Sick of NHS reforms

So-called "privatisation" is no longer the big issue. Nor is payment by results, practice-based commissioning, or choose and book - all done deals, though not quite up and running. The new agenda is more radical: the atomisation of all UK healthcare provision (Comment, June 27).

Patricia Hewitt revealed how she will achieve this by encouraging "instability", and by creating a "proper counterweight to the power of hospitals", which she clearly sees as a continuing threat to "modernisation". The variety of tools is breathtaking. The hospital and general practice PFI programme stutters on; elective care is moving to independent sector treatment centres; chronic disease to incentivised primary care; acutely ill patients will be kept out of hospital A&E departments with home treatment by paramedics; primary care trusts are being "reviewed"; medical education will soon move from the royal colleges to a new board; and a white paper on "health outside hospitals" is due next year.

Hospitals have changed remarkably and mostly for the better, in the past five years; but success seems not an op tion. Will we be the first western country to see the demise of the general hospital?
Dr David Levy
London

Jacky Davis's attack on independent sector treatment centres fails to recognise the benefits a range of providers can bring to our health service. ISTCs enable healthcare trusts to focus on specific areas and develop specialisations. They also improve quality and efficiency. It is unfair to accuse ISTCs of "mopping up" easy cases, as it is the government that decides the procedures they are to perform and stipulates all terms and conditions such as whether or not they are required to teach and train. What is really important is the contribution ISTCs are making. Early evidence from the Department of Health shows ISTCs have led to a five to eight-fold increase in the number of operations in areas such as cataract surgery.
John Tizard
Director, public services, CBI

The latest NHS financial report sadly reflects the way performance is measured and managed in the public sector. We see again how easily num bers can mislead. Many NHS bosses will now be in crisis mode, trying to claw back the so-called losses and probably doing more harm than good.

It's a paradox because it's the overspenders who will be threatened, not the underspenders, who perhaps didn't achieve as much as planned. In this form of performance management, the problem is in forecasting accuracy - not necessarily in the way the NHS is run. Hence, an efficient hospital could be castigated because the managers were unable to make accurate forecasts. Look more carefully at the report for operational definitions and you will find the definition of "significant over- and underspending" is 0.5% of total income. Not many private sector companies achieve such accuracy without serious manipulation of the data.

Managers have three choices: cheat the system, cheat the data or improve the system. Only the third option works in the long term, yet we will probably see more of the first two.
Dr Mark Wilcox
Huddersfield, W Yorks

The government is launching yet another fatuous "conversation" (Report , June 23). There is nothing more disem-powering a focus group that raises hopes, only for them dashed to be when unpopular changes are made. The Department of Health will then claim decisions are made by the NHS locally. This is true for cottage hospitals, where local people are consulted before hospitals are closed, but have little real influence over the decisions. If the millions being spent on these consultations were spent on community hospitals or more GPs then perhaps people would see some real improvements.
Steve Webb MP
Lib Dem health spokesman