JIM Proctor (Letters, November 3) suggests that we should move to a Louisa Jordan model of pandemic care rather than create so called "superhospitals". However, he fails to take into account that the former was a stop-gap solution which would not meet current NHS guidelines on patient safety.

Consolidating patient care into one massive building as in the QEUH does increase the risk to patients in terms of spread of infection when compared to five small individual hospitals. But at least we can design in infection control from the outset whereas the Louisa Jordan was severely compromised by being an existing open-plan building not suited for healthcare.

Equally, whilst five separate buildings may be desirable, you also dilute the level of expertise available to treat patients with increasingly complex diseases. Consultants tend to prefer large hospitals where they will encounter a wider variety of problems because it increases their skill set. You then get better outcomes, albeit at the expense of patients often having to travel huge distances to get seen.

That said, there are simpler solutions for addressing pandemics or even flu outbreaks. One of them is to rewrite the NHS guidance on A&E design to accommodate not just pandemics but also major incidents. It’s woefully lacking in that respect, especially in waiting area provision.

When working on the new A&E at Glasgow Royal I asked how they would cope with the arrival of mass casualties after a major incident. I was told they would accept what patients they could with any surplus being directed to other hospitals. I then asked what happened if the incident occurred during the flu season when the other hospitals would be stretched to capacity. The reply I got was “We’ll cross that bridge when we come to it”.

I got the same answer when working on the new A&E at Ayr hospital and also when designing a new A&E for St Thomas’s hospital in London. In all of these instances any contingency planning turned out to be aspirational rather than pragmatic.

In the case of St Thomas’s we suggested adding a couple of floors to a new ward tower being built directly over A&E. This would be "shelled space" for use during any major emergency. Whilst being complimented on this "innovative idea", we were nevertheless told that the current financial plan could not accommodate it, even though they admitted it would save them money in the longer term.

This is what I found so frustrating about the NHS. Whilst clinical staff were often receptive and even enthusiastic about the suggestions we put forward, our proposals would invariably run aground when the administrators got involved. For them innovative design that could produce better patient outcomes was always secondary to staying on time and to budget. Their fear of the runaway train was palpable.

Robert Menzies, Falkirk.

Read more: The move to super-hospitals has failed us

Cyclists must remain alert

THE issue over bikes ("E-bike couriers scare me yet I’m on their side. Here’s why", The Herald, November 3, and Letters, November 6) seems to me to be about considerate use of shared space, rather than a competition about who causes most harm.

The shared space in question are pedestrianised areas, which in legal terms are still classed as a road viz, a way over which there is a public right of passage by whatever means. Custom and practice in regard to shared use of pedestrianised areas means that people on foot using these rarely expect to confront other users who are not on foot.

In regard to e-bikes, the ones being discussed are those which can achieve a constant speed of around 15mph, are silent and, in the main, not fitted with bells. This means that the rider needs to be alert at all times and ride the bike in a careful and considerate manner. The debate currently appears to be between those who say riders are being careful and considerate and those who argue they are not. If one is riding an e-bike at a constant speed, one should be in control of the speed and direction of the bike and consider other users of the area. If, however, your hood is up, your head is down and you are looking at your phone, you are not in control as previously described, Paying due care and attention is crucial.

Stuart Brennan, Glasgow.

Police ignoring lawbreaking

CATRIONA Stewart’s article was derived from two basic facts.

First, cyclists, whether basic or e-powered, are not allowed on pavements and must obey the Highway Code in the same way as vehicle drivers. This rule has not been sufficiently advertised or subsequently policed.

Secondly, cycle couriers are taking the place of small vehicle delivery drivers yet they do not possess the insurances, licences or pay road tax as required by the latter.

The results are that we frequently see both types of cyclists steering through roads in the wrong direction or using pavements, with little care for pedestrians or traffic. When they cause an accident they cannot be easily sued. A driver can be fined for using a mobile phone in transit but cyclists do it frequently with impunity.

My town has pedestrian precincts with delivery access only in one direction but cyclists (and mounted police) use them in any direction. Outside the central police station is possibly the safest for cyclists to break the law without prosecution. Perhaps we should be replacing traffic/parking wardens with cycle controllers.

JB Drummond, Kilmarnock.

Fraction infraction

APPARENTLY there are lies, damned lies and then the astonishing statistic reported in today’s Herald (November 6) that "British women are having almost one fewer child than they wish to". Pardon? Almost?

Fortunately the article later explains that south of the Border "women… wish to have 2.35 children", as opposed to the England and Wales fertility rate of "1.55 children per woman". Ah, of course, the missing 0.8 child conundrum. That explains it. Perhaps it would have been more appropriate for this article to have appeared in The Herod, not The Herald.

Alastair Clark, Stranraer.

Verbal confusion

I WAS amused, shortly after Halloween, to hear an advert on the television. It was for a well-known insurance company, stating that it had just been nominated as "the Witch Insurance Brand of the Year".

Alas for all the guisers with inadequate cover, it was just the English announcer who pronounced "wh" as "w".

David Hay, Minard.