Restructuring the NHS and reducing waste

The NHS is a top-heavy, sclerotic organisation, and remains largely unreformed. More funding will not help because it will not reach the front line until the NHS has different priorities. Professor Briggs’s concerns about clinical efficiency may be explained by the NHS’s management structure focusing on rationing rather than best practice and increasingly managing the managers and over-managing the medics.

Unfortunately, the NHS resists being restructured from outside and only a clinically led call for reform such as the Briggs initiative may have a chance of making progress.
Dr Mark Scibor-Rylski
London SW6

Sir, I belong to a small voluntary group which raises money for our local hospital. Recently we had a request for an expensive piece of equipment, for which we were quoted a price. We found that we could source this equipment considerably cheaper but, upon approaching the hospital, we were told it could not accept this, as it was on contract to get its equipment from a particular firm and had to accept that quote.
Norma Elliott
Stevenage, Herts

Sir, Though I agree with Professor Briggs’s view that the NHS needs to reduce waste rather than ask for more money, neither approach will work unless there are basic changes in the way the NHS is managed. The present structures not only cannot control waste or efficiency but, even when they have money, tend to spend it on bureaucracy.

Important decisions, from NHS England at the top through to the smallest administrative department, are being made by people without the knowledge or experience to do so. This is compounded by the inability of NHS management to listen to or respond to those who do have that required knowledge, ie, those on the shop floor, be they nurses, doctors or administrative staff.

To improve efficiency, reduce waste and improve quality, the management must be proactive in facilitating our ability to work, listen to and respond to our knowledge and experience.

Medical management should also become a profession, with mandatory membership of a professional body which oversees training, quality and licences all those who are making the crucial decisions.
J Compson
Consultant orthopaedic surgeon
London SW15

BRITISH COUNCIL
Sir, The winding up of some of the work by the British Council (report, Aug 5) makes me wonder if our government knows how to set up the support our business people need to sell our goods and services worldwide after Brexit.

I spent 25 years in international sales and marketing, mainly in Africa, the Middle East, the US and Australasia. From the early 1960s to the 1980s, I lived in Johannesburg and Cairo and commuted to the UK to find suppliers of British products required in the countries I visited. The consular staff in the British embassies worldwide enabled me to meet the possible clients of those countries I visited, be they government officials or local businessmen, through setting up meetings with suitable, vetted local buyers or agents. Part of the help I was given was achieved by the British Council who, by promoting the English language and British culture, added grease to the exporting engine, which made my job much easier.

Our Brexit team, consisting of ministers who have no experience of pre-Europe trading, talk of trade deals while cutting our local embassy support to business. Now they are going to cut the soft diplomacy of the British Council. This is not the way to support export trade. Brexit ministers can negotiate with other governments to open the door to freer trade but in the end it is the businessmen, our “boots on the ground”, who will be the ones to negotiate the deals and sign the contracts.
RF Andrews
Draycott-in-the-Clay, Staffs

UNIVERSITY LIFE
Sir, When Alistair Jarvis writes that “the shift in 2012 to £9,000 fees in England replaced income that universities used to receive directly from government funding” (letter, Aug 5), his words could mislead. The government’s intention was that fees would normally not exceed £6,000, with a £9,000 fee allowed only “in exceptional circumstances”. However, the botched implementation of the policy meant that all universities were able to raise their fees to £9,000. The intended fee increase would have kept universities’ funding more or less level, by replacing direct government funding of approximately £3,000 per undergraduate with additional fee income of almost £3,000. The actual increase boosted university income for teaching by almost 50 per cent. Sadly, universities did not respond by increasing the resources for teaching.
Professor Alasdair Smith
Vice-chancellor, University of Sussex, 1998-2007

Sir, In highlighting the potential damage to Britain’s overseas influence of a tougher immigration position towards students (“British universities are best at turning out world leaders”, Aug 5), the Higher Education Policy Institute overlooks that many of today’s world leaders studied at Britain’s leading independent schools before moving on to university, both in this country and elsewhere. Indeed, the positive effects of a British secondary education extend well beyond direct political influence into equally important spheres such as business and academia. Our private schools are a vital weapon in promoting Britain’s soft influence yet, like our universities, are increasingly under threat from countries now seen as more open and welcoming. If Britain is to maintain its international influence after Brexit, government needs to act urgently to remove both schools and universities from the student visa regulations.
Neil Roskilly
Chief executive officer, the Independent Schools Association

ETHICAL GENE EDITING
Sir, While the news of a breakthrough in germline gene editing (report, Aug 3) has created excitement and trepidation in equal measure, what we need are cool heads rather than a rush to premature celebration or judgment. As with all proposed novel techniques, gene editing must pass rigorous tests of safety, efficacy, ethics and prudence before we can utilise it in a clinical setting. We must begin a debate on these issues so that well-informed, ethically defensible decisions can be made when the time comes.

Precisely what gene editing offers (and its limitations) and how it might be used wisely requires honest, comprehensive discussion. That debate needs to be open and inclusive if what eventually emerges is to gain the support and confidence of society. In the meantime, a little space for reflection is in order.
The Rev Dr Brendan McCarthy
National adviser on medical ethics, The Church of England

THE SOUND OF MUSIC
Sir, Philip Collins is right to commend British artists for making up 17 per cent of global pop music sales (Comment, Aug 4). However, he is wrong to assert that we have the best musical talent in the world. If you want innovative music you should look to Norway, Finland, Iceland, Germany and other European countries. Britain, like the US, turns out lowest-common-denominator formulaic pop stuck in the 1980s.

The rest of Europe embraces modern, vibrant new music. You cannot imagine Jaga Jazzist, one of the most accomplished bands in the world, being British. When UK bands are playing something new, they have to travel to Europe for an audience.

Sales have never been a good measure of talent particularly where music is concerned.
Andy Cole
Cleethorpes, Lincs

BOLT ACTION
Sir, How many people had mixed emotions on Saturday evening watching Usain Bolt lose the 100m final? Sadness that, unlike Mo Farah’s triumphant run, victory was not to be his on the track, but cheered by the adulation he received from the crowd.

The difficulty for me was in trying to come to terms with how a twice-convicted drug cheat was even on the track, far less receiving a gold medal. This was the same sport that banned a whole nation from competing, no doubt including innocent athletes.

I am all for forgiveness but expect those forgiven to reform and put something back into the sport. What role models are we parading for future generations?
James Watson
Dunbar, East Lothian

THEATRE ETIQUETTE
Sir, Theatregoers beware — there is another menace besides sweet-paper rustlers, coughers, snorers, noisy yawners, plastic bottle scrunchers and those who don’t turn off their phones or who text during the play. This week as I settled down to watch Company at the Donmar Warehouse, a woman sat beside me, proceeded to take off her trainers and socks, and then put her very smelly feet on the back of the seat in front. Fortunately, the play only lasted an hour and 20 minutes.

I hope this isn’t a trend.
Roger Taylor
London W2

RAZOR’S EDGE
Sir, Georgina Gatzen (letter, Aug 4) says that “men would never dream
of enduring significant pain, injuring themselves or risking permanent disfigurement simply to make themselves more attractive to women”. Does that mean I can now stop shaving daily with a razor with the significant risk of pain, injury and even disfigurement, and grow the beard that my wife abhors?
Ian Cherry
Preston, Lancs

MINCING WORDS
Sir, Further to your correspondence about bogus occupations (Aug 4 and 5), I had a friend at school who said his father was in meat packaging. It was only years later I discovered that in fact his father sold underwear.
Jonathan Winegarten
London NW2