Letters: Undermining the NHS

Meddling ministers and lack of funds undermine the NHS

Sir: The crisis in the NHS appears to worsen, generating the usual knee-jerk response from politicians and the media: "reform and reorganise". In my experience (going back to before 1948) there are two major problems for an NHS which struggles to provide a modern, easily accessible service to all, free at the point of provision; and not rationed by postcode or patients' wealth.

The first is a surfeit of reforms and reorganisations. Should health care professionals introduce an untried and untested new treatment in an area of medicine of which they know little, there would be justifiable outrage. Yet ministers do this regularly without any protest other than from the professionals who have to try to cope with the resulting chaos and waste of money.

The second is funding. Nye Bevan, one of my health heroes, aimed for the ideal that top-quality health care should be available and accessible to all irrespective of wealth or geography. He mistakenly believed that it would largely pay for itself by reducing work lost through disease or injury and prolonging productive life. He could not reasonably have foreseen that advances in health care would enable the expensive survival of those who, one or more generations ago, would have swiftly died of their affliction, or that the cost of modern healthcare would rise so dramatically.

I vividly remember in 1948 my father, a GP, telling me, a 12-year-old who already knew he wanted to be a doctor, that this was the best day of his professional life. For the first time money no longer came between doctor and patient. He could revisit a sick child two or three times a day if he was worried, without the parents accusing him of raising the bill.

The dilemma we face is this. Does the population of this democracy want a health service that does not ration by perceived worth or by geography; or one that is rationed by various pretexts. If the former, then do not believe the politicians who care more for your vote than your health and tell you this can be done without considerably more expense. If the latter then I fear that imperfect allocation of health care to the more "worthy" will mean that the rich or fit will live, and the poor or disabled will die.

JOHN ATKINS, FRCOG

HON CONSULTANT FETAL MATERNAL MEDICINE, SWAINBY, NORTH YORKSHIRE

Democratic ideals trashed by Labour

Sir: I agree with much that Johann Hari writes "There are still reasons to choose Labour" (4 May); however, I still would not be able to bring myself to vote Labour if my council were up for re-election, just as I was unable to vote Labour again in the last General Election.

I myself, my family and friends have all seen direct personal benefits in the nine years since Labour came into power: Child Tax Credit (everyone I know with children); winter fuel allowances (my grandmother and father-in-law); civil partnerships (many of my friends finally able to make their commitments legal); improved NHS services (all of us), to name a few. I honestly believe this is a party which genuinely tries and succeeds in making positive social changes.

But the reason why I cannot vote Labour any more is simple. They do not respect democracy and democratic principles (front page, 4 May). No amount of positive social change is worth giving up the checks and balances which enable democracy to work. No amount of social change is worth turning our backs on protection for minorities. No amount of social change is worth condoning political corruption. When I look at the Labour government I see Orwell's pigs turned to people. Power has corrupted and corrupted absolutely. This I cannot forgive.

LUCY FISHER

CROMER, NORFOLK

Sir: The extent to which the media have encouraged local voters to take account of such things as foreign policy and Iraq is crazy and worrying. These are matters over which local politicians have no influence and it must be frustrating for councillors who lose their posts not because of their performance, but that of the Foreign Secretary. My councillor has no influence on our withdrawal from Iraq but he has influence on such areas as refuse collection, street lighting and other matters which affect my council tax bill.

J K C HENDERSON

LEATHERHEAD, SURREY

Power of pro-Israel lobby is exaggerated

Sir: Robert Fisk's defence of the Mearsheimer-Walt paper fails on several counts ("United States of Israel?" 27 April). Fisk does not recognise the incendiary charges in the Mearsheimer-Walt paper: that supporters of Israel, meaning Jews, control and distort American policy in a way to serve Israel's interests against the interests of America.

