How to cure what ails the NHS

Wrong cure

Sir: In referring to the UK as the highest-spending European nation in healthcare proportionate to GDP (‘Hospital pass’, 4 December), Kate Andrews paints an exaggerated picture which is based upon additional expenditure in the NHS during the Covid pandemic, partly accounted for by £38 billion spent on test and trace. The figures are further inflated by the UK suffering a relatively greater fall in GDP.

In reality, the NHS has been woefully under-resourced compared to its European counterparts over the past decade, leaving it with approximately 50,000 fewer doctors compared to OECD averages, the second-lowest numbers of hospital beds per capita, and the lowest numbers of MRI scanners.

Given the scale of this deficit in workforce and infrastructure, it is not surprising that the NHS has struggled with access and delays in treatment. It also resulted in the UK having to cease routine services throughout the pandemic’s first wave, to create capacity for the Covid surge, which itself has led to the current record backlog of 5.8 million patients waiting for treatment.

Ms Andrews is therefore correct in observing that the NHS is failing. But the flaw is in thinking that the cure requires a new system akin to other European nations. What the NHS needs are the numbers of doctors, nurses, beds and equipment, and the level of community facilities that are taken for granted in comparator nations.

Planning and investing to achieve this will enable the NHS not only to provide access and health outcomes at least equivalent to those of our European neighbours, but also to protect against the higher transactional costs inherent in systems characterised by high levels of privatisation and competition.

Dr Chaand Nagpaul

Chair of the British Medical Association

London WC1

In practice

Sir: Kate Andrews’s critique of the NHS makes two claims about general practice that I would query. Firstly, she says that GPs are refusing to see patients in person. Yet of the 34 million patient consultations made in general practice in October — the second-highest on record — almost two-thirds were conducted in person. Face-to-face consulting will always be an essential part of general practice, but good, safe and appropriate care can be, and is being, delivered remotely.

She also claims that patients attend A&E because they can’t see a GP in person. We know of no hard evidence to support this. In fact, the vast majority of patient contacts in the NHS are carried out by GPs and our teams, alleviating pressures elsewhere in the health service, including emergency departments.

Dr Gary Howsam

All ye faithful

Sir: As a Church of England parish priest in the heart of London’s East End, I am thankful for the many positive contributions my Muslim brothers and sisters are making to faith, culture and community here, as described by Tanjil Rashid (‘Common prayer’, 11 December). I see the presence of mosques here — whether purpose-built or located in what were previously shops or churches — as an enrichment of our common life. Tower Hamlets was the first Muslim-majority borough in the country and is therefore a continual target for far-right groups who want to ‘reclaim’ us either for Britain or Christianity. When extremist thugs protested outside the East London Mosque holding large white crosses and demanding the closure of mosques, I declared that they were undermining my Christian mission here and that these mosques are our mosques, part of the whole communal life of the area. It is my Christian duty to defend them, as I know my friends at the East London Mosque would do for me if the situation were reversed.

However, I am not quite ready to turn the lights off in my church and hand over the keys. Rashid is right about an overall decline in church attendance and about churches being turned into desirable flats. Too many churches were built here after the Napoleonic Wars and they have been closing and merging since 1850. People no longer think they have to be in church as a sign of conformity or status. Together with my Muslim friends, and those of other faiths, this is a time of great opportunity to show the value of our faiths in serving the communities amongst whom we live.

The Revd Alan Green

Rector of St John on Bethnal Green and Chair, Tower Hamlets Inter Faith Forum

London E2

Wisdom from excess

Sir: In ‘Excess baggage’ (4 December) Cosmo Landesman does David Hockney a disservice in denying his drinking and smoking a moral dimension. Hockney would be intimately familiar with the work of another great English artist, William Blake, who famously rationalised his own questionable lifestyle choices with the claim, in The Marriage of Heaven and Hell, that ‘The roads of excess lead to the palace of wisdom’. Some might say that quite a lot of Hockney’s Californian work was inspired by another Blake aphorism; ‘The lust of the goat is the bounty of god.’ Respect.

