Your article “This can’t go on: NHS chiefs urge new debate”, and commentary by Oliver Wright (11 July) argue that the NHS is facing a black hole in its finances, and that hospital reconfigurations are a necessary response. I believe it is dangerous to make this link.
While some hospital reconfigurations for complex, specialised problems such as major trauma or cardiac surgery do make sense, the British Medical Association at its annual conference last month voted: “that this meeting opposes any reconfiguration that is driven purely by financial considerations; insists reconfiguration should only be considered if there is sound evidence of benefits to patients”.
It is not true that the medical profession supports the closure of district general hospitals in favour of larger units. District general hospitals do a different job from highly specialised units, and there is still a great need for local hospital services working closely with GPs, particularly in the care of people with long-term conditions, and for maternity and paediatric care.
Our ageing population and medical advances do mean that the NHS will cost more. Where there is a will there is a way. The nation needs a comprehensive National Health Service and must find the means to pay.
Dr Pamela Martin MRCGP, London SE14
The recent announcement by Jeremy Hunt that non-EU foreigners will have to pay to see a GP is particularly curious given the recent media attention on the strain placed on struggling A&E departments.
Inappropriate attendances, which would be better handled in primary care, are already a serious issue facing A&E units, and the threat of charges will only force people into an already straining emergency system, in order to avoid paying.
As the cost of an A&E admission far outweighs that of an appointment in primary care, this decision leaves the impression of a Government less concerned with the actual issues facing the health service than with focusing on an easy scapegoat for the NHS’s complex problems.
Dr William Nevin, Birmingham
The Government’s proposed NHS charge for migrants is a politicised response to the misperception that “health tourism” is rampant in the UK.
Less than 1.5 per cent of patients at our clinic in east London left their country of origin for health reasons; on average, they had been living in the UK for three years before seeking a doctor’s help. The majority have come to this country to work, or to seek safety from persecution, not to get medical care.
Around 0.03 per cent of the NHS’s annual budget of £97bn went toward healthcare for migrants. A levy on GP access is unnecessary, and will exclude vulnerable people from medical care they are entitled to.
Leigh Daynes, Executive Director, Doctors of the World UK, London E14
No hope for democracy in religious states
Michael Gove’s reform of the school syllabus has come too late to benefit those of our ministers who make speeches about democracy in the Middle East and other regions where religion is a powerful force.
For many centuries in England those who did not accept the state’s Christianity were hounded to death or into exile: the Jews, the Lollards, the Henrician deviants (both Roman and Protestant), the Marian Martyrs, Elizabethan Puritans and Catholics.
A limited pluralism came into existence under Oliver Cromwell and the de jure Anglican monopoly of power which existed from 1660 to the early 19th century was increasingly moderated by a de facto acceptance of the existence of religious dissent. But fierce and bloody sectarianism could break out, as in the Gordon riots and anti-Catholic hysteria in the 1850s, and could continue in Northern Ireland until much later. The biblically based discrimination against women only began to wane in the 20th century.
I suggest that the historical record shows that “democratic” government can only come into being when religious people cease to believe they have the sole prescription from God and therefore cease to persecute each other; when religious people are fully tolerant of those of other religions; and when the political community is able to accept that people who have no religious beliefs can live without being discriminated against.
Except perhaps in Turkey, nowhere in the Middle East do these conditions apply. So for our Foreign Secretary to expect “democracy” to appear in Egypt, Libya, Syria or elsewhere in the foreseeable future is to show that a clever mind and fluency of expression are no substitute for historical knowledge. I hope he does not stay long enough in office to send British troops on another Afghan-Iraqi nonsense mission.
T H C Noon, Cadeleigh, Devon
It was impressive to hear Malala Yousafzai speak at the UN. She seems to be a born orator and, yes, her message is clear and correct and we should be promoting the rights of girls. But wouldn’t it be easier to promote those rights if we weren’t buzzing those villages with drones and letting loose a guided missile every now and again?