Such exaggerations of the power of this pro-Israel lobby, the disregard for the consistently broad-based American public and bi-partisan support for Israel, the omission of the very many interests that the US has in a strong and safe Israel, and their overriding theme that policymakers are controlled by the "lobby", adds up to an effort to delegitimise the work of pro-Israel activists and has elements of classic anti-Jewish conspiracy theories.

There is lively debate when it comes to how to approach US policy toward Israel, in particular in the media and on college campuses, where the viewpoint is at times clearly anti-Israel. Even within the Jewish community there is a diversity of opinion. Those who ignore this multitude of opinions are intent on seeing the world through their own narrowly conceived and intentionally distorted prism.

Mearsheimer and Walt try to give the impression that they are dealing seriously with Middle East issues, but their paper amounts to nothing more than a conspiratorial anti-Semitic analysis invoking the canards of Jewish power and Jewish control. And it appears that The Independent has bought into their conspiratorial analysis by the cover image of Israeli stars on the American flag alongside the column's title, "United States of Israel?"

ABRAHAM H FOXMAN

NATIONAL DIRECTOR ANTI-DEFAMATION LEAGUE NEW YORK

Sir: Robert Fisk's article of 27 April prompts the question "How do we define anti-Semitism?" I was given that label when, living in a largely Jewish community with many Jewish friends in New York in 1967, I had the temerity to condemn the pre-emptive strike carried out by Israel on its neighbours without a prior declaration of war; even though some liberal Jews also questioned the morality of that action.

One should be able to criticise the policies of the state of Israel and should be able actively to oppose those policies and their consequent actions, without being labelled anti-Semitic.

The world community has accepted the legitimate existence of the state of Israel through the United Nations, but Walt and Mearsheimer are right to point out that the United States (and Britain) should have no interest in supporting the policies of that government unless there is a clear commonality of interest. As those policies, as pursued since 1967, stand condemned by resolutions of the United Nations, then neither the USA nor the UK should support them.

To argue against the policies of the state of Israel is not to be anti-Semitic. Only verbally or physically attacking Jews and their personal rights can justify that dreadful appellation.

ANTHONY D WOOD

LISKEARD, CORNWALL

Bear bile prohibited in Chinese medicine

Sir: You report that Chinese police have seized hundreds of bear paws and dead pangolins smuggled into China where they are prized for use in traditional medicine (28 April).

The Register of Chinese Herbal Medicine (RCHM) is one of the largest professional associations representing and regulating the practice of Chinese herbal medicine in the UK. We are greatly concerned about the threat to wild animals and plants that have come as a result of the growth in demand for traditional medicines. We strongly condemn the illegal trade in endangered species and have a strict policy prohibiting the use of any type of endangered species by any of our members.

The RCHM uses information supplied by Convention on International Trade in Endangered Species , the Wildlife Liaison Office of the Metropolitan Police and the Department of the Environment, who work to stop the trade in illegal substances.

We also strictly prohibit the use of bear bile by our members. It is wholly unacceptable for healthcare professionals to use medicinal substances derived from endangered species. Not only is the production of medicinal substances involving inhumane methods unacceptable on ethical grounds, but in most cases alternatives can be found among plant medicines.

EMMA FARRANT

REGISTER OF CHINESE HERBAL MEDICINE, NORWICH

The evangelical right, Aids and Africa

Sir: The Pope may be poised to rethink the Catholic Church's stance on condoms (3 May), but of increasing importance are the views of the American evangelical right and their influence on US development money. Flying in the face of 20 years' experience of what works, they are exporting to Africa an aggressive and highly moralistic HIV prevention approach based on abstinence and fidelity.

US Aids funding sounds impressive: $15bn over five years. But its prevention approach of restricting condom distribution to so-called "high risk" groups such as commercial sex workers and truck drivers, ignores the reality of the African epidemic, which is young and female. It assumes African women possess a level of control over their lives and sexuality that they often do not.

