Letter: NHS staff driven to despair

NHS staff driven to despair

Sir: In her predictive review of a Labour-governed 1997 (30 December) Polly Toynbee restates your editorial theme that the post-1990 NHS structure "actually works well" and will be left unchanged. Certainly few hospital clinicians would press for major organisational upheaval but even fewer would tolerate the loathsome hypocrisy of the internal market for another five years.

The reality of hospital funding through individual GP transactions and short-term health authority contracts is a two-tier, stop-go service where clinical need is subverted by financial caprice and public accountability is replaced by self-serving propaganda from managers and quangocrats.

Hospital staff around the country are battle-weary from protecting patient services from the sham of the market. Unless this is replaced by a long- term commissioning system for secondary health care, increasing numbers of doctors, nurses and paramedicals will retreat disillusioned into retirement or private practice. Health care in the UK will be in danger of following the US example of escalating costs and inconsistent standards.

MALCOLM SIMMS FRCS

Consultant Surgeon

Birmingham