If the former head of the Care Quality Commission really believes that the introduction of five-yearly revalidations for doctors will be the "strongest driver of quality" (report, 5 September) I fear she may have missed the point. The strongest driver for quality, unfortunately in a negative direction, is the overall reduction in funding by central government and the nonsensical savings targets imposed by the NHS itself.
She is right that far too many NHS organisations are getting the basics wrong, but the reasons are less to do with the competency of doctors and more to do with ruthless, misguided cost-cutting by hospital trusts whose boards and personnel have little experience of how to develop and implement more efficient ways of working. The only recourse that many trusts envisage is an overall reduction of staff and a revision of the terms and conditions of those remaining.
To profess, as Cameron, Osborne, Lansley and Letwin have done, that these Tory-inspired cost-cutting measures will not affect patient care is nonsense. The appointment of a Tory yes-man in the post of Health Secretary will do nothing to assuage the fears of hospital staff and their patients that the NHS is being driven towards a second-rate healthcare system.
Your article "Health warning over army of NHS 'temps'" (3 September) highlights what the so-called reform of the NHS really means – a fragmented and disjointed health service, increasingly relying on casual labour.
If clinicians are put on these zero-hour contracts, they will miss out on team meetings and the sharing of professional issues, which will be to the detriment of patients. The concept of ongoing training and professional development will disappear, as managers, working to the privatisation agenda, slash costs.
This is the next stage in the disintegration of a universal NHS, as we have known it since 1948. David Cameron's election pledge that the NHS would be safe in Tory hands is in tatters.
National Officer for Health
Unite, the Union
Can disillusioned voters rescue our democracy?
All credit to Andreas Whittam Smith for his diagnostic skills in concluding that the public's faith in British politics is in the critical ward (4 September). The mood he describes and the statistics he quotes are compelling: a third of those polled by YouGov couldn't even think of anything praiseworthy about our political system, 62 per cent branded our politicians consistent liars.
Arguably, however, Whittam Smith's diagnosis fails to take into sufficient account the wider state of the British public's sense of disillusion and betrayal. It isn't just our politicians, but so many other cornerstones of a democratic society – bankers, corporate executives, lawyers, police, teachers, PR men and the press.
All of which raises the question of where Whittam Smith hopes to find his dedicated new army of untainted citizen/politicians to tackle the malaise. Far too many candidates are already in the disillusioned majority.
There is another hurdle, too; many electors can recollect politicians whose early careers promised principle and independence only see those qualities swamped by the win-at-all-costs party culture or the temptations of self-aggrandisement.
None of this automatically discredits the ambition of Andreas Whittam Smith's Democracy 2015 campaign, or the hope that worthy allies will suspend scepticism and rally to the cause in sufficient numbers to make a real difference.
St Albans, Hertfordshire
I accept Andreas Whittam Smith's analysis of the problems with the British democracy and congratulate him on his wish to bring about a change. He is also right to say that if his "temporary" MPs are to have an influence beyond their single parliament, there will need to be structural changes.
There would be advantages to having an elected premier who is free to choose their own cabinet from anywhere: academia, industry, business. This will offer the premier the chance to bring into government those with expertise and a proven track record of success to run government departments instead of just giving the job to a career politician who fancies running, say, a health service. It allows MPs to act more independently in scrutinising government policy as they would no longer have to toe the party line out of a fear that they might jeopardise their chance of a ministerial career.
Headley Down, Hampshire
My heart sank when I read Andreas Whittam Smith's call for "democracy". Hundreds of political activists from all parties pound the streets daily trying to engage people. Whenever they see someone not currently politically active who might be suitable as a candidate, they ask them to be one.
After years of backbreakingly hard work with virtually no reward, none of the parties get close to having 650 quality candidates and some parties get fewer than 650 candidates full stop. The idea that this campaign can succeed in three years where the efforts of thousands of people, amounting to hundreds of years of activity, did not, is ridiculous.
