NHS spending, Terror tactics and others

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Spending more money on the NHS will not improve its services

Spending more money on the NHS will not improve its services

Sir: As a lifelong Liberal Democrat and consultant working in the NHS, I welcome David Laws' call for social insurance to replace the current NHS, and I do not accept Dr Richard Grayson's characterisation of Continental healthcare systems (letter, 4 September).

Dr Grayson cannot, of course, dispute the fact that countries such as France , Germany and Switzerland have far superior health outcomes: negligible waiting lists, better cancer care, patient choice. Instead he argues that the only reason for this better performance is years of higher funding. But we already know from the experience of Wales and Scotland (where I worked until recently) that spending at much higher levels does not on its own produce better results, since the NHS in these countries has longer waiting lists and worse outcomes than in England.

By 2007 Britain will be spending the same amount per capita on healthcare as the French - one of the most expensive systems in the world. We will soon see which system delivers more for the same level of spend.

The modest up-front charges for healthcare in France can be reinsured against and the poor are reimbursed. On the Continent the poor receive the same access to high quality care as the well off. In the NHS, the least well off receive the poorest care while the rich opt out. Social insurance could realise the ambition of three generations to create a truly equitable and responsive healthcare system.

In a recent study the NHS rated 18th out of 19 national healthcare systems. Only Portugal's health service was worse. Simply arguing that higher spending, plus a bit of tinkering to make services "more responsive", will make it better denies the elephant sitting in the room: a central healthcare monopoly does not work and will not work, even when it has half as much resources again.

Consultant Obstetrician and Gynaecologist
Founding Signatory of Doctors for Reform
Taunton, Somerset

What terror tactics are meant to achieve

Sir: We liberals understand terrorists. For example, we understand that a terrorist's first priority is to achieve unity on his own side. An atrocity is the best method. An atrocity will destroy any rival moderate parties seeking a negotiated settlement. "Don't tell me to talk to child killers," says Putin, as do Sharon and Bush.

In doing this you will be helped by your worst enemies - the extremists on the other side - who have a similar need to destroy the middle ground. A weak government will be forced to react with extreme violence, which will fall on the uncommitted and convince them they have no choice but to fight.

As the war drags on, some cooler heads among your enemies may begin to think they should have gone for "hearts and minds" instead, but it is already too late. That just leaves the other methods - concentration camps, hostages, assassinations etc but most democracies get uncomfortable with this after a while (unless they can employ a Saddam Hussein type to do it for them).

Sometimes one side will win outright. Sometimes it settles down with power divided between the extremists of either side, fairly peacefully in Northern Ireland, miserably in Israel/Palestine.

We should all try to understand terrorists - then we might stop reacting in the way they want us to.

London SW19

Sir: It is no use denying Putin has a point. Were we not all Americans during the aftermath of 9/11? What was the European Union's spontaneous reaction to the school siege? They demanded an "explanation"! Many of us may disagree with Puntin's policies but that is not the question after such a callous and vicious attack.

This was one of the most brutal terror attacks the world has ever faced, and the one thing the victims do not need is such patronising behaviour on the part of the Western world. The one thing that must not happen is that terror can prove successful in political terms. Western governments are well advised to drop their double standards and accept that Putin will not talk to people whom, had they hit us, we would hunt with all our power.

Heidelberg, Germany

Sir: Iain Morley (Letters, 7 September) wonders why the world's media has been reluctant to declare the Beslan murderers "Muslim fundamentalists". Has he considered that it may be because, while they were Muslim, they were not fundamentalists?

Osama Bin Laden and al-Qa'ida have committed atrocities from New York to Bali, motivated by the "vicious religious bigotry" that Morley describes. However, this was no more the motivation of the Beslan terrorists, the Janjaweed militias, or necessarily the Palestinian bombers he clumps together, than Catholic fundamentalism was the motivation of IRA terrorists.

While these conflicts have been committed by people of one religion against another, the religions are secondary or inconsequential to the IRA's republicanism, the generations-old conflict over land in between a nomadic and a settled people in Sudan, exacerbated by a government murderously supporting one side over the other, and what was originally a conflict over land between Palestine and Israel.

Rather than religion, the quote used in Deborah Orr's article ("This was not terrorism. It was nihilism") sums up the Chechen terrorists' motivation: "Russian soldiers are killing our children in Chechnya, so we are here to kill yours."

While Muslim leaders should, and have, condemned Muslim fundamentalist terrorism, expecting them to condemn Beslan is equivalent to expecting the Bishop of Durham to condemn white, Christian mercenaries in Africa. Revenge is no more of a justification for murder than politics, land or power are, but it cannot help to confuse one with the other.

Hayes, Middlesex

Sir: The "war on terror" can never end terrorism (and may even add to it) because it attacks the symptoms and not the causes, when both need dealing with. What is needed is a war on the causes of terrorism too.

This will be harder to fight, more costly in resources, less productive of vote-winning headlines and more demanding of courage by political leaders, but it can in the end triumph whereas a simple war on terror cannot. There has, quite rightly, been outrage expressed at the killing of innocent children, but what has been forgotten is that those who did this killing were at one time themselves innocent children. What has brought about the change in them?

Ripon, North Yorkshire

Language differences

Sir: David Hook, as a professor of Hispanic Studies, should be examining the historical differences between French and Spanish for the explanation of my Spanish reference grammar being three times the size of its gallic equivalent - rather than fatuously suggesting an ignorance of typography (letter, 7 September).

