ALISON Payne in her Agenda article ("NHS in Scotland relies heavily on private sector for delivery of care", The Herald, August 23) about the involvement of the private sector demonstrates a misunderstanding of the workings of the NHS that is either profound or mischievous.
It sounds like a poor attempt to muddy the waters regarding the profound risk of cutbacks to the NHS should a No vote emerge on September 19.
GPs do indeed operate on the basis that their practice is run as a business under their direction and control, but they enter into a very tight contract with their health board which ensures that they follow best practice and serve their patients diligently and effectively. Their monetary reward will partly reflect the burden of clinical work which they undertake and to a smaller extent will vary with the skill they have in running the business side of things - staff costs, running costs, premises maintenance, and so on.
Other contractors to NHS Scotland include pharmacists, dentists and opticians, all of whom also operate under close supervision by the health boards with which they are, like medical GPs, required to work in close collaboration and with a myriad of rules and regulations to ensure adequacy and consistency of service to the public. All are able to improve their financial rewards by putting extra effort into the service they provide. This provides entrepreneurial incentive to do the best job they can.
This arrangement works well and the suggestion by Alison Payne that GPs should be salaried is unlikely to be popular with anyone. She does not suggest any way in which service to patients would be improved. Removal of incentive, on the other hand, is very likely to discourage at least some doctors from being quite as diligent as they currently are.
Readers should be aware that the contracts between health boards and doctors (and other health professionals) bear no resemblance to those which have been and are still being signed with multinational companies like Virgin, Atos, and G4S to run clinical services in England. The provision of cancer services for 10 years, for example, at a cost of £1.2 billion is vastly different; it involves these companies urging doctors to use their services, hence competing with each other and clouding clinical decisions with commercial considerations. This is anathema to any physician.
Dr Willie Wilson,
NHS for Yes, 57 Gallowhill Road, Lenzie.
AS an employee of NHS Scotland I accept there are major issues with the service which require to be addressed urgently, and what despairs me and many of my colleagues is the unwillingness of the SNP Government to do anything about them, despite having the powers so to do (powers which the SNP are very careful not to admit to).
I will give one illustrative example. Thousands, possibly millions, of pounds are wasted each year paying overtime rates and other significant salary enhancements to staff who are off sick, often for long periods, simply because they were scheduled for overtime shifts during their sick leave.
This ridiculous practice, which would never be tolerated in the private sector, has rightly now been stopped in England but scandalously continues in Scotland - despite the SNP Health Directorate having the ability to address it, as no doubt they view such cessation as a vote-loser.
The SNP and the Yes focus is solely on bluster and blaming the UK for any of their problems, while in reality they have the devolved power to resolve matters if only they had the ability, leadership and direction to do so themselves.
Independence under Alex Salmond and his inept and unfocused team will resolve nothing - working together and sensibly will.
Steph Glasgow,
71 Hughenden Gardens,
Glasgow.
A WRITTEN constitution in the hands of politicians is a nightmare in the making.
I, a minority voter in Scotland, believe in the future of nuclear energy. I also believe in Trident, especially with regard to the technical expertise that comes with the complete package. The SNP state that everything nuclear will be removed from these shores and that their prohibition will be enshrined in a constitution.
This is a recipe for a police state. A constitution is surely a device that protects the individual as well as ensuring that the individual has responsibilities. A constitution should be positive, not negative. To forbid elements of research and the industrial advances that can be gained by having nuclear programmes is a recipe that can only lead to industrial stagnation. Now the NHS is to be "protected" by enshrining its public status in the constitution. Public health, like politics, is too important to leave to the politicians.
John Macmillan,
40 Ferry Road,
Monifieth.
Why are you making commenting on The Herald only available to subscribers?
It should have been a safe space for informed debate, somewhere for readers to discuss issues around the biggest stories of the day, but all too often the below the line comments on most websites have become bogged down by off-topic discussions and abuse.
heraldscotland.com is tackling this problem by allowing only subscribers to comment.
We are doing this to improve the experience for our loyal readers and we believe it will reduce the ability of trolls and troublemakers, who occasionally find their way onto our site, to abuse our journalists and readers. We also hope it will help the comments section fulfil its promise as a part of Scotland's conversation with itself.
We are lucky at The Herald. We are read by an informed, educated readership who can add their knowledge and insights to our stories.
That is invaluable.
We are making the subscriber-only change to support our valued readers, who tell us they don't want the site cluttered up with irrelevant comments, untruths and abuse.
In the past, the journalist’s job was to collect and distribute information to the audience. Technology means that readers can shape a discussion. We look forward to hearing from you on heraldscotland.com
Comments & Moderation
Readers’ comments: You are personally liable for the content of any comments you upload to this website, so please act responsibly. We do not pre-moderate or monitor readers’ comments appearing on our websites, but we do post-moderate in response to complaints we receive or otherwise when a potential problem comes to our attention. You can make a complaint by using the ‘report this post’ link . We may then apply our discretion under the user terms to amend or delete comments.
Post moderation is undertaken full-time 9am-6pm on weekdays, and on a part-time basis outwith those hours.
Read the rules hereComments are closed on this article