Despite the "listening exercise", the diagnosis for the Coalition's very sick Health and Social Care Bill is terminal and its prognosis is extremely bleak. The fragmented "marketplace" ethic at the heart of the reforms is almost universally hated and GP consortia are likely to be another toxic exercise in privatisation.
The problem with the present reforms is that they have been devised through the rosy lens of an MP sitting in an affluent, healthy southern area of England with few major social and economic problems. What might be envisaged to work in wealthy Cambridgeshire may not adapt well to the less utopian areas of England. The proposals fail to take into account the implications of a market-based model for Hull, Birmingham or a poor London borough where hospital services could face meltdown.
In its present form, unless totally rewritten, the Bill is blighting the Coalition and is in danger of turning the NHS into another poll-tax quagmire from which the Conservatives will never recover their credibility. The only cure for this hopeless case is to take a blank prescription pad and write a new regimen for health under a new Secretary of State. Meanwhile, let Mr Lansley, (along with his Bill) take a long pause for thought and "spend more time with his family".
Steve Richards comments that: "As long as the NHS is financed centrally and free at the point of use, the Government cannot step back and allow a free-for-all, administered by quangos. This is the dynamic that the NHS Bill fails to recognise ... In the end, the democratic link can only be made where the money is provided, the dreaded centre. Yet the Government plans to fund the NHS and then have virtually nothing to do with it." (Opinion, 10 May.)
But this seems to miss the point of the exercise. The provisions in the Bill run much deeper than simply transferring the commissioning of care to private companies representing GP consortia. In line with the Government's small-state ideology, and following the prescription guiding the privatisation of higher education, they are intended to transfer the cost of health care from the state to the individual by introducing user charges, so that the tax-funded element can be steadily reduced.
As Professor Allyson Pollock makes clear in her dissection of the plans: in addition being able to enter into commercial contracts with "any willing provider", GP consortia, no longer under the direct control of the Secretary of State, will be able to determine which services constitute "NHS" care, and which are chargeable; they will have no duty to provide a comprehensive range of services, only "such services or facilities as [they] consider appropriate".
In addition, the cap on foundation trusts' generation of income from private care will be abolished, and they will be able to charge for accommodation. As the number of private beds increases at the expense of NHS beds, those with means will effectively be forced to "choose" treatment in the private sector, leaving a Medicaid-style rump for those unable to afford "co-payment" or insurance premiums.
The whole aim of the Bill is to undermine the foundations of a system financed centrally and free at the point of use.
The GPs are right to be apprehensive about the Government's proposals to reform the NHS.
The idea that competing for patients will raise standards and reduce costs is wholly fallacious. It is always possible to do things a little cheaper and a little worse – a downwards spiral which will in time damage standards of care for all but the wealthy by driving out best practice. Competition and choice require spare capacity, and spare capacity is wasteful and inefficient.
The problem with the Government's thinking is that they are applying half-understood ideas about the private sector to a public service. The Confederation of British Industry often comments that the mindset of public-sector workers is different from that of private-sector workers. You bet it is! Public sector workers are, on the whole, motivated by altruism and worry about maintaining the best service they can, with often meagre resources. Contrast that with the attitude of B-team businessmen – always seeking to cut costs and corners in the pursuit of short-term gain. It is disastrous to attempt to apply such attitudes to public services such as the NHS.
Fragmentation and constant chopping and changing drive down standards and put up costs. Stable, simple structures, understood by all, promote team-building, raise standards and cut costs. Much more wise, moderate and prudent proposals are required from the Government.
In 2008, at the age of 55, I resigned from the NHS to register the withdrawal of my consent from what has been and is being done to it. News that one third of my erstwhile fellow GPs are planning to leave cannot be a surprise.
Professionalism and vocationalism remain the fulcra around which huge sections of national life revolve. They are major assets. Perhaps all the nation's professions should collaborate to limit the destructiveness of political vainglory. The problems all derive from the political process. It is not enough to construct castles in the air from pieces of abstract political thought-experiments and then attempt to corral the real world's inhabitants within them.
