The NHS is broken, but not yet critical | Letters

I have recently retired after more than 30 years of NHS service. The NHS is indeed broken (Editorial, 3 March), but it’s not quite in critical care, and there are signs that Wes Streeting is addressing some of the problems, including the use of the “private sector”. While this may sit comfortably with parts of the Labour party and patient groups, it’s important to understand three things about the use of the private sector. First, it’s NHS staff who perform the surgery, second, the private sector is paid the same price per procedure as an NHS trust and, finally, using the private sector creates additional capacity in the NHS.

There are a number of things that Mr Streeting should look at to expedite his plans. He should address the payment system, as payment by results needs an urgent overhaul. It’s fine for low-cost, high-volume activity (like that undertaken in the private sector) but needs drastic reform for urgent and more complex care. He should also reform the consultant contract – for example, ensuring that consultants have to work a number of years as an NHS consultant before they can work privately. Next, move community services back to general practice. GPs can’t prevent people going into hospital if they have no support in the community to look after people. Finally, GPs (and employers) must be more proactive with the public and staff about the importance of being active.
Malcolm Cunningham
Sale, Cheshire

With all the discussions about the need for a revolution in healthcare needed to save the NHS, there has been little talk about the changes needed in working practices, particularly those of doctors. The working week of a doctor has changed little since I qualified in 1975, apart from trust-mandated training and governance. It is still based around ward rounds, outpatient clinics and operating days.

The NHS needs to use its workforce more wisely. A return to a Skills for Health approach this time, with the involvement of the doctors, would be an easy win. Why do certain specialties such as old-age medicine, paediatrics, dermatology and neurology still mainly exist in the acute sector? Why are there more physio and speech and language therapists in hospitals than the community?

Acute hospital care is precisely that and mainly involves emergency, acute and intensive care medicine. Other specialties can be sited in the community (as in a lot of European nations) and brought in as needed. Changes in working practices can drive the changes that Mr Streeting wants to see.
Chris Clough
Retired neurologist and former medical director of the Royal College of Physicians, Whitstable, Kent