The article on prioritisation in health care ("Patients to be told if hospitals blacklist latest drugs", 28 August) highlights what should be fundamental values in any commissioning organisation, namely openness, honesty, and ensuring the involvement of stakeholders, especially the public.
Even in such a culture of inclusion and engagement, Oliver Wright's commentary serves to underline the enormous difficulties faced by commissioners in a world where the gap between demand and available resource is ever widening.
Often, it is not simply a question of whether we should fund treatment A or treatment B, rather, given our limited budgets, what treatments must we stop commissioning in order to be able to afford either A or B in the first place. Inevitably, the treatments considered for decommissioning tend to be of a much lower profile than the headline-grabbing anti-cancer treatments, but will potentially cause distress to a much greater number of patients.
All well and good Nice producing guidelines regarding new treatment pathways, and raising expectations, but when it comes to decommissioning there are few friends, and the world can seem a very lonely place.
Dr Adrian Canale-Parola
Chair, NHS Coventry & Rugby Clinical Commissioning Group
The patent for any new drug has historically allowed the manufacturer sole rights of production for 10 years. The price set will be the highest the manufacturer thinks the NHS will pay. After 10 years, other manufacturers may produce it, often more cheaply.
But if the patent was originally awarded for, say, a two or three times a day dosage form, then, lo and behold, the original manufacturer can suddenly, nearing the expiry of the original patent, come up with a "new" slow-release once-a-day form, and obtain another 10-year patent. Guess which formulation patients will want to take. Memorably, a soon-to-be-out-of-patent hayfever drug was once produced in mirror image molecular form (beta isomer) and marketed as the "new improved" version, with accompanying new 10-year patent.
As a retired pharmacist I am glad that at least some PCTs are going for generics where they can. Why should the taxpayer bolster drug companies who manipulate the patent system so cynically? The decline of UK manufacturing means the threat of withdrawal abroad has become a winning card in the hands of British multinationals. This abuse of the patent system should be outlawed.
Why Virgin is going to court over rail franchise
Your leading article "Even a mega-star like Sir Richard must respect the rules" (28 August) suggested I had recourse to the law if I believed that rules were broken over the decision to award the West Coast franchise to FirstGroup.
Reluctantly that is what I have had to do in order to demonstrate the failings of a franchise process that rewards unrealistic, undeliverable bids over sensible, achievable proposals. We are taking legal proceedings as the only way of finding out information that should be readily available under a transparent process.
You suggest I am desperate because I offered a pragmatic solution to try to get the information by extending the current franchise without any profit. There is certainly no desperation on my part from a personal perspective. But I am desperately asking the Secretary of State for Transport, Justine Greening, and her department to be totally transparent on how they have conducted the process of evaluating the bids for the West Coast Main Line franchise.
If they can demonstrate they have used a rational procedure then I will accept that we have lost the bidding process fair and square. However until now officials refuse even to answer my questions on the process and that is why we have resorted to challenging the processes through the courts.
Sir Richard Branson
Founder, Virgin Group of Companies, London W6
It lies ill in the mouth for Richard Branson and Stagecoach now to complain about not being able to continue to impose their woeful service on long-suffering passengers for the foreseeable future. Hallelujah, I say.
Why it is that the Department for Transport fails to require prospective rail franchisees to undertake to ensure that the standards of travel are maintained to no less a standard than that which they inherit? If this had been done at the time Virgin acquired the franchise in the Nineties, there would still be a good restaurant car, proper catering, normal (not aircraft) seats, bigger carriages and more of them, with concomitant absence of cattle-truck travelling.
Like many others, I am appalled at the prospect of Virgin Trains losing the franchise of the line to our neck of the woods. I use the train regularly to travel to London and have rarely had a significant problem; usually any problem is the fault of some other operator or signalling failure.
How many employees of the Department for Transport have actually used the line to experience the ever improving service that Virgin has delivered over the past years? Have they surveyed current passengers to ascertain our views? Certainly I and have not been consulted.
As I understood it, the line is operating at capacity now, so how this FirstGroup are going to run more trains on the line defies logic and safety. It ain't broke and don't need fixing!
