Burglars, surgical practice and others

Victims of crime are not so relaxed about tackling burglars

Sir: I am dismayed at your cursory leader (6 November) on reform of the law on householders and burglars.

I could go on about the total lack of protection provided by a dysfunctional police force. I could ask what "reasonable force" means to a befuddled middle-aged person woken up by the sound of intruders in the middle of the night. I suppose you would suggest they call out into the darkness: "I say chaps, sorry to bother you, but have you got baseball bats, knives or guns? I need to know so I can make arrangements to defend myself in an appropriately legal fashion. And can you hold on please, because I'm not as quick on my feet as I was."

I won't. What I would like to know, however, is whether you would have written that leader if, like me, you had suffered two burglaries, and your daughter at University had been attacked at knifepoint in her own bedroom by intruders desperate for a few pounds for a fix. Most of us have been the victims of crime or violence. You speak dismissively of the fear of crime as if it were a perfectly normal and acceptable state of mind. It is not, and your response is unthinking and reprehensible.

ROD HEATHCOTE
Tunbridge Wells, Kent

Sir: It's good to see from the statement by David Davis that the Conservatives really are moving towards being a Party of the People. Time was when you had to be an extremely wealthy criminal to be a Conservative but the announcement of the householder's right to kill gives golden opportunities to lesser beings such as the common burglar.

It's ironic that the punters believe this change in law would benefit them; clearly they haven't thought through the position from the burglar's viewpoint. To defend oneself from being killed is a basic human right, so a gun becomes a defensive weapon, rather than an offensive one - an absolutely essential tool of the trade; and if a householder gets shot as he comes downstairs waving a rolling pin, it's easy enough to claim self-defence, since he was clearly about to kill the intruder, who was unprotected by law.

Well done David. Introducing legalised violence between burglar and householder is a great step forward for Conservatives and criminals alike.

DAVE NEALE
Truro, Cornwall

Surgeons and the medical 'closed shop'

Sir: The leader article "A closed shop for surgery does patients no favours" (6 December) is wrong to imply that doctors have concerns about nurses undertaking surgery because they want to protect "their own pay and prospects". Doctors and nurses work together as part of a team; we need each other. As doctors we are totally supportive of nurses expanding their role and doing more advanced procedures under supervision.

However, I am very worried by the prospect of "surgical practitioners", with only two years of training, being able to practise autonomously. It takes around 15 years to train to be a consultant surgeon. Routine procedures can sometimes turn into medical emergencies and knowing what to do when things go wrong is a skill that is acquired through extensive training and experience.

Patient safety must always come first and must certainly not be compromised by a quick fix to meet government targets.

Dr PAUL MILLER
Chairman, Consultants' Committee
British Medical Association
London WC1

Sir: Most doctors actively involved in health care in this country are extremely concerned about our ability to produce doctors with the training and experience to provide adequate care, in the light of changes in the length of training and hours and patterns of work of these trainees over the last eight years or so.

This situation is exacerbated by the fact that those doctors already trained - consultants or other permanent staff - are so busy picking up the work that these trainees did, but can no longer do, that they do not have time to improve the quality of the training that is offered. The expectation that they will be able adequately to supervise the training of surgical assistants of one kind or another is completely unrealistic.

Trainee doctors in this country now commonly do their best to extend the length of their training as far as possible, taking on additional service or "academic" posts or going abroad for a number of years. In the past, doctors from abroad came here for good experience. The public should be scared - very, very scared - by the realisation that UK doctors now feel the need to gain experience abroad.

Your suggestion that the representatives of these doctors are expressing concern over the suggested changes out of concern for their pay and protected status is beyond fatuous. They are expressing genuine concern for the level of service they will be able to provide to their patients.

The changes reported in your article are driven completely by the Government's desire to achieve artificial targets in health care and completely contradictory to their expressed desire to have a specialist-delivered health service.

SIMON GRANT
Consultant Obstetrician and Gynaecologist, Royal Cornwall Hospitals Trust, Truro

Sir: As you hinted in your editorial, many surgeons both trained and in training fear that their privileged position (and their pocket because of private practice) might be threatened if others are trained to carry out some routine surgery.

The division between medical and nursing responsibility has always been rather blurred and often changes with time and circumstance. For instance in America babies are usually delivered by doctors and anaesthetics sometimes given by nurses. In Britain babies are usually delivered by nurses and anaesthetics always given by doctors.

Allowing surgeons to do private practice seems to suit everybody: the health insurance industry, the surgeons and the Government, who can underpay surgeons working in the NHS and underfund the NHS itself because of private practice. However the the private practice tail and private practice agenda should not wag the NHS dog when it comes to deciding what skills and training are appropriate for a doctor and what are appropriate for a nurse

JOHN SANDFORD-SMITH
Retired consultant ophthalmologist
Leicester

Sir: Your front page article "Nurses to train as surgeons" (6 December) raises three issues.

First, the concerns about "sacrificing safety" to reduce waiting lists and the feared detrimental effect of surgical care practitioners (SCPs) on the training of future surgeons are without basis. Every study which has examined the issue has found that SCPs have had a beneficial effect on both service quality and surgeon training.

Second, Jill Biggins states that "stripping the veins from the leg for coronary bypass operations" is done with "no formalised training programme". This is simply not true. There are some 60 SCPs in cardiac surgery. All have received training and over 45 of them hold the Royal College of Surgeons/Society of Cardiothoracic Surgeons national diploma, which is only granted after two years of training and a formal examination.