Anyone being bombed by a foreign power resents those attacks and instinctively rejects all that the foreign power stands for, regardless of the worth of those (foreign) values. So surely we should accept that the West is part of the problem?
The first step to take would be to stop our aggression. This would reduce hostility and radicalisation and then the money saved (by missiles which remain unfired) could be spent on schools and hospitals for those regions. Indeed, I wonder how many schools or how many thousands of text-books could be bought for the value of one unfired missile?
Alan Mitcham, Cologne, Germany
Paymasters of the parties
Both unions and wealthy contributors to the Tory party argue that it is fair for both wings of society to fund those parties whose main concern is to look after their supporters’ interests. So, who is there to look after the interests of the vast majority of us who are neither union members or wealthy?
Perhaps this void at the heart of society explains why so few electors, who have no vested interest in either side and so feel disenfranchised, find any party worth voting for. The only sensible route to solving this dilemma is the funding of political parties by all the electorate in a democratic society – that is, state funding.
Mark S Bretscher, Swaffham Bulbeck, Cambridgeshire
Broad defies the spirit of cricket
The only defence that I have seen of Stuart Broad’s outrageous refusal to “walk” when palpably out is that “the Australians do it too”. Two or more wrongs do not make a right.
Broad’s behaviour is contrary to the very spirit of cricket, and a terrible example to players of the game at all levels. Let us hope that there will be condemnation from cricket’s governing bodies.
John Gibbs, Mexico City
I have arranged to be in Australia for the Adelaide and Melbourne Ashes Tests. I am sure the genteel folk of Adelaide will abstain from comment, but Stuart Broad’s decision not to walk after an atrocious umpiring mistake will certainly prompt the more boisterous Melbourne crowd to welcome him to the crease with a chant of “Cheat! Cheat! Cheat!”
I might even be joining in.
Brian Burbage, London SE20
South American postal service
Mark Steel (12 July) is not being funny when he asks “Are you ready to deliver your own letters?”. Visit Venezuela, where there are no post-boxes. Letters must be taken to the central post office for posting (there are no other POs).
To receive letters you must rent a box at the same PO and pick them up yourself. This obviously is “more efficient” for the post office, as labour costs are the biggest expense in a letter service. For us, it’s not just the Outer Hebrides who will suffer from Royal Mail privatisation – we are all in this together.
John Day, Port Solent, Hampshire
Trayvon a victim of US gun laws
A month ago a burglar tried to break into my house. He couldn’t, and climbed the wall, smashed my neighbour’s window, and went in. But another neighbour saw all this and phoned the police, and by the time the burglar emerged six police were waiting to arrest him.
Irrespective of whether the burglar was black, white or Hispanic, neither I nor my neighbours needed a gun. Nor did the police. So isn’t the shooting of Trayvon Martin at least as much about gun control as about race?
David L Gosling, Cambridge
You learn what you eat
Do the debates on school dinners and the curriculum offer an opportunity to “join things up”?
Imagine what might happen if school dinners were cooked by the (older?) students, using ingredients bought by (younger?) students in the local market, to a budget, with everyone writing something appropriate afterwards – so integrating cookery, nutrition, maths, business studies, economics, biology, geography and English, as well as chemistry and physics (what happens during cooking).
Dennis Sherwood, Exton, Rutland
The tax you know
I note the Lib Dem plans for a mansion tax. Can anyone explain the substantive difference between council tax and mansion tax, apart from who sets and collects it (Treasury or local council)? If there is no substantive difference, wouldn’t it be cheaper to tweak the existing council tax rather than introduce all the new procedures required to manage a new tax?
H Trevor Jones, Guildford
A government committee says that farmers face a severe water shortage that could lead in the near future to much greater reliance on imported food (report, 10 July). A little while ago it was reported that fracking requires huge quantities of water.
Peter Salway, Stanton Harcourt, Oxfordshire
One wonders if Damien Hirst would look so happy if the severed head with which he posed for a photograph (13 July) had been that of his mother or father.
Peter Fonth, Keighley, West Yorkshire