Cutting the NHS staff bill (Report, 13 November) ignores a truth that successive health ministers prefer not to tell. Compared to the other 20 main developed nations, the UK is joint bottom of the league table on GDP health expenditure. Over past 30 years only Ireland, Japan and Spain have on average spent as little. All developed nations face the same demographic pressures, but most spend proportionately more on health than we do. If the public understood that we get our NHS relatively cheaply, most would accept 2p on income tax. In terms of reducing adult deaths and money spent, the evidence is that the NHS is one of the most effective and efficient services in the world. We can’t go on demanding more from a frontline staff facing continued pay restraint without providing more resources across the system.
Professor Colin Pritchard
University of Bournemouth
• I am a consultant health economist and recently found myself working on the better care fund for a clinical commissioning group. I was not remotely surprised by the National Audit Office assessment (£1bn NHS savings plan is unrealistic, 11 November). The savings associated with different components of the scheme were simply being made up. This is a part of a culture in the NHS where it is acceptable to tell NHS England you are going to make savings, even though you do not expect to do so. Challenging the evidence is too much like negative thinking, while going along with the game at least buys time for the NHS. But there was no clear evidence to support the figures I saw. In one case, there might have been some savings to the NHS, but not to the public sector. Part of a hospital was to be redesignated as a residential building so long-term patients would be able to live on housing benefit and other social security payments.
Peter West
London
• The Quality Care Commission’s findings on Colchester hospital (Report, 15 November) are very worrying, but we should also put some of the spotlight on the North East Essex clinical commissioning group. This is the group of GPs set up to commission care for their patients. Surely the CCG which set up multimillion-pound contracts with the Colchester hospital has a responsibility to monitor those contracts and the quality of care? A good indication maybe that the Governments expensive NHS reforms are not working.
Peter John Boileau
Birmingham
