Sir, Your report (“Surgery delayed to save money”, Dec 3) will come as no surprise to those working in the NHS.

At least one hospital in Hertfordshire is now booking referrals to consultants in the oral surgery department for nine months ahead, compared with three months earlier in the year. Many of these patients require urgent treatment and suffer from recurrent episodes of severe swelling and infection.

The situation you describe is undoubtedly widespread, with all the sordid associated “tricks” to delay appointments we have become familiar with.

The Department of Health’s disingenuous response that “this is an operational issue for the local NHS” is typical of new Labour. Gordon Brown trumpets how much money he is giving to the NHS, but when the money runs out halfway through the financial year, the Government will accept no responsibility.

Perhaps it would be of more benefit to the country if Tony Blair used the proportion of the EU rebate he is so anxious to give away to support the failing public services in this country — rather than to extending the Metro in Warsaw and to repairing the sewers in Budapest.

DAVID ROITH
Dental surgeon
London NW11

Sir, If the NHS wants to save money let it start with the food that it serves in hospitals. Last January I was admitted to a three-star foundation hospital with a chest infection. On Day 1, lunch was meat pie with soggy pastry, powdered potato and bullet peas. Pudding was pink mousse in a plastic pot with fake cream. On Day 2 it was dried-up Chinese, followed by pink plastic pudding. On Day 3 we had fish, but it was hard and dry as cardboard. Pink pudding again.

Sick patients need the simplest of nourishing meals to aid recovery. A bowl of fresh soup — tasty and so quick and easy to prepare in ward kitchens; a roll and butter followed by fresh fruit — rarer than hens’ teeth in hospitals — would have been enjoyed by all of us.

Most of the food on my ward was untouched and returned to the trolley to be thrown away. I lost 4kg in seven days and others in the ward looked equally frail by the time I escaped.

GILLIAN SHEPHEARD
Royston, Herts

Sir, Another reason for falling productivity is the demand on clinicians to reduce the uncertainty inherent in medicine by earlier and more accurate diagnosis. For example, a problem that could probably have been sorted with a simple X-ray now gets a scan “just in case”. A GP faced with an indeterminate symptom will refer rather than wait and see and risk criticism. Specialists may cross-refer even a simple problem outside their immediate field. Patients get more treatment (or at least more investigations) but more patients do not necessarily get treated.

Whether or not this is a good thing is difficult to say, as the cost-benefit analysis is complex, but it is certainly expensive.

JOHN COOKSON
York

Sir, If we want a situation in which membership of the NHS is compulsory, we had better also make it compulsory for the NHS to treat us in accordance with defined obligations. If it is optional for the NHS to treat us, we should make it optional for us to fund it. This is not public health care insurance, it is insurance fraud.

PETER BERRIE
Hickling, Norfolk

Sir, NHS managers know from experience that the way to get funded is by “shroud-waving” — running out of money, then getting doctors to say that patients’ lives are at stake.

We organise health services in such a way that it pays them to run out of money. Is it surprising that they do it?

NIGEL HOWARD
Brighton

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