Finally, Paul Miller describes SCPs as non-medically qualified surgeons. This depends on the definition of a surgeon. In my opinion, a surgeon is not, and never was, simply defined by the technical performance of a procedure. A true surgeon has the knowledge (of when and how an operation is performed), the judgement (to ensure that the surgical treatment is selected and delivered in the patient's best interests) and the accountability (to take overall responsibility for surgical care and to know how to deal with complications). These attributes can only be achieved by lengthy surgical training, and indeed require a medical qualification. SCPs are not consultant surgeons: they merely help us deliver surgical care. It is my experience that, with appropriate training, they can do that superbly well.

SAMER A M NASHEF
Chair, RCS/SCTS examination board for SCPs, Consultant Cardiac Surgeon, Papworth Hospital,
Cambridge

Straw's invasion plans

Sir: The UN's plan to protect people from oppression, mass killings and genocide by their own government is welcomed by Jack Straw as it gives him and his neoconservative friends the opportunity to plunge into war without the nuisance of having to give their actions a veneer of legality ("Straw welcomes UN plan for strikes on rogue states", 6 December).

There is a crucial element missing from the UN's plans to invade "rogue" or "failing" states - the prior application of non-violent persuasion. There should be a statutory instrument in place that measures objectively the performance of all states, along the lines of the Index of Human Rights, and a set tariff of smart sanctions designed to disable the ruling elite. Will Jack Straw be as swift to welcome this proposal as he is to welcome the opportunity to wage war failing states?

RICHARD LAWSON
Congresbury, North Somerset

Children of the state

Sir: Among the policies outlined in Gordon Brown's Pre-Budget Report (3 December), I find his attitude to family life positively chilling.

He grants parents paid leave for nine months following the birth of their child. Implicit in this policy is that such leave is a concession granted by the Government, after which parents are expected to hand their young child to the state whilst they return to work. He is happy to increase childcare provision for earning mothers, yet does not give a penny to mothers who opt to stay at home to care for their own children.

Margaret Hodge has announced a dawn-to-dusk childcare guarantee for children aged three to 14. Coupled with Charles Clarke's schemes in secondary schools, increasingly New Labour seems hell-bent on destroying family life.

For millennia the family unit has made a pretty good fist of rearing its own young, inculcating standards of acceptable behaviour, passing on the mores and ethics which make us what we are. We are bound by bonds of love and are given a sense of worth and belonging.

In his first term as Chancellor, Gordon Brown first showed his contempt for the family unit. He cut single-parent benefit and mounted a campaign to persuade single parents into paid work. Thus children who had already suffered the trauma of losing one parent were handed over to a carer and lost the one constant parent in their life. Mothers who choose to stay at home to nurture their children clearly have no importance in the scheme of things.

NAOMI BALCAM
Norwich

Blunkett's obsession

Sir: That Mr Blunkett has an affair with a married woman tells no more than that he has succumbed to a rather conventional weakness. This is not news, neither should it affect his position as Home Secretary.

However, what is of grave concern is his inability to let go, to give Mrs Quinn the right to choose to end the affair. His determination to pursue the issue of his paternity of her children and contact rights against her wishes suggests obsessive tendencies.

It gives the impression of a man who intends to exercise control over the life of Mrs Quinn by claiming an ongoing intervention in her life through very young children. It is hard to imagine that this presence in her family will help to promote a secure family environment for the children, never mind the security of her marriage.

In a report on the planned ID cards, you quote him as saying "Knowing your true identity and being able to demonstrate it is a positive plus. It is a basic human right" (30 November). It would appear that Mr Blunkett has got his personal and public life inextricably entwined.

Very few of us need to be helped to know our true identity, and certainly not by a Home Secretary displaying obsessive control tendencies. Can we afford this in a democracy?

JOSE JOHNES
Crowle, Worcestershire

Urban fox-hunters

Sir: Your list of celebrity hunt supporters (Pandora, 7 December) confirms what many of us have believed for a long time - that hunting foxes with hounds is largely the pursuit of a "sophisticated" urban elite whose view the countryside as their playground. Is it too much to ask them to stay at home in the cities, leaving the countryside to those of us that truly know and love it?

MICHAEL HARRIS
Edinburgh

Doing our best

Sir: In response to Johann Hari's article on alternative remedies, Andrew Anderson of Bedfordshire complains about GPs who suggest that patients "try this, and if it doesn't work come back and we'll try something else" (Letters, 6 December). He calls this process "blind fumbling", and implies that the process of alternative medicine is in contrast far more precise. In reality most healthcare practitioners of all disciplines would agree that there is a great deal that they do not know. Maybe Mr Anderson would prefer that we all become more dishonest with our patients?

Dr GAVIN FRANCIS
Edinburgh

Age of Attlee

Sir: Attlee himself stressed the importance of collective Cabinet decisions (letters, 7 December). He recorded that there were times when the President of the Board of Education would say of another Minister's plans: "It sounds a good idea, Prime Minister, but I have been trying to explain it to my wife and she doesn't think it will work." Attlee seems to have regarded this as tantamount to a veto. The trouble with modern Cabinets is that they no longer have access to the advice of George Tomlinson's wife.

DEREK COLE
Hastings

Constitutional practice

Sir: It is encouraging that so many people are seeking copies of the proposed EU Constitution (letters; 6, 7 November). I assume that when they have finished reading they will place it on the shelf beside their copies of the British Constitution.

MICHAEL SMITH
Dublin