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Realistic solutions urgently needed to consider future funding of the NHS

Andrew McKie elegantly points out to us what no politician dare say, and what so many members of the public cannot contemplate ("Why has real scandal been swept under the carpet?", The Herald, February 18).

The NHS is not the envy of the world, and in its present form is not sustainable in the long run. This is in no way a criticism of anyone who works in it, nor an attack on a service free at the point of need. It is not a clarion call for more privatisation nor an appeal for more knee-jerk root-and-branch reform. There are no ready answers, no easy solutions and no apparent European remedies.

What is unforgiveable is the reluctance by politicians to engage in meaningful debate about the problems of providing health care in the years to come. No doubt the SNP hope the NHS in Scotland will not produce too many unfavourable headlines before the referendum, claiming the system is working well in Scotland.

The truly terrible revelations emerging from the Staffordshire inquiry should be a warning to politicians at Holyrood that no-one can be complacent about standards in public institutions. It is inconceivable that such a scandal could occur in Scotland, and for the man in charge at the time to then become responsible for the country's health service. One would like to think the Scots' innate sense of honesty and decency would condemn such unbridled greed and lack of contrition, so that promotion for such an individual was blocked. The frightening thing about the Mid Staffordshire Trust was that the medical director and director of nursing felt unable to prevent the situation from deteriorating, and consultants who are responsible for the welfare of the patients under their care did not have the courage to whistleblow.

Historically, Scottish doctors and Scottish medical practice have justifiably been held in high regard in this country and throughout the world. Scottish politicians of all parties will be anxious to see this favourable situation continues for the forseeable future. They should read Andrew McKie's column and tell the public how they think the NHS is going to be funded throughout the next decade if medical standards are to be maintained.

Management consultants may "think the unthinkable" but canny Scots could come up with realistic solutions.

John Sinclair,

Bridgegait, Milngavie.

Any preventable death in hospital is regrettable and a tragedy. The estimated 1200 such deaths at Stafford Hospital appear potentially criminal. That Sir David Nicholson should still be head of the NHS in England is an outrage.

In this Andrew McKie and I are in agreement. What one cannot agree with is his selective conclusion drawn from the report of the London School of Hygiene and Tropical Medicine on preventable deaths in English acute hospitals (for 2009).

He quotes: "1000 preventable deaths every month", a truly shocking figure supporting his case. One problem, this is not the conclusion of the report, but that of a previous report which this one set out to rebut. This one reads: "There would have been 11,859 adult preventable deaths in England ... much lower than previous estimates." This is per year not per month.

Having completely misrepresented the report he goes on to assert there are only "minor differences in administration (of the NHS) north and south of the Border". This simply is not the case. The differences are fundamental. Two of these differences will suffice:

NHS Scotland focuses on health, in England the focus is on illness.

NHS Scotland's aims are perused by planning, in England the NHS is predicated on market forces.

These differences are, if nothing else, fundamental.

Bob Cuddihy,

143/2 Constitution Street,

Edinburgh.

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