The King’s Fund’s pronouncement on the “damaging” Tory NHS reforms (Report, 6 February) is illuminating in laying bare the waste reaped by the biggest top-down restructuring in the NHS’s history, but obfuscatory in its insistence on separating that reorganisation from privatisation. The reforms were introduced precisely to bolster competition in the NHS. This is not the cuddly, provider-blind competition between NHS providers, “the independent sector” and voluntary-sector providers, but a slow and determined march toward profit-making privatisation, with all the implications that brings for the pay and working conditions of staff. The talk of a Hunt phase two, with a renewed push towards integration, is also misleading since competition will still trump integration. The privatisation train may be slow in getting out of the station, but with the facilitating framework in place, it will gather pace. Could this perhaps a case of praising with faint damnation?
Jason Glynos University of Essex, Ewen Speed University of Essex, Karen West Aston University
• The King’s Fund is right about the damage done. As an NHS trust governor I am appalled at the byzantine complexity of the NHS in England. We have a plethora of bureaucracies which have to be paid for out of public funds: clinical commissioning groups, local commissioning sub groups, hospital trusts, ambulance trusts, community health trusts, NHS England (national and local), health and wellbeing boards, Monitor, the Care Quality Commission, the Department of Health, Health Education England, Public Health England, PFI contractors, private healthcare contractors and external consultancy firms. All drain money that ought to be spent directly on patient care. Under the NHS in Scotland, there is one local health authority for each region of the country that organises and provides health services in its area. However, I suppose it is too much to expect the current ideologically driven Tory administration to be willing to adopt the common sense approach to the NHS as implemented in Scotland.
Ian Arnott
Peterborough, Cambridgeshire
