WHEN Tony Blair has his interview with St Peter at the Pearly Gates, he will have a lot of explaining to do. It was the former Prime Minister who introduced targets in the public services. At a stroke, the traditional chain of command was gone and in its place came the tick-box culture with the paper pushers taking over.

When Gordon Brown became Prime Minister, he attempted to row back on the target culture but the virus was already embedded in the DNA of Scottish public (“NHS targets should be scrapped, say doctors’ leaders”, The Herald, December 28).

In quantum physics there is a phenomenon known as the observer effect. In simple terms, the act of observing changes the results. The observer effect has been well documented in NHS targets. Wheels have been taken off trolleys to make them count as beds to tick the box for no patients stacked up on trolleys in A & E corridors as one ingenious example. Targets encourage all sorts of deviant behaviour and distract staff from their real jobs treating patients or teaching kids.

Infection control in our NHS hospitals is now a tick-box exercise. Administrators visit wards and tick boxes. We should have trained bacteriologists taking swabs of the area and doing a proper analysis for pathogens.

Targets were introduced by a politician as an easy way to score success or failure.

Targets are a failure and should be scrapped.

John Black,

The Scottish Jacobite Party, 6 Woodhollow House, Helensburgh.

I NOTE with interest your article on the warning by the British Medical Association's Scottish Council. The ghastly four-hour rule is on the way out. Well three cheers to that, I say. But we must be careful that targets are not replaced by some other equally damaging political initiative. How do you run an emergency department? When I was Clinical Head of Middlemore Hospital’s Emergency Department in Auckland, New Zealand. I used to orientate new doctors to the department every four months. I stopped wading through a morass of fine detail and just presented the Ten Golden Rules of Emergency Medicine:

1. Remember: Emergency Medicine bites!

2. Be on time.

3. Practise the ritual of courtesy.

4. Believe the history.

5. Expose the injured part.

6. Plan for the worst possible scenario.

7. If in doubt, ask.

8. Keep a good record.

9. If you want to panic, think “Airway – Breathing – Circulation”.

10. Ignore any of the above rather than have a nervous breakdown.

In other words, it’s all about the medical consultation, which should be timely, expert, and definitive. Nothing should be allowed to get in its way. Politicians must stop telling emergency physicians what to do, but rather ask them, “what do you need?” By the same token, emergency physicians must show qualities