There are many people who believe that politics must change fundamentally, but it must now be accepted that the majority in this country do not agree. They had the chance to vote on a new electoral system. They voted no. The arithmetic of the polls was such that the Liberal Democrats had a serious chance of winning the last election. When it came to the ballot box, the country changed its mind and the majority said they did not want change; they still wanted either Labour or Conservative.
I think the country was wrong on both counts, but I am in the minority. The result of these votes must be respected. The majority does not want the change you are seeking.
GCSE goalposts were moved
David Prescott (letters, 3 September) is correct in pointing out that the GCSE English coursework has been replaced by controlled assessment (that is, work done under exam conditions). He implies that this is what has lowered the grades.
I suggest, rather, that this is what has puzzled and angered teachers even more: it is scarcely credible that students who were able to achieve A or B grades for their controlled assessments were, in the exam taken shortly afterwards, able to achieve only D or E grades, thereby lowering their overall grades. The goalposts must have been changed during that period.
As a former examiner/assessor for art and design, I was astonished at the assertion by Ofqual's chief executive, Glenys Stacey, in a TV interview, that the marking of English is more subjective than the marking of maths. No it isn't. If co-ordination meetings take place and examiners stick to the standards set at those meetings, the marking of English papers should be as objective as that of any other subject.
That said, she was wrong about the marking of maths papers too. As I understand it, the quality of the working out is also judged, as well as the accuracy of the answers.
Cameron's got a rum set of cards
Animals seem to have featured prominently in recent headlines, what with toxic cats, Essex lions, imported vipers and beached whales. Our prime minister was even identified as a potential mouse by one of his fellow Tories. Following the so-called reshuffle and ongoing paralysis in the face of a double-dip recession, I wonder whether we're not all enduring a government of rabbits staring into the headlights.
David Cameron's reshuffle must have been difficult even for a posh card sharp; in the pack there were many more jokers than aces.
Gilfach Goch, Porth
By wheelchair down the Tube
The Mayor and TfL have invested hundreds of millions of pounds to improve accessibility across London's transport network. New lifts, trains, platform humps, wide aisle gates, tactile paving and audio-visual displays mean London's is the most accessible transport system serving any Olympic or Paralympic Games.
Yet as James Moore's journey demonstrates ("My wheelchair Tube marathon", 1 September) there is clearly more to do. We recognise that and will continue to invest in and improve accessibility.
It is wrong, however, to describe Tube station staff as an "endangered species". We are committed to staff on our stations at all times. The success of Oyster smartcard ticketing means many of our staff previously stuck behind ticket office windows are now out in ticket halls, on gatelines and platforms where they can be of most assistance to all our passengers.
As Mr Moore said, there really is no substitute for having someone who's willing to come up to you to offer help and that's what we remain committed to.
MD, London Underground
Menace of the deep-fried Mars
John Walsh (6 September) is full of common sense, supporting the maxim "eat less; move more". But in the same issue Simon Usborne extols the virtues of the deep-fried Mars Bar.
Does he have any idea that he is encouraging already-willing fatties to encounter serious health problems in later life? These fatties are already going to be a real drain on the resources of the NHS without any encouragement.
The voice of reason
Methinks Peter Bunker (letters, 31 August) watched Newsnight with Peter Hitchens and Russell Brand through a mirror.
Innuendo and insult largely came from Hitchens, and reasoned argument from Brand. Hitchens completely misread the argument, and failed to realise that Brand was winning almost every point. He failed to spot that he and Brand were actually saying the same thing – that throwing methadone at heroin addicts is not the answer.
Plans for action
So Mr Cameron is going to get "the planners off our backs" to enable building to take place. In my many years experience as a chief planning officer I spent more time fighting those who did not want development near to them, than I did preventing development. Once again the Prime Minister reveals his lack of understanding of town and country planning.
I must take issue with the claim (leading article, 28 August) that the coming climate crisis threatens our planet. It doesn't. It threatens the pyramid of life on the surface, with Homo sapiens sitting atop the pile, and in danger of falling the farthest.
You report (6 September) "Costa Rica: Island shook by 7.6 quake". That must have been some earthquake, to turn this Central American country, which in my atlas has land borders to Nicaragua in the north and Panama to the south, into an island.