The professions are largely self-selecting, vocationally driven, extremely skilled and highly committed groups. What does it say about the politicians that they are destroying such assets?
Dr Steve Ford
Haydon Bridge, Northumberland
The best possible insurance policy
For years I laboured under the misapprehension that the point of insurance was that the customer paid a sum of money upfront and then, if something went wrong, the insurance company would pay to put it right. My experience of insurance companies in recent years is that, while marvellously efficient at answering the phone and taking my premiums, they become strangely coy when I come to make a claim.
In every case, after many hours of calming music, when the phone was finally answered, a helpful person would explain to me that there was, in the small print, a perfectly valid reason why, in this particular case, no payment would be forthcoming.
I therefore take my hat off to the executive at Lloyds bank who invented PPI, which for some individuals would not pay out anything, in any circumstances, ever. Surely, from the insurance industry's perspective, the ideal policy.
I'd be interested to know the size of this person's bonus in the years this product was being sold, and when they intend to start paying it back.
Biotech patents do not work
Patenting of genes and cells from plants, animals and humans has been a disaster for biotech research ("Ruling on stem-cell patents may spell end of research in Europe", 28 April) and scientists holding life science patents, such as Professors Wilmut and Smith, are wrong to cling to this deeply flawed method of securing research investment.
Patents grant monopoly rights to those commercialising research for more than 20 years. For pharmaceuticals, the system has helped big pharma to invest in R&D, but also restricted access to new treatments because of the inflated costs of patented medicines.
In biotech, the problem has been largely the opposite: patents have underpinned a system of investment that has sucked in vast sums of money but delivered very little. The adoption of the European Patenting Directive in 1998, which allowed the controversial patenting of life, has resulted in a plethora of patent claims at a very early stage of research, most of which are useless. These patents underpin a system which encourages scientists to make misleading claims about the future benefits of their research in order to create spin-out companies and secure public subsidies and venture-capital investment. The main output of this system has been a lot of failing companies.
Most of your readers will be shocked to learn that the European Patent Office has been granting patents not just to embryos but also to whole plants and animals, including tomatoes, broccoli and pigs. This goes way beyond what the European Parliament originally intended.
It is time we found a better system to reward early-stage research, which does not mislead investors (including taxpayers) or potential patients, and which delivers on its promises.
Dr Helen Wallace
Director, GeneWatch UK
'SlutWalks' miss the point
If a woman dresses provocatively then she has brought rape on herself ... but of course that doesn't justify the rapist's actions ... so it was the victim's fault, but he shouldn't have raped her. That, sadly, appears to be the general public opinion, and I fear that marching through the streets in lingerie waving such banners as "It's my hot body; I do what I want" will do little to shift such a view ("Women mobilise for first British 'slut walk' rally", 10 May).
Rape is a hate crime, focused on gaining absolute control over another person, and has nothing to do with how that person looks, dresses or acts. From the sounds of it, this "SlutWalk" currently being planned will simply appear as if women are reclaiming the right to dress revealingly as some kind of expression of their sexuality, as well as encouraging more young girls to follow in these footsteps. A poor example to teach them and missing the bigger picture entirely.
The focus of such a movement is to prevent the violent act of sexual assault no matter what the situation – there is never a justification for rape. I hope the actions of this movement don't mean their message is lost.
Vote on a Sunday
Why do we insist on Thursday as polling day? We should switch to Sunday voting, as most other countries do, as a matter of urgency.
In my Kent borough on 5 May, 12 of the 63 polling stations were schools. That meant closure or part-closure and the education of hundreds of children was needlessly disrupted. In the London Borough of Lewisham 43 of the 109 polling stations were schools. This pattern is replicated nationwide.
Such an attitude suggests to children (and parents) that education is a low priority – especially this year given the longer than usual Easter/May Day break. Children and learning should always be first priority for any school building.
Polling on Sundays would solve this problem very simply. It might also lead to a higher turnout because most people have more free time on Sundays than on a weekday.
The wives of tyrants
Every morning I open the paper desperate to read that one, just one wife of an unspeakable tyrant has forgotten which side her bread is buttered on and has renounced and denounced him (Christina Patterson on wives of dictators, 7 May). But no, the kind of girl who marries these almost always much older and always extremely rich and powerful ruthless kleptomaniacs will take great care only to hear the propaganda that suits her.