Simon Collins

Sydney, Australia

Gladstone tidings

Sir: Boris Johnson’s colleagues will no doubt be spending Christmas exchanging WhatsApp messages complaining about his latest misjudgments (Leading article, 11 December). In the 19th century, politicians sat beneath the holly in their grand country homes moaning to each other in long letters. On Christmas Day 1885, Gladstone was the subject of much abuse after suddenly expressing support for Irish Home Rule without consulting his Liberal colleagues. At Knowsley in Lancashire, Lord Derby devoted many pages to denouncing a policy that ‘could not be given effect to without splitting the party’. At Chatsworth, Lord Hartington was no less long-winded in condemning Gladstone for ‘putting us all in a position of the greatest difficulty’. In Oxfordshire, Sir William Harcourt had two letters on this theme in his Christmas Day post; ‘really Gladstone’s behaviour is becoming intolerable’, he told his son. But there were no chatty rats among the underlings telling the press about their masters’ recriminations. In the Christmas Day entry in his diary, Gladstone’s private secretary, Edward Hamilton, noted blandly: ‘Xmas cards are becoming a frightful tax on the Post Office authorities. The custom has grown with surprising rapidity.’

Alistair Lexden

House of Lords, London SW1

Last word on the Beatles

Sir: James Delingpole stated that Let It Be was the Beatles’ last studio album and that it demonstrates that they had nothing left to say (Arts, 4 December). Let It Be was their final album to be released, but the last recorded was in fact Abbey Road, which contains some of their finest material.

Jean-Marc Evans

London N12

Power grab

Sir: Martin Vander Weyer’s source tells him that hydrogen is ‘the nirvana of the energy scene’ (Any other business, 4 December) because it has the potential to power trucks, buses, ships and planes that are unlikely to convert to electricity. Martin’s source is correct, but it is only half the story. Hydrogen, as a zero-carbon fuel of the future, needs to be harnessed by a technology that delivers the right amount of power, torque and acceleration where it’s needed.

This cutting-edge technology already exists — it’s the internal combustion engine (ICE). The humble ICE has been much maligned in recent years, wrongly blamed for crimes against our climate, when the real culprit is fossil fuels. However, the ICE is making a welcome comeback to centre stage, with hydrogen in the combustion chamber and only steam emitted from the exhaust system.

JCB’s all-new hydrogen motors are now in prototype JCB diggers and loaders that will eventually be in production and with construction industry customers by the end of 2022. I have long argued that batteries are not the solution for every industry sector. Cars may have succumbed to an all-electric future, although Toyota is bucking the trend by offering hydrogen-powered vehicles as well as electric vehicles.

My son, Jo, runs a bus manufacturing business in Northern Ireland. Known as Wrightbus, it makes buses that run on batteries and hydrogen fuel cells. The latter work well on buses, but fuel cells don’t really make sense on large heavy machinery. The internal combustion engine is a better solution. Let’s raise a glass over Christmas to spark plugs, pistons and hydrogen, the nirvana fuel.

Lord Bamford

Chairman, JCB
Rocester, Staffs

Blight on Blyton

Sir: In Sam Leith’s review of Andrew Maunder’s new book on Enid Blyton (Books, 4 December), he suggests that ‘Blyton wasn’t original, but originality was hardly the point’. I beg to differ. Blyton did not consciously write her books; what she called her ‘undermind’ did. This is most unusual. She could write a full-size book in a week; all she had to do was keep up with the stream of words and images that her subconscious came up with. In this she succeeded so well that at the end of the week the book really was finished, bar the odd typo; no structural changes or plot tweaks needed; no boring areas needing revision. Just a flow of action that delights any open mind that comes across it, adult or child.

It’s no good taking side-swipes at Noddy and the short stories featuring elves written for younger children. At the centre of Blyton’s oeuvre is the Mystery series. Fifteen books about a group of teenage Find-Outers based in Peterswood, a fictionalised Bourne End in Buckinghamshire, where Blyton raised her two girls, which draw on her multilayered memories and love/hate feelings for the village. ‘Fatty’ and his fellow Find-Outers run rings round its plodding policeman and put smiles on the faces of anyone who encounters them. The Mystery of the Burnt Cottage slaughters Blyton’s first husband, subtext. The Mystery of the Missing Necklace, with its bonkers but logically consistent plot, suggests that the most important thing in life is to be able to successfully disguise yourself as a tramp. Fatty’s powers of scathing mimicry, spontaneous poetry, benign leadership and flashing wit echo Enid’s own. Yet all contemporary critics seem able to do is object to his name.

Duncan McLaren

Blairgowrie, Perthshire

Cream of the crop

Sir: With reference to Hannah Tomes’s piece on Baileys (‘Notes On…’, 4 December), I thought I would add that the original inspiration for Baileys came from my experience a decade earlier in helping to transform Irish butter from an anonymous commodity into a brand: Kerrygold. Since 1974 I have engaged in several other cream ventures, most notably Sheridan’s (coffee and cream) and Coole Swan, the sophisticated face of cream liqueurs. All these stories can be found in my book That S*it Will Never Sell!, the title of which was based on the comment of an American pundit when he first saw and tasted Baileys.

David Gluckman

London SE9