NHS finances, Wolfowitz and others

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The Independent Online

The NHS will never be able to afford to meet the demands on it

Sir: I am prompted to write this following a week practising as a Consultant Neurologist faced with an unbridled demand and a limited resource.

Consideration of current expenditure on health I believe highlights the essential dilemmas of health spending. Assuming a spending of £70bn per year or a per capita spending of £1,000 per person, this lifetime level of contribution leads to an accumulation £70,000 of health funds i.e. 70 years at £1,000 per year. (The money is not invested but used for current needs)

Is this enough to pay for all of public health services, immunizations, obstetric care, psychiatric care, emergency services, GP services, major orthopaedic procedures such as hip or knee replacement,minor surgical procedures such as hernias, and cholecystectomies as well as hysterectomies, treatment of cancer (i.e. 25 per cent of the population), treatment of rare disorders (some of which are very expensive such as renal dialysis), Alzheimer drugs and terminal care, in addition to fertility treatment (for 10 per cent of the population), cosmetic surgery, alcohol services, addiction services, mental handicap services, NHS direct etc.?

I very much doubt this, as a practicing doctor, knowing that an MRI scan costs £500, blood tests often cost £30-£300 per test, and an inpatient day in hospital costing £250-£500 etc.

Modern treatments are on average costing more each successive year. Patient expectations (whipped up in part by political rhetoric, and the popular magazine culture) are even more inflationary . As a doctor at the front line I very much doubt that even £140,000 of contributions would ever cover current and future health needs.

I do not believe it is at all possible to provide an NHS available to all for all conditions free at the point of need (or desire). It is a wonderful idea but an impractical and unrealistic objective.

Consultant Neurologist

Wolfowitz's dubious record in Indonesia

Sir: As ambassador to Indonesia during the Reagan years, Paul Wolfowitz may have paid lip service to democratic reform (profile, 19 March), but on the whole he defended the Suharto dictatorship. That regime was responsible for hundreds of thousands of deaths and extensive human rights violations in East Timor and elsewhere. The Suharto family and his cronies became extremely wealthy siphoning funds from the development projects and business deals that Wolfowitz promoted.

In May 1997, Wolfowitz told the US Congress that Suharto provided "strong and remarkable leadership" and dismissed illegally-occupied East Timor's aspirations for independence. A year later, a popular revolt against Suharto's failed economic policies and the brutal killing of student protesters forced the dictator from office. Five years later, East Timor gained independence. Wolfowitz's policy prescriptions on Indonesia, look no better than his later ones on Iraq.

More recently, as number two at the Pentagon, Wolfowitz advocated of stepping up military engagement with Indonesia, despite that fact that the main reasons for limiting that US engagement remain largely unresolved. No Indonesian officials have been held accountable for crimes against humanity in East Timor; security forces continue to systematically violate rights in tsunami-stricken Aceh and elsewhere; and the killings of two Americans in West Papua in 2002 remains unresolved, despite evidence of military involvement. The military, whose "reform" Wolfowitz champions, remains the greatest roadblock to democracy in Indonesia. He must not bring similar attitudes and policies to the World Bank.

Outreach Coordinator, East Timor Action Network
Brooklyn, NY, USA

Sir: When I was the UK Alternate Executive Director on the Board of the World Bank, I suggested to my government that, while not seeking to overturn the convention under which the USA nominated the President of the Bank, Europe should be prepared to veto a nominee who was manifestly unsuitable. Given Mrs Thatcher's "love-in" with President Reagan and her antipathy towards the Bank, there was no prospect of the suggestion then being adopted.

It is imperative that such action now be taken to prevent the appointment of an ideologue whose philosophy is inimical to the interests of the Bank's clients. If Mr Blair is genuinely interested in promoting the welfare of the poor countries, as I believe he is, he should be prepared, on this occasion, to work wholeheartedly with the European countries. There should also be full consultation with our Commonwealth partners.

If the issue could not be settled "out of court" and it were brought to a vote in the Board, with proper preparation there would surely be a large majority against the appointment of Mr Wolfowitz, possibly with only the USA voting in favour.

Sevenoaks, Kent

Voting for values

Sir: In "Abortion: the facts" (16 March), you suggest that Christian opposition to abortion before the fifth month began with Pope Pius IX in 1869. This is far from the case. Jewish teaching, of much greater antiquity than Christian teaching, has always been that, even though the child only acquires full personhood at birth, abortion at any stage may only be permitted in exceptional circumstances to save the life of the mother. Christian thought largely followed the Jewish lead, and has always maintained that killing an embryo is wrong at any stage.

There has been debate about when the soul is infused into the person: most Christians have believed that the soul is present from conception, and indeed begin Christian salvation history with Christ's conception rather than his birth, but some Christians, following Aristotle, have argued that the soul was only infused into the person after forty days, and some of these latter Christians have regarded late abortions as more serious than early abortions; but the fundamental teaching, which Pius IX simply restated, has always been that Christians should not practise abortion.

In your editorial ("The last thing Britain needs before an election is a debate over abortion") you go on to describe as malign the possibility of an American-style campaign that turns on values, and you say that abortion should only be debated after the election. Why, in a democracy, should elections not turn on values? If values are the most important topics that can be debated, are they not precisely the things that should exercise voters choosing a Parliament?


