Letter: Acute need to avoid a two-tier NHS

Sir: Rodney Walker suggests that "the health service had to become 'a safety net' for the old and the weak", with strong encouragement being given to extending "private cover for non-emergency care" ("NHS 'to decline into safety net for old' ", 16 September).

I had the privilege of working in the NHS for 40 years, from its foundation in 1948, as a trainee, and later consultant, surgeon. It is fair to say that it became one of the nation's most valued services, and yet one of the most economical health schemes in the western world. Life in acute medicine and surgery is quite unpredictable in its demands on emotions, skills and time: everything depends on morale in all grades of staff, and this used to stem from a strong sense that we served a whole community, and met the needs of each patient without respect of age or position.

Acute hospitals worked as an integrated whole, taking the full range of elective and emergency work. As a junior one saw, and as a consultant one sought to teach, the delivery of a high standard of care, which depended on this daily experience in each medical team of all aspects of clinical work. How will we be able to maintain these standards of practice and training if we see in the NHS hospitals only the old and weak, and consultants spend much of their time in private hospitals operating on non-urgent conditions?

Having recently required major surgery, I am gratefully aware that very high standards of care are still available. These must be maintained, and surely this means that acute hospitals must offer a comprehensive service to their whole community.

Finance for this valued but expensive service is essential. Could a graduated insurance scheme for working people be devised that would ensure high- class NHS care for all? Surely, this is what the great majority would prefer to further development of private health schemes.

Yours sincerely,

Peter F. Jones

Emeritus Clinical Professor

of Surgery

University of Aberdeen

Aberdeen