As he should know, when the vast Spanish empire dissolved in the 19th century many hispanic nations and communities found themselves geographically and culturally isolated, and regional variations evolved in the language. My reference book seeks to identify and discuss these differences, relished today as examples of national individuality.

In contrast, most of the francophone world stayed under the highly centralised control of the French colonial and educational systems until the end of France's empire in the 1950s. Today correct French remains remarkably uniform throughout the world - hence the need for a much smaller grammar book and less to learn.

Wallasey, Wirral

Sir: Further to earlier letters about the usefulness of learning Spanish or French (3, 4, 7 September), I have a solution. Do as I did, and learn Latin.

I continued my Latin studies up to AS-level. I found it to be helpful as a foundation for my French studies, but it was invaluable when it came to improving my general English: it helped with learning the meaning of different tenses and their uses in English. I can work out the meaning of almost any new word I encounter, by deriving it from common Latin roots. Entering (and winning) reading competitions has improved my skills in oration (especially when reading Cicero). It has all been incredibly wonderful.

Besides all that, it is of immense value as a tool for impressing old

men at boring dinner parties.

Highworth, Swindon

Mass of contradictions

Sir: I sympathise with Alan Tucker (letter, 7 September) in his confusion between weight and mass. For the man in the street the difference is academic, and he can go through life using the terms interchangeably, ignoring pedantic smart-alecs who would confuse him with facts. They are, however, quite different.

Mass is a measure of how much stuff there is, and it is measured in kilograms. Weight is the force exerted on that mass by gravity. "One kilogram weight" is actually a force of about 9.8 Newtons. One Kg of chocolate would still be one Kg of chocolate on the moon, and would be just as fattening. However, it would weigh less because gravity there is less.

Old fashioned kitchen scales compare masses. A bag of sugar balanced against a 500g mass (weight in common language) in his kitchen would still be balanced on the moon. However, a spring balance would read much less on the moon because it measures weight, not mass.

My advice is that he shouldn't worry about it one bit, unless he plans to go to the moon.

Sittingbourne, Kent

Poaching teachers

Sir: The Commonwealth agreement to restrict the active recruitment of teachers from the world's poorest countries is welcome (report, 2 September). Whilst agencies like VSO are working with the Department for International Development to support developing countries to improve their education and health systems, the UK's poaching of key workers from these countries is undermining all our efforts.

From VSO's point of view there is an embarrassing lack of joined-up government thinking and a desperate need for the Government to develop a clear cross-departmental position on migration. The Department of Health's proposals on international recruitment announced last month were weak and self-serving. It is not yet clear whether the Department for Education will actually maintain similarly self-interested policies.

The Prime Minister talked last week of tackling immigration abuses. VSO calls on the Government to put the needs of developing countries first when it comes to migration.

Director, International Programmes, VSO, London SW15

Mini invitation

Sir: James Ruppert's article "Happy Birthday, Mini" (24 August) gave me the distinct impression that it is not a marque he is enamoured with.

He questioned as "inappropriate", the inclusion of the BMW in the exhibition currently on show at the National Motor Museum, Beaulieu, celebrating 45 years of the Mini and implied that BMW had "gate-crashed" the party. We at Beaulieu invited BMW to lend a car for the exhibition as a comparison with the other Minis on display, allowing visitors to see the evolution of the marque to the present day.

National Motor Museum
Beaulieu, Hampshire

Rove's roots

Sir: Bruce Anderson (6 September) believes Karl Rove to be one of the greatest political choreographers of history: "Mr Rove's Germanic name is the key to his modus operandi; this man has the Prussian general staff in his DNA." However, Mr Rove is a Norwegian-American, not a German-American. It has been suggested seriously, within the Beltway, that the White House's contempt for the (now vindicated) UN Weapons Inspector Hans Blix was increased by Mr Rove's assertions about the historical duplicity of Swedes.

Church Enstone, Oxfordshire

Past pride

Sir: It occurred to me as I returned to Britain, how increasingly jingoistic this country is becoming. Travelling in France and Italy during the Olympic Games I was able to see British athletes on television, but apparently this was not reciprocated to the same degree on British television. Next year we have the 200th anniversary of the Battle of Trafalgar and the VE celebrations, both sources of national pride, but further evidence that Britain is sinking further into isolationism, jingoism and nostalgia, most of which derives from a racist streak against France.


Privilege politics

Sir: Like Matthew Hoffman (Opinion, 7 September) I have a vote in the US election. Like Matthew Hoffman I find both Bush and Kerry worrisome, and for many similar reasons. But, Matthew, I have a suggestion: let's vote Nader. He has a strong stance on Kyoto, for a start. Sure, it might seem a hopeless vote, but until people start considering alternatives, we Americans will face similar unappetising choices between two faces of privilege politics, and will continue to inflict our selection on the rest of the world.

Uppermill, Oldham

Junk targets

Sir: Since most of the mail we receive consists of junk mail I wish that Royal Mail would not be so efficient in delivering it. It really does not matter whether 90 per cent of the junk mail that I will put in the bin arrives the next day, the day after that or a week later. And the more junk mail that gets lost the better, so some targets for losing junk mail would be most welcome.

Studley, Calne