Letters: Future of the NHS

Tuesday 14 December 2010 01:00

NHS shake-up will not work

Your editorial (7 December) and article from Andreas Whittam Smith (9 December) do well to highlight the "madness" of Andrew Lansley's proposed NHS reorganisation.

The current system has serious problems – encouraging destructive conflict between primary care trusts and providers and incurring major expense in administering the artificial market. However the concept that GP consortia should make the purchasing decisions is fundamentally flawed. None but a tiny minority of GPs have the knowledge, skills or interest to be effective in either evaluating and balancing the provision of a whole health service or implementing major service change.

GP consortia purchasing health care for populations of about 50,000 are doomed to failure as evidenced by the history of PCTs, which rapidly amalgamated to purchase for populations of 300,000 or greater.

Much is made of patients' choice but of greater importance are disparities in the availability of treatments ("post-code provision") and when small GP consortia make parochial decisions, these will inevitably increase.

All doctors could justify doubling what is spent on their patients. Controlling these ambitions, so as to achieve a health provision that is equitable and affordable, is a challenge requiring the combined skills of GPs, hospital consultants, public health doctors, managers, directors of finance and others.

The current plan sets general practitioners and consultants in a position of destructive competition.

Dr D H Cove

Consultant physician


We wish to add our voices to the groundswell of concern about the scale and pace of the changes to the NHS proposed by Mr Lansley. It has recently been reported that thousands of GPs are applying to begin extensive commissioning as "pathfinders" prior to the planned 2013 start nationwide. It is wrong to deduce from this that GPs welcome the proposed changes.

We work within an established GP commissioning group which has been working closely with the primary care trust, local hospital, community services, local council and public health for years to find ways to improve efficiency. Building relationships, designing pathways that work, and changing established referral patterns by GPs all take time.

In London primary care trusts have already been destroyed, with 50 per cent cuts to their management budgets from April 2011, extensive redundancies, and forced mergers with neighbouring trusts. If we did not apply for the extra funding offered by pathfinding, we would lose our local health management, and GPs cannot do the work of professional managers as well as our clinical work.

We support the intention to let GPs develop pathways of care for our populations, but this can be done within the current structures. It is not necessary to restructure the whole NHS to achieve the stated aims of the White Paper. Such restructuring will waste money and increase risk as services fragment.

We hope that when the legislation is finally presented it will have amended many of the original proposals in the White Paper in response to widespread concerns.

Dr Pamela Martin

Dr Brian Fisher

London SE14

Children who defy teaching

It is worrying that Britain's performance in education is falling relative to that of other countries, ("British schools slump in global league table", 8 December).

Look at those countries that come highest in the table. In their schools, lessons are more formal and regimented but discipline is excellent. In Britain, we are reluctant to talk about an "underclass" but we have a stratum of society in which income (wage or benefit) is low and the upbringing of children chaotic. These children are doomed from the moment they walk into school if not, indeed, from the moment that they are born.

The report suggests that the level of achievement in English and maths of the bottom 20 per cent is sufficiently low as to limit their chances of gaining employment. This is not strictly true. I have taught many pupils of very limited ability who have good personal qualities, have drawn fulsome praise whilst on work experience and have gone on to find employment. When, however, limited ability is allied with a truculent laziness and aggressive "yobbishness", then their employment prospects are bleak.

The Government has little doubt where the fault for educational failure lies. Ofsted inspections are based on the principle that any child, no matter how wild, will respond with enthusiasm if only the quality of the teaching is good enough. We need to end this fiction and tackle the problem of the "underclass" in a determined manner. If we can succeed in this then improved educational performance will be just one of the benefits that society will reap.

Stephen Shaw


American scores on an international test of reading (the PISA) show exactly the same thing that UK scores show: children of poverty don't read very well. American students in schools with few children of poverty scored near the top of the world, those in schools with mostly high-poverty children scored near the bottom of all countries tested.

Similar to the UK results, our research also shows that middle-class English language learners often do better on reading tests than children of poverty who speak English as a first language.

The research tells us why: studies done world-wide show that high poverty means less access to books at home, in school and in the community. This results in less reading, and less reading means lower performance on reading tests.

A necessary part of the solution: more support for libraries and librarians in high-poverty areas.

