The Prime Minister asks, "All the time businesses are asking 'Is Scotland going to stay part of the UK? Are they going to stay together? Should I invest?", then going on to say, "We are beginning to see companies asking those questions..." ("Uncertainty 'harming Scotland's economy'", 9 January).

Which is it? Are they asking "all the time" or are they "beginning to ask"? This is classic Cameron at its worst, the slippery use of a seemingly reasonable question in a seemingly plausible way which is almost instantly betrayed by his own words.

Richard Carter

London SW15

It is refreshing for us Africans, who use "war-war" and not "jaw-jaw" to gain independence, to know that Mr Cameron has "denied trying to dictate the terms of the referendum from Westminster, and insisted it will be for people in Scotland to decide whether they stay in the Union" (report, 9 January).

Mr Cameron must be aware of the Scottish 1320 Declaration of Arbroath, which made clear that "as long as but a hundred of us remain alive, never will we on any conditions be brought under English rule. It is in truth not for glory, nor riches, nor honours that we are fighting, but for freedom, for that alone, which no honest man gives up but with life itself".

But it was the Declaration of Arbroath, which many pre-independence Scottish colonial teachers in Africa smuggled into the curriculum, that informed the bloody independence wars by Eritrea from Ethiopia, which took 30 years at a cost of two million lives; and the equally lengthy process of divorce by South Sudan from the North, which claimed millions of lives.

Sam Akaki

Director, Democratic Institutions for Poverty Reduction Africa, London W3

High-speed system but with a taxi

Will we end up a 21st-century high-speed rail system, where you can travel direct from Manchester to Paris, or a Third World system where you have to stop and catch the Tube or taxi to get the Chunnel train to Paris?

The HS2 website does not say, and the map of the London route says "not available". The terminus will be Euston. So does that mean a Manchester-to-Paris commuter will have to get off and catch a taxi from Euston to King's Cross, to get the Chunnel train? Is this going to be an interconnected 21st-century transport network, or a complete disaster? I can see this becoming the laughing-stock of Europe.

Roger Ellis

Knutsford, Cheshire

Your turn, Tehran

After a cyber-attack that stole thousands of Israeli credit card details (7 January), Israel's Deputy Foreign Minister, Danny Ayalon, warned hackers that such attacks are "a breach of sovereignty comparable to a terrorist operation, and must be treated as such [...] and no agency or hacker will be immune from retaliatory action". Given the expert view that the US and Israel were involved in the Stuxnet virus attack on Iranian nuclear reactors last year, is it possible Iran would be justified in responding in a similar vein?

Chris Webster

Abergavenny, Monmouthshire

Neatly put, Newt

In your report from the New Hampshire primary (10 January), Newt Gingrich was quoted as saying: "Is capitalism really about the ability of a handful of rich people to manipulate the lives of thousands of other people and walk off with the money?" To which I can only reply: "Of course it is."

Meredydd Morris

Bodorgan, Anglesey

Muscular moles

Mole-handling is indeed a memorable experience (letters, 9 January). Some time ago, a mole crossed the road from our mole-ridden wood and burrowed into the soft soil of a newly planted flower bed. I quickly detected and captured it, and I shall never forget the impression of silkiness, yes, but also muscular power as I transferred it to a bucket of soil for return to the wood.

Colin V Smith

St Helens, Merseyside

Poor pelicans

It is Humped Pelicans (letters, 10 January) I watch out for at a nearby crossing. Poor things. Perhaps we should think of providing tunnels, as with toads and hedgehogs, though hardly practical for zebras, even slow-moving ones.

James Snowden

Nottingham

No Games fan

Dr Hunt (letters, 9 January) claims to know the Olympics are being held in a foreign country. This resident of London wishes dearly that Dr Hunt was correct.

Keith Wilkinson

London E9

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