Sir: Christians in the US were urged to support Bush, who was anti-abortion, but whose right-wing policies worsened poverty, thus creating the conditions in which poor women were pressurised into having abortions because they could not cope financially. Bush has probably caused more abortions than he has prevented.

The same issue is now facing us in Britain. As a Christian I will not be voting for Mr Howard, because I know that while he argues for a lowering of the age for abortion, the Tories have never been good for the poor. But take no comfort, Mr Blair, I will not vote for anyone who makes unjust war. Being pro-life is about more than just banning abortion.

Stretford, Greater Manchester

Sir: If there's a gay vote, and a grey vote, why not a Catholic vote?

Southam, Warwickshire

Diamond truths

Sir: It would be an outrage if the Natural History Museum installs an exhibition about diamonds, sponsored by De Beers, without including information relating to the eviction of the Bushmen from their ancestral lands. (Pandora, 16 March)

Unfortunately for the Bushmen, Botswana's vast diamond deposits lie under the Kalahari sand. As a result, these hunter-gatherers were forcibly removed from their homes. They now live in squalid camps where they are likely to remain for the rest of their lives.

The Bushmen will not share in their government's prosperity; they will not reap financial rewards. Instead they can look forward to poverty, sickness and desolation. I thought the major role of museums was to educate, not obfuscate. By refusing to reveal the sorry fate of the Bushmen, the curator is little better than a shill for corporate interests.

Uplyme, Dorset

Community fears

Sir: Jeremy Laurance's observations about community care policy for the mentally ill (Opinion, 17 March) are only partially accurate. He says the number of killings by the mentally ill has not increased over the past 40 years. This is a widely repeated myth that is based on an academic paper published in 1999.

The figures in that paper relate to people convicted of manslaughter on the grounds of diminished responsibility, which is the usual outcome for people suffering from schizophrenia who kill. The glaring and unacceptable omission is the very large number of people convicted of murder who suffer from a range of complex personality disorders, including psychopathy. These people end up in prison because they are considered untreatable by psychiatrists and this explains why our prisons have become psychiatric dumping grounds.

The mistake is to take a very narrow view of precisely who should be served by mental health services and then to sit back and say that a few homicides here and there is the price we should be prepared to pay for an open-door policy. However, as personality disorder is no longer considered a diagnosis of exclusion, and many forms can be treated by psychologists and psychotherapists, it is essential to make sure new mental health laws close the loopholes that currently exclude them. Hence the Government's proposal to broaden the definition of mental disorder.

Director, The Zito Trust
Hay-on-Wye, Powys

Sir: More than half a million people in this country have severe mental illnesses like schizophrenia and live safely in their communities. They are neither "ranting fools" nor "naked wretches", in Howard Jacobson's words (19 March). Tragedies such as the case of Peter Bryan are terrible events, yet their number has not increased since community care replaced the outmoded long-stay hospitals of old. Comments such as Jacobson's merely reinforce the prejudices that lead so many people with severe mental health problems to be excluded from the communities they live in.

Chief Executive, The Sainsbury Centre for Mental Health
London SE1

Literary lightweight

Sir: I was so impressed by the formidable number of volumes - a good eight so I gathered - that Boyd Tonkin's very generous article (18 March) calculates it took Michael Holroyd to get through his biographies of Strachey, Shaw and Augustus John that I staggered to my bookshelves and found there alternative editions for readers (such as myself) with less stamina: in short, a single volume for each life. The man is obviously a bibliographical nightmare, but I hope this drastic reduction in the width of his work will not diminish his scholarly weight.

London, W10

Not so random

Sir: Teletext proudly announce that 2,627 phone-in responders gave their opinion - good or bad - on Chancellor Brown's budget (Teletext page 348, 19 March, 10.30 hrs). For an expenditure of £3.00, I made 25 phone calls at 12p a time to express my views. That equates to about 1 per cent of all responders. Hardly a random sample!


Cod picture

Sir That was a good article on cod in Saturday's Global Kitchen supplement (19 March), but unfortunately the accompanying photograph showed a display of haddock. Perhaps the fish should have been represented in it's more familiar form, deep fried in batter. The readers would then have been none the wiser.

Tanroagan Seafood Bistro
Douglas, Isle of Man

Too many words

Sir: Guy Keleny (19 March) was quite right to draw our attention to that breathless paragraph: "a former motorcycle gang member and a mother of 12 who wrote her first novel after she was widowed, were among 20 authors etc". But for the wrong reasons. Why is the subject (singular) associated with the verb form, "were'"?

The problem may arise from the proximity of the plurals - "mother of 12" and "20 authors". It may also arise from trying to fit so many facts in a 37-word sentence; by the time the writer's half way through he may have forgotten where he began.


Second thoughts

Sir: Michael Howard says that he was wrong to introduce the homophobic "Section 28" in 1988 (report, 19 March). I wonder what he'll be saying in a few years' time about his current attitudes to gypsies and asylum seekers?

London E8


Sir: Imitating a horror film to advertise marmite (letters 19 March) is surely a bit unsavoury?