In Uganda, billboards that used to promote abstinence, fidelity and the use of condoms have disappeared. Eighty million condoms are locked in government warehouses. We see marches of virgins, and proposals for university scholarships for those who remain "untainted". A wave of stigma has overtaken the country: people with HIV are defined as "loose". Civil society, the backbone of any approach to defeat Aids, has become divided in the scramble for US grants.

The inevitable outcome is a rise in infection rates. Uganda had reduced its prevalence rates from one in five in the early 1990s to one in 20 in 2005. But a recent survey shows a reversal in that trend, with the highest increases among the most vulnerable, including people in conflict-torn northern Uganda and poor urban women. The only way to fight Aids successfully is to put our reliance in evidence-based strategies, not faith-based, ideologically driven approaches.

BEATRICE WERE

HIV/AIDS TEAM LEADER, ACTIONAID, KAMPALA, UGANDA

Foreign criminals: no new laws needed

Sir: So the Home Secretary is going to toughen up the law on deportation of released criminals (report, 4 May). He ignores the fact that the current law has the potential to deal with them adequately. It only fails (and spectacularly so) when it is not implemented and managed professionally. This management failure was brought to the attention of Mr Clarke's predecessor in 2001 by the then Chief Inspector of Prisons. Nothing was done until the press took control.

We do not need another tough-sounding law, which will be poorly drafted in a media-focussed rush, and thereafter picked apart in the courts. We do need a Home Secretary who recognises his fault and responsibility, and stands aside for a cooler head than his to repair the damage.

NICHOLAS TAPP

BIRCHINGTON, KENT

Overpriced actors

Sir: I am a regular theatre-goer and I was horrified to read that, yet again, the West End is pandering to Broadway "stars", agreeing to cough up £16,000 per week for Idina Menzel's performance in Wicked (Pandora, 2 May). Obviously, her salary will be passed on to the punters in the form of yet higher ticket prices. Producers moan that there are fewer and fewer young people coming to the theatre, whether West End or subsidised, when they've only themselves to blame in agreeing such ludicrously high salaries.

ANN CAIRD

LONDON N1

Down the toilet

Sir: The Mayor of London raises the point that water supply is not keeping up with consumption ("Red Ken's green manifesto: do not flush the lavatory" 2 May). In many countries, including Australia, a "dual flush" lavatory is mandatory. Can't we learn? A simple rule requiring that all new lavatories were "dual flush" would reduce the amount of water used until we have a dual system, of drinkable and grey water, in cities. Surely this is relatively easy for the Mayor, and/or the Government, to take on immediately?

MICHAEL DAVIS

LONDON SE1

Oil dependence

Sir: Hamish McRae writes "We must learn to live with expensive oil" (Opinion, 3 May). How about learning to live without expensive oil?

BILL LINTON

ENFIELD GREEN PARTY LONDON N13

Danger plants

Sir: I can add (from personal very painful experience) further caveats on your selection of "What to grow in the 21st century" (Extra, 28 April). Agave, or century plant (Spanish "pita") not only has fearsome spines but an aggressively alkaline milky sap which will cause severe blistering (akin to mustard gas) on exposed skin. This type of sap is common in plants from arid regions. Mimosa (another of your selections) is a further example whose sap is to be avoided.

D GARETH JONES

PYRFORD, SURREY

Switching sides

Sir: The case of an ex-Lib Dem parliamentary candidate switching to the Tories (report, 28 April) is more honest than those MPs and councillors who cross the floor after being elected. I have been a party activist for 20 odd years and feel great sorrow for those workers who put in hours of foot slogging while canvassing, leaflet delivering and fundraising for elected politicians, who then realise that they have backed a loser and seek furtherment in another party. The honourable thing to do is to resign your seat and seek re-election on the new ticket.

R G BEECH

STANFORD-LE-HOPE, ESSEX

The devil of a day

Sir: Further to Neville Atkinson's letter (3 May) I hope that he is equally excited about events next month. Namely at 06:06:06am on 6/6/06 it will be a truly beastly time. Not a revelation to some.

ALAN LEDIARD

HALESOWEN, WEST MIDLANDS