Stephen Krashen

Professor Emeritus, Rossier School of Education,

University of Southern California, Los Angeles

Dr David Lambert's view (letter, 10 December) that the success of the Chinese education system is based on the concentration of its teaching time on the communication and the production of knowledge, explains why they are so high in global league tables.

The fact that he did not observe any scrutinising of knowledge, explains why they tend to do badly in creative subjects. These, of course, are harder to quantify and hence not included in global league tables.

Kartar Uppal

West Bromwich, West Midlands

I can't see why anyone is surprised that the standard of UK education has dropped to 25th, below countries such as Belgium, Poland and Estonia. Young shop staff can't add up the cost of a few items without using the till calculator and anyone who reads internet forums can see that most contributors are illiterate. We need better teachers and smaller classes.

Peter Bergman

Altrincham, Cheshire

Stop knocking estate agents

It is time the practice of vilifying estate agents is stopped ("Trust me, I'm an estate agent", 10 December).

I have a small accountancy practice and have estate agents among my clients with whom I have worked very closely for years. They are professional, exceedingly hard-working, and certainly do not engage in the practices you describe. The fees charged reflect the costs of running offices and websites, and definitely do not create abnormal profits.

From the professional point of view, they are members of the National Association of Estate Agents, who as you say are introducing a licensing system. However, significantly omitted from your article is the fact that every licensed office (every individual office, not the firm) must be staffed by at least one fully qualified and full member of the NAEA. No such individual is going to jeopardise their career and livelihood by misdescribing properties in the way you describe.

Adrian G Charlton

Eglwyswrw, Pembrokeshire

Your entertaining study, "Trust me, I'm an estate agent" pays proper tribute to imaginative agencies seeking to improve on stereotypical advertising.

Tribute should be paid to the late and great Roy Brooks, who in the Sixties startled the market – and potential buyers, let alone sellers – with his deliciously frank and witty descriptions of properties for sale.

Typical was this gem: "Darkest Pimlico. Seedy FAMILY HOUSE two rooms in the basement, ground, 1st & 2nd floors and attic rm. on 3rd. Decor! peeling, faded and flyblown. If you are too late to secure this gem, we have a spare along the road rather more derelict. A lightly built member of our staff negotiated the basement stair, but our Mr Halstead went crashing through."

Murray Hedgcock

London SW14

In limbo, waiting for CRB checks

I write after reading Peter Day's letter "Giant backlog of CRB checks" (29 November). I am currently waiting for Criminal Records Bureau clearance and have been for about two and a half months.

I cannot work as a supply teacher without clearance (and rightly so), so was forced to claim Job Seeker's Allowance. I have no idea when I will be given clearance by the CRB. I have therefore been unable to say to potential employers how long I will be available to work for them. That being the case, there are few employers interested in taking me on, so I have been claiming benefits for over two months. Obviously, I haven't been paying income tax either.

Although this is not a massive amount of money in the eyes of the Government, I am clearly not the only one in this position. I do not need to stress the situation with the Government's balance sheet, but almost £800 a month (JSA and income tax) from me alone wouldn't hurt.

Capita registrars administer the CRB clearance process. Capita have an agreement with the Metropolitan Police that their checks will take no more than 60 days. I appreciate the police are busy, but 60 days to perform a simple administrative task is a bit excessive. No one seems to realise that money is being wasted and people's lives are very seriously affected by such an inefficient system.

Tom Clarke

London N20

The BBC needs all its friends

David Johnstone's letter (10 December), among others, regarding the alleged dumbing down of Radio 3 is concerning, not least because the BBC is viewed as a target by many in the present government who would happily reduce its national influence.

The remit of the BBC is to educate and entertain, and Radio 3 and Radio 4 have consistently done this for me in a vast array of programmes: campanology throughout Europe; the effectiveness of the Police Complaints Commission; insects who lay their eggs behind the ears of frogs; how Stravinsky composed The Rite of Spring. The list is endless. Of course there are irritants, but they are insignificant compared to the good. There are many people who enjoy what I dislike.

The BBC radio service, and much of the television, is irreplaceable. It needs our support for it has been and still is the institution of which our country can be really proud.

