CREDIT to The Herald for sponsoring the Creating a Healthier Scotland summit, and to Health Minister Shona Robison for seeking an open debate. The challenge will be to move on from a Tower of Babel in which politicians, managers and clinicians all talk at once, in different languages, serving different imperatives.

While many struggle to cut the various Gordian knots in which the NHS is tied, a useful first step would be to recognise long-standing shibboleths for what they are. For example, the notion reported in Helen McArdle’s piece (“Minister: Patients would travel to super-hospitals”, The Herald, August 26 that A&E attendances peak in mid-winter: as I am sure Dr Jason Leitch, the national clinical director for the Scottish Government knows, statistics show the months with highest A&E attendances are generally from May to September (the quietest month is February), whereas I imagine it is in winter that patients are slower to recover and/or need more step-down care - whether in hospital or community.

This in turn applies pressure on other services, and the move toward integration of health and social care, however tricky it may be to implement, shows a determination to avoid service anomalies and smooth the patient journey.

But resources are always going to be at a premium, so decisions cannot be made on the basis of hunch or hubris, and proposals for service change must be built on measurable bases. Thus the job description of that Alexander to cut the knot must include the analytical nous to take a complex wiring diagram and simplify it.

James Sandeman,

3 Scone Place, Newton Mearns.

YOU are to be congratulated for your NHS Time For Action campaign. As someone in a rural location heading as an ageing OAP into the zone for increasing need for health care, I fully support the idea of centralised high volume high quality healthcare. But the rider I would add is: let us have affordable and convenient access by way of transportation.

The remaining conundrum is the fact that local health boards appear to gobble resources, providing little obvious return, when they should be able to act as a screening service for the basic diagnostics to support the centres without the need to endlessly compete for that which could be provided nearby.

Thomas Law,

Boarhills,

Cromlech Road, Sandbank, Argyll.

WE are advised that early presentation at hospitals can be important for accident and emergency cases. Every minute can be crucial for speedy diagnosis, prompt treatment and successful outcomes.

On about 50 per cent of my recent journeys from the north by car on Wednesday mornings to the Queen Elizabeth University Hospital I have been delayed by a temporary closure of the Clyde Tunnel. Typically this build-up of traffic has lasted between five and 15 minutes.

Can an assurance be given to the concerned residents of north-west Glasgow, Bearsden and Milngavie that ambulances and other emergency vehicles will not be delayed unnecessarily? Will casualties from north of the river be able to proceed unhindered to their re-located Accident & Emergency department, recently transferred from the Western to the further distant Southern via this vital lifeline?

Robin M Brown,

46 Buchanan Street, Milngavie.

I SPENT three nights in Inverclyde Royal Hospital, Greenock, earlier this month receiving treatment for a chest infection. I was in a four-bed ward shared with a patient being treated for cancer related problems, and two patients with advanced dementia.

One of the dementia sufferers was extremely disruptive during the night and got out of his bed as many as 15 times during the night.

On the first night a siren warning indicated to staff he had left his bed, and was impossibke to sleep through. On the next two nights the alarm did not work, and I would press my alarm to alert staff. This went on continuously through the second and third night. Sometimes I would find him standing by my bed with just his underpants on.

Dementia is a terrible cross for anyone to bear, but surely it can't be considered good practice to have those sufferers on a ward with patients being treated for, or recovering from, clinical problems.

I estimate that I got no more than eight hours’ sleep over the three nights.

Donald MacKinnon,

38 Sandhaven, Dunoon.