One cannot but agree with Jeremy Hunt that many who work in the NHS need to change their priorities and their attitudes to patient care (Hospital care failings are shocking betrayal of NHS values, says Hunt, 7 January). What he does not seem to want to talk about, however, is how NHS staff came to have the “compassion that led them into the profession … ground out of them”.
For the last three decades the NHS has been subject to a constant stream of Stalinist directives: “You must do this – no discussion, no piloting, no argument – and you must do it by the day after tomorrow.” Often these directives are based on zero evidence of benefit and are enormously disruptive. They are introduced with a great fanfare, only to be dropped a year or two later.
Hunt also fails to mention the constant denigration of public sector staff as being lazy, incompetent, immoral or a combination of all three; their requests for their professional opinions to be taken into account are dismissed as special pleading. He also fails to mention the lies told by generations of politicians, who pretend a small uplift in budget or yet another “cost improvement programme” can deliver more and more services, of greater and greater complexity, without any real attempt to understand the true staffing and other costs of the planned service.
If the culture of the NHS is showing signs of serious decay then the politicians who have managed it so badly for so long must take a large share of the blame.
Bedale, North Yorkshire
•?Characteristically, in the context of the report of the inquiry into the appalling deaths of patients in Stafford, David Cameron seeks to devolve blame and centralise credit (PM says satisfaction test should apply to GPs, 4 January).
Many witnesses to this inquiry, including myself, gave evidence of uncompromising management bullying in the service which ignores quality of patient care. This autocratic culture is clearly linked to the unthinking political imposition of destructive competition, fragmentation, constant reorganisation, incompetent regulation and relentless political targets. It stems from the very top and is based on the premise that No 10 is always right. This is the issue Cameron needs to grasp if he is to have any credibility in relation to future development of the service.
Visiting professor in health policy and management, University of Glamorgan
•?I am grateful to Denis Campbell for his article about the “any qualified provider” (AQP) process that is creeping through the NHS (105 private firms to treat NHS patients, 7 January). In September I was contacted by a “procurement officer” working for Hertfordshire NHS who informed that I would no longer be able to provide the psychotherapy service in a surgery where I have been working for 12 years unless I undertook the AQP process.
Psychotherapy would no longer be available to the patients in the surgery, and my only option would be to run a time-limited counselling service. Having looked at the application forms and the business jargon used, I was ready to give up on a service I’ve very much enjoyed providing as part of a clinical team with six GPs. I was asked to provide three years of my personal accounts, and write long pieces about care pathways and critical incident policy. With the help of our practice manager, who was more familiar with the language, the form is completed. It is still to be seen whether I’ve “qualified”.
•?Do we yet know how many NHS staff are required to assess the qualifications of “any qualified provider” companies? Or how many will be required to monitor their performance on an ongoing basis?
•?You report that “private firms such as InHealth, Specsavers and Virgin Care have already taken advantage of the controversial extension of competition”. I had never heard of InHealth until a few months ago when my GP referred me to them for an x-ray; I looked them up and found they are a complex web of companies, each owned by one at a higher level until eventually they all vanish up themselves in one, Pegasus Management (Holdings) SCA, registered in … Luxembourg. Now why would they do that?