Fran Plumb

South Molton, Devon

Australia foundering

I am sure that I am not the only person to be concerned at your headline "Australians in panic mode as they take a punt on untested Beer" (11 December). While like most civilised people I have little love for the convicts in our Antipodean plantations, this seems like cruel and unusual punishment.

As a graduate of Oxford and resident of Cambridge I have some experience of punting and would never dream of taking a punt on beer before I had thoroughly tested the beer for taste, alcoholic content and presence of box jellyfish, sharks, crocodiles etc. That our Australian cousins are prepared to do so without even determining whether the beer is Carlings or Fosters indeed demonstrates a degree of panic that is alarming.

Rather than indulge in this incredibly risky venture, would it not be better for the cricketing authorities of our Antipodean plantations to admit that they are being thrashed by a far better team and concede the remaining Test matches?

Peter Croft


Equally feared

I have always appreciated The Independent's commitment to exposing discrimination in the workplace, and challenging gender stereotyping. What a pity, then, to find the glass ceiling shimmering away in your offices: "Many workers do not want their boss at the Christmas party, fearing his presence will spoil the fun," and "they might not be able to resist telling the boss exactly what they think of him" (Briefing, 11 December). Or is it just that everyone likes female bosses?

The Rev Sharon Grenham-Toze

Wilstead, Bedfordshire

Perspectives on rioting

They take no notice of peaceful protest

A common reaction to political violence such as the recent student riots is that this kind of thing is not necessary in a democracy, where change can be effected by the ballot box.

However, people voted for a party which gave a cast-iron guarantee not to do something which, when elected, it immediately proceeded to do. This makes a mockery of the ballot box and leaves politically motivated people with little option but to demonstrate.

Experience has shown that peaceful demonstrations are largely ignored by the media and are entirely ignored by those in power (for example the 2 million-strong Iraq war demonstration in 2003). It took a riot to get rid of the poll tax; nothing but rioting will make the political class pay attention and put a stop to these unnecessary cuts.

Patrick Browne


At last, revolting students are back

Andy Martin's report of his experiences at Cambridge ("My students have had a political awakening", 6 December) heartens me: at last, students are revolting again. We who were students in the 1960s we were always revolting about something: we had CND and the anti-apartheid movement to start with; and, yes, even in those days, plans to means-test student grants. We had sit-ins and marches; nights spent discussing burning issues of the day (as we saw them); we had protest songs and music. And all peaceably on the whole.

All that disappeared in the late 1970s and 1980s when the prevalent "me first" attitude meant students seemed more concerned with getting the degree that would enhance their earning power in the City.

It is perhaps a pity that what has driven them to revolt is an attack on their own status, but maybe now they've understood that their voices can be heard, we'll hear more student opinions and see more action on world affairs – climate, poverty, wars.

Chris Bratt

Arnside, Cumbria

Police violence puts democracy in peril

If democracy is not to be damaged irretrievably after the events during the student protest march, then a balanced view from our politicians is essential.

While I have every sympathy with the fear felt by the royal couple when their car was attacked, I was equally appalled by the sight of policemen and women swinging their batons, bludgeoning students, some of whom were possibly trying to get out of the way. There is no excuse whatever to strike anyone around the face or head. I do not condone that action by either the police or protesters.

I was nauseated by the pompous outpourings of the Prime Minister who offered whole-hearted praise for the actions of the police, but said nothing of the student undergoing brain surgery.

Democracy is damaged if citizens are afraid to protest lawfully because they fear for their safety from a police force which is meant to protect our rights, not use disproportionate violence to maintain peace.

Anne Macallum

Milton Keynes

An insult to our treasured symbol

A scruffy-looking youth was photographed swinging from a piece of cloth in central London. Nobody got hurt and no damage was done. A non-event.

But because the piece of cloth was the Union Flag, and because it was attached to the Cenotaph, all of a sudden the mindless mass media are behaving in exactly the same way that the Muslim press reacted to the Danish cartoons depicting their prophet. They all go mad and call for the immediate reintroduction of capital punishment.

This is disappointing. Are our treasured symbols so fragile that they are threatened by a lone youth? And what does that say about our maturity? A truly civilised people would have tutted, raised their collective eyebrows, muttered a well-deserved "Prat" at the youth and got on with their lives. We still have some way to go.

Paul Harper

London E15

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