But what about the sons and daughters? How predictably they become clones of their fathers. So sad that blood is for ever thicker than water and that family solidarity always trumps concern for the nation. I'd love to hear of exceptions to the rule if anyone knows of any.
Working people against Tesco
I know the area of Stokes Croft, Bristol well, and I can assure Julie Burchill (5 May) that many of the people opposed to the new Tesco Express were not "toffs", as she claims, but local business owners and residents from all walks of life, including the working class.
The subject of the protests was not to promote Trotskyist ideals, but to express concerns about the threat of supermarket chains to local shops (owned by ordinary, hard-working, often struggling traders), and show their support for small business, which after all, deserves to be defended, as it accounts for more than half the UK economy.
The sparrows of Paris
Not only in Berlin are there more sparrows than in London (letters, 4 May). One of the joys of Paris this past weekend was the continual sound and sight of sparrows – flocks of them in Jardin des Tuileries and Place des Vosges.
What has made London so inhospitable to these birds? We have as many trees and green spaces to harbour the insects that they require to feed their chicks. Can it be that central Paris has fewer sleek, sanitised modern buildings, and more old ones in a less than immaculate state of repair, providing plenty of ledges, crannies and holes for nests?
Pick a club
Good to see you picked up on the sang froid of the members of the Richmond Golf Club in 1940 (Digital Digest, 27 April) but you have attributed it to the wrong club; it was in fact Richmond Golf Club, Petersham Surrey, of which I am pleased to be a member. A similar spirit prevails; we regard ourselves as more of a club with a golf course outside than a run-of-the-mill golf club!
Perspectives on justice for Bin Laden
Yet another execution
I congratulate Robert Fisk, Geoffrey Roberston and your coverage in general for providing some rationalism amid the hysteria following the announcement of Osama bin Laden's death.
It was truly saddening to hear leading statesmen and world leaders congratulating the US on yet another summary execution at the expense of an opportunity to exercise true justice. Had the option been possible, a scenario that is still unclear, to apprehend Bin Laden and subject him to the rigour of international law (though undermined by the ludicrous trial of Saddam Hussein), the cruel killer's self-created mythology would have been laid bare for what it was: pure, unrestrained evil. Not to mention the inconvenient truths of his relationship with the CIA during the Russian war with Afghanistan and numerous other ties with influential figures in the US government.
Hopefully one day the US and indeed their supporters, will look back on an era that resulted in two wars and the death of millions of Arabs, not to mention many military personnel of multiple countries, and consider whether it was worth unleashing such misery on the world for the sake of one man who had been racing towards redundancy ever since the protests spread from Egypt across the Middle East.
Perhaps one day we will question with greater urgency the actions of George Bush and Tony Blair, whose supposed hunt for Bin Laden now looks more suspect than ever, particularly given Bin Laden's actual location.
Sadly the west still resembles a blood thirsty bully intent on revenge, not the justice and democratic values we purport to embody. Yes, the world is better without Bin Laden, but it is infinitely poorer for lack of a criminal trial.
The extrajudicial killing of Osama bin Laden in another sovereign state, justified by the 9/11 al-Qa'ida attack on the twin towers, seems to me to be no less culpable than the extra-judicial killing of Americans as a consequence of the perception in the Arab-Islamic world of the American terrorist attacks on their lands.
Massive retribution by the Americans followed 9/11. Why should the West expect anything different from the Arab-Islamic world?
An eye for an eye and a tooth for a tooth after all.
Dr Mary Campbell-Brown
Terror will go on
The death of Osama bin Laden has brought about much discussion on how it will it change future terrorist actions. The demonisation of and focus on this one individual has, as usual, taken us down the wrong road. There is no discussion on the causes of terrorism. These remain completely unchanged by this revenge killing. The fires of injustice that motivate terror acts still burn bright in Palestine, Israel, USA and in recent Iraq history. Osama bin Laden may have fanned the flames and lit torches from the fire, but his demise will change nothing.