IT WAS unfortunate that Simon Jenkins assumed that Rotherham hospital was representative of the NHS as a whole: many hospitals instituted the type of change advocated by Gerry Robinson some time ago (Brown can’t cure this paralysed NHS, so he plans to privatise it, Comment, last week). A shame too that he chose not to point out that when Robinson’s intervention resulted in an increase in patient throughput, the commissioning primary care trusts (PCTs) didn’t have the money to pay for the extra work. This is happening across the country, with clinical teams made to rein in their activity until the new financial year.

In blaming consultant greed for the financial plight of the NHS, Jenkins falls prey to the London-centric view of consultants as arrogant upper-class wastrels, bleeding the NHS dry from their Harley Street chambers. In fact, half of consultants do no private practice. Alan Milburn’s new consultant contract, “imposing” a 40-hour basic week on a workforce that was already putting in an average of 48 and being paid for 37, was always going to be expensive.

Jenkins was right about the private finance initiative (PFI) scandal, though, and money is also being thrown away by forcing PCTs to commission services they do not want or need from private providers.

Dr Bob Bury
Consultant in radiology
Leeds General Infirmary

MARKET FORCES: As the Boswell of Thatcherism Jenkins should know where the blame for the chaos in the NHS should be laid. It was Mrs Thatcher’s failure to follow her instincts and privatise the NHS which led to the creation of the internal market, and all the subsequent disasters have followed from there.

After 25 years as a GP I feel free healthcare is great in theory, but in practice means that about 10% roundly abuse the service to the detriment of everyone else. That is certainly the reason why our out-of-hours service, once one of the best in the world, has become vestigial. It is also the reason why we are so reticent about extending opening hours. My experience of Saturday morning and late evening opening (long before the new contract) was that it provided still more opportunity for the 10% to clog up the system.

The question which needs to be addressed is “free healthcare”.

Dr Chris Nancollas
Yorkley, Gloucestershire

MEDICAL SURPLUS: Jenkins mentions the power of medical consultants and “a reported surplus of 3,200 expensively trained NHS consultants by 2010”. Perhaps someone has realised that the best way to reduce the power of consultants is to arrange a surplus. Might there be an “intelligent designer” in Whitehall after all?

Richard Hall
by e-mail