Private-sector health, Live8 and others

The benefits of private-sector health care are far from proven

Sir: I take issue with your editorial on the health service (28 June) on several counts. I am the first to welcome falling waiting lists, but your assertion that the private sector has brought proven benefits in terms of new hospital buildings warrants further analysis: PFI has paid for new hospital buildings, it is true, but at a highly inflated cost which we and our children will be paying for for the next 30 years, by which time most of the buildings will have fallen down! Not only that, but building companies have made vast profits at the expense of the taxpayer; only recently the resale of a PFI contract at the Norfolk and Norwich Hospital made the building company millions of pounds profit. Hardly a resounding success story, or value for money.

Secondly, why assume that private-sector provision of health care is better than the NHS? It only seems better because it has more money, easier patients and no emergency provision. My experience of private health care is that it's only great if you're otherwise fit, only a little bit ill and then only between 9 and 5, having a straightforward operation, like a hip replacement. Oh, and they're not interested in training any more doctors; they'll leave that to the NHS, thank you very much.

Sadly many people don't fit into these categories; the private sector will therefore always be at enormous advantage in competition with the NHS. And who do you think does the actual operating in the private sector? Why, none other than NHS consultants in their spare time, or else overseas doctors who fly in for short contracts, presumably because they can't get a job at home for some reason. Hardly someone I'd want to do my hip replacement. Certainly use the private sector to get the waiting lists down in the short term, but why not put all this money into expanding NHS provision in the long term; it would almost certainly work out cheaper.

And at least admit the possibility that some doctors might be worried about the "reforms" because they care about patient care: after all unlike you we actually see what goes on.

DR KATHERINE TEALE

CONSULTANT ANAESTHETIST, MANCHESTER

After Live8, the spotlight falls on G8

Sir: A vital issue the G8 agenda appears unlikely to tackle is the role of business in the diminution of poverty. In today's globalised economy the private sector is the main engine of growth, spreading its operations ever more widely into the developing world. It brings the benefits of investment, employment and the provision of goods and services, but these benefits are too often offset by the abuse of the human rights of the labour force, the pollution of the environment and the destruction of communities.

The private sector could, if its operations were based on principles which ensured a living wage, safeguarded the health and safety of its employees and protected the environment, contribute more effectively and immediately than governments to the prosperity of communities and the diminution of poverty. Companies cannot be expected to solve world problems, but they can legitimately be expected to alleviate rather than worsen them through the manner in which they operate.

International business is today inadequately transparent or accountable, and will ultimately need an international regulatory framework. This, requiring international treaties, lies in the future. For the present, a clarion call from the G8, the home countries of the majority of transnational companies, adjuring business to observe the principles enshrined in the United Nations Declaration of Human Rights and expressing willingness to observe such principles in their own commercial decisions, could assist in making companies an effective part of the solution instead of part of the problem which too many remain today.

SIR GEOFFREY CHANDLER

FOUNDER-CHAIR, AMNESTY INTERNATIONAL UK BUSINESS GROUP 1991-2001 NEWDIGATE, DORKING

Sir: In Live8 we have witnessed a defining moment in history; never before have so many people taken part in an event. Targeting the G8 leaders ahead of their Edinburgh summit was a masterstroke by Bob Geldof and Midge Ure. The message could not be clearer: "Change things or else there will be trouble." The heat is on those eight leaders.

KENNEDY STEWART

WIGAN

Sir: The "VIP" area in front of the Live8 stage told you everything you need to know about humanity, its innate behaviour and the reasons why Africa is in such a bad way. The hundreds of thousands of people who had democratically won tickets for the event were a quarter of a mile from the stage, whilst a small number of "VIPs" had their own area at the front, with room to dance, stretch their legs and pose for the cameras. If it was for security reasons, surely they would have been safer backstage? I find this at best, distasteful, and at worst, deeply saddening. Simply put, it was a privileged minority enjoying an ascendancy over everyday people. No change there then.

ASHLEY TYAS

LONDON SE14

Sir: I am surprised that there has been no mention in any of the Live8 adverts of the damage arms sales to Africa have played in the scale of poverty. In 2001 alone, as revealed by Campaign Against the Arms Trade, Britain exported £400m of arms to Africa. A fifth of Africa's debt also comes from arms sales. If more people protested outside arms companies, and made clear to Labour MPs that they will not tolerate the links between Labour and the arms trade, perhaps the quality of life in Africa would improve. I urge Bob Geldof to add a total ban on arms sales to Africa to the demands of Live8.

RICHARD BRENNAN

UNIVERSITY OF SUSSEX, BRIGHTON, SUSSEX

Sir: Am I the only one, apart from the entire population of Africa, left unmoved by the Live8 debacle? Live8 may appear a worthwhile cause to those who have flocked to the various concerts, and to the wealthy pop stars headlining the events around the world, but in reality, it will not make one iota of difference to African countries or their poor who will continue their hand-to-mouth existence in the most appalling conditions. This well-meant gesture is likely to convince those involved that they have done their bit and that they can now move on quickly to the next "big" thing.

The countries of Africa and their poor do not need the conscience-salving properties of a Live8 concert. They do need clear, concerted action from the leaders of the G8 group of countries who have all the means at their disposal to end the iniquitous economic processes which prevent these countries addressing and solving their own problems. Sadly it seems unlikely that any of the gutless wonders at the G8 conference will have the courage to do the right thing.

PETER COGHLAN

BROADSTONE, DORSET

Why the child-free are unhappy

Sir: I read with some interest your coverage of the "fertility timebomb" (21 June) and the Chief Executive of the Equal Opportunities Commission's arguments for further positive discrimination towards parents (letter, 27 June).

