Letter: What the health service can afford

Sir: The Secretary of State for Health is seeking to reshape the NHS and to break down the barriers between health and social care ("Quick surgery to save the bleeding NHS", 26 June). He needs now to face up to the real costs of care in the community, something that successive ministers in the past have failed to do. It is not a cheap option.

The British Medical Association believes that services could be improved with fewer hospitals, and Mr Dobson evidently agrees. Many of the small local hospitals have already been closed, and there is now no halfway stage between occupying an expensive bed in a large hospital and being discharged home.

To care for an elderly widow with `flu in an NHS hospital at a notional cost of pounds 1,000 a week is clearly wasteful and inefficient; but Mr Dobson's belief that she could be equally well cared for at home for a notional cost of pounds 50 a week assumes the existence of a willing, and unpaid, carer to provide the 24-hour care she will require. Mr Dobson should look at the cost-effectiveness of reopening small local hospitals: the elderly widow would almost certainly be better cared for in one of them - and it might well cost less than the true cost of keeping her at home.

ANGELA CRUM EWING

Reading, Berkshire