Christopher R Bratt
Don't blame pensioners
Simon English must have been bitten in his pram by an old person, to judge from the outburst of anti-pensioner bile in his Outlook column of 24 August.
There are many pensioners who do not have shares to offset lower annuity yields; who do not have holiday homes in Marbella; who do not drink banana daiquiris; who are not "Saga louts"; who have not benefited from house price rises; and who could not possibly have anticipated the drop in the value of their pensions. Mr English roars that they should have paid more into their pensions, but by the time they discovered the shortfall it was far too late to do anything about it.
Pensioners are just one of many groups who are articulating the problems which they are experiencing in the financial slump. None are, as Mr English puts it, asserting moral superiority nor claiming to be the only ones feeling the pinch. We are, indeed all in it together. Rubbishing the problems of individual groups (who is next on the list?) is a divide-and-rule approach which deflects attention from those responsible for the crisis and from those charged with sorting it out.
As a pensioner, I fully agree with Simon English's article. Many of my contemporaries greet any possibility of a cut in one source of their income with moan, moan, moan. We should be giving thanks every day that, while our children's generation are suffering real-terms cuts in their income with the ever-present threat of losing their jobs, our standards of living, helped by all the perks for the over-60s, have gone on steadily rising.
Move MPs out of London
John Kampfner is right. We should go for something more radical ("Don't refurbish the Palace of Westminster. Abandon it", 28 August). A new Parliament should be built at or near Ripon in Yorkshire, the approximate geographical centre of the UK. The Scots would feel less out in the cold if they only had to pop down to Yorkshire to see their MP.
London is the centre of business and commerce and the arts and entertainment. A move of Parliament and central government to Yorkshire would free MPs and Ministers from these distractions, enabling them to concentrate fully on running the country.
And the new Commons chamber should be round, thus reducing yah-boo politics and the ridiculous weekly charade of Prime Minister's Questions.
Government and Opposition should seize the opportunity offered by the crumbling ruin at Westminster to introduce a new era for our political system worthy of our place as a cradle of democracy.
Perhaps John Kampfner should look farther north than Birmingham or Manchester as a possible temporary location for the Houses of Parliament.
Making Glasgow the venue could have three advantages. First, it would provide a healthy education about Scottish life to those London MPs who otherwise seldom go north of the border. Second, the UK Parliament meeting in Glasgow would make a clear statement by the major parties about their commitment to the Union in the run-up to an independence referendum.
Finally, it could do much to restore Glasgow to its rightful place as Scotland's principal city, as I am sure all the enlightened thinkers of Edinburgh would agree.
A crime not to heed Clegg plea
May I through your columns call upon our criminal classes join in the national effort which Mr Clegg says is now required to save the Coalition ("We need rich to pay emergency tax, says Clegg", 29 August)? A strictly time-limited reduction of, say, 10 per cent in the number of crimes would take pressure off the budgets of our hard-pressed police and jails.
Serious career criminals might also like to consider taking their crimes abroad until, say, 2015. In this way, they would also help save our National Treasure Mr Kenneth Clarke who is in danger of being closed down. Criminals should reflect that time-limited restraint may now be the only way they can in future pursue business as usual.
Irregular salute for Harry
You publish a picture of a group of servicemen giving a naked salute to Prince Harry (29 August). Their decency is preserved by their rifles hanging in front of them.
It has long been established practice in the British Armed Forces that you do not salute when bareheaded. Therefore these individuals should have had their right arms in a more appropriate position – which is to say holding their personal weapons.
Mayfield, East Sussex
Thank you for publishing Robert Fisk's reports from the battle lines of Syria. Those reading your brave reporter's lines have to conclude that both sides in the war have committed terrible acts. The age-old conflict between Sunni and Shia is being played out yet again. The West needs to be very wary of backing the "Free Syria Army" containing as it does elements of al-Qa'ida. Non-Muslims cannot hope to solve this problem. We do best to stand aside, offering humanitarian assistance wherever needed but no more.
D R Allum
Thank God that Desmond Tutu is prepared to address the elephant of immorality in Tony Blair's decision to support the invasion of Iraq ("Desmond Tutu quits summit with Blair over invasion of Iraq", 29 August). I shall be one of those cheering if Al Jama-ah succeeds in arresting Blair.