While infertility may contribute to Britain's low birth rate, it is also low because of an increasing number of people of all ages and backgrounds deciding that they don't want children.

Parents receive increased tax credits, benefits and assorted rights that are not extended to those who are childfree or infertile. So the burden of taxation is shifting away from people with children and towards people without them.

The Government uses complaints to the EOC to track discomfort among the child-free and childless (or so it claims). So, Britain is faced with more people choosing not to have kids and more people physically unable to have kids and the Government's response is to increase taxation on all of them.

And what of the public body that we are supposed to complain to? Its Chief Executive seems to want us eradicated through pro-natalist politics. Is it any wonder that we are unhappy?

JONATHAN MCCALMONT

CHAIRMAN, KIDDING ASIDE: THE BRITISH CHILDFREE ASSOCIATION, LONDON SW3

Sir: You report that in 2020 a third of couples could be infertile. Looking at the graphs published by the Government Actuary's Department, it appears that this would be just enough to result in a stable population in that year, instead of the continued growth now projected.

The real fertility time bomb that the world faces is population growth, which exacerbates grave problems such as global warming, shortage of fresh water, mass extinction of species, and wars over oil. A stable population in Britain would help to reduce these problems. Schemes to boost the birth rate can be entertained after world population is stable at a safe level.

RICHARD STALLMAN

CAMBRIDGE, MASSACHUSETTS, USA

Don't misuse the ambulance service

Sir: Your editorial on improving our emergency services (1 July) highlights many of the problems facing the modern ambulance service. As an employee of an A&E ambulance trust for four years, I know that many people call for an ambulance because they cannot obtain an appointment, or home visit, with their GP and feel they are left with no other option but to dial 999. Or they think that calling an ambulance will enable them to jump the queue at A&E (it won't). The new responsibilities of emergency care practitioners to prescribe drugs, take blood samples, and so on are currently the responsibilities of the GP and district nurse, both of whom are understaffed and underfunded.

Better education of the public is needed so that they can access the NHS at a relevant point. My suggestion would be for everyone who calls 999 for an ambulance to be put through to NHS Direct so their call can be directed according to medical need

Ambulance staff are highly skilled and dedicated people who carry out a specific acute medical role that is often misused by people within the NHS and abused by the public. While it should be welcomed that their role is expanded it should not be used to plug holes in the system.

BEN JONES

GILLINGHAM, KENT

Mental illness: pills are not enough

Sir: Raj Persaud (Opinion, 30 June) valiantly defends psychiatry against the anti-medication stance taken by the Church of Scientology. It is true that medication can significantly improve the lives of people with mental disorders. But at the same time many patients have to put up with appalling side effects (a major reason why some patients stop taking the pills). For others, medication results in no therapeutic benefit.

The real problem facing mental-health services at the moment is not the lack of medication options but the lack of alternative, evidence-based interventions, most notably talking therapies. These are shown to be widely effective but there are long waiting times for referrals and too few practitioners.

At a time when the Government is proposing a new Mental Health Act that will allow the compulsory treatment of some mental-health patients in the community (overwhelmingly through medication), we need to fast track the development of effective alternatives to pills and injections for people with mental-health needs.

SIMON LAWTON SMITH

SENIOR POLICY ADVISER, MENTAL HEALTH, KING'S FUND LONDON W1

Card-carrying citizens

Sir: If ID cards are to be foisted upon us whether we want them or not, I can suggest a simple way for those "conscientious objectors" such as myself to make life hell for the Government, that would avoid falling foul of the law. Before going in for your ID card sign up, change your name by deed poll to John or Jane Citizen.

BRENT MARTIN

LONDON N5

Sir: I find it suspicious that Tony Blair could not, or would not, answer Jeremy Paxman's question during the election campaign concerning the number of illegal immigrants in this country. He eventually said something to the effect that it was impossible to calculate. Now we are told that it is circa 570,000. Could this figure have been produced to worry us into accepting ID cards, or am I being cynical?

PATRICK WISE

CIRENCESTER

Cycle helmets save lives

Sir: While we agree wholeheartedly with your editorial sentiment regarding cyclist deaths on the road (2 July) and what could be done to prevent them, you missed a fundamental point: helmets.

Ironically, major cycle groups have actively lobbied against the compulsory use of helmets on the grounds that this will reduce the number of cyclists. It is true, that, as army generals found out on the introduction of metal helmets in modern warfare, injuries will go up. But the number of grieving families will go down.

CHRIS BAIN AND FRED ELLIS

LONDON SW2

Zimbabwean detainees

Sir: After hearing an interview on the radio with a Zimbabwean detainee and reading the letter "Better to starve than return to Zimbabwe"(1 July) I made my way to Harmondsworth to express support. I was not allowed any contact, not even to submit a letter making clear that people on the outside were thinking of them. Even convicted criminals are allowed visitors, and detention centres are not prisons, in spite of the barbed wire!

PERIN PARRI-HUGHES

HAMPTON, MIDDLESEX

Subsidised salesmen

Sir: Steve Mackinder (letter, 1 July) reminds us that a wide range of agricultural suppliers are dependent on the CAP. It was bad enough when we thought we were only subsidising the farmers. I am sorry, Mr Mackinder, but providing an artificial boost to the business of a fertiliser salesman in Norfolk is not a good enough reason to maintain a grossly wasteful mechanism that helps, at vast expense to the people of Europe, to keep large parts of the world in poverty.

GUS PARK

LONDON W12

How to convince Bush

Sir: So Bush does not admit our world is warming (report, 1 July). OK maybe we need a different tack. Forget the scientific evidence nonsense; who can trust scientists anyway? How about feeding him vague, unsubstantiated rumours and giving the army a key role. Perhaps then we'd see some action!

PAUL GEE

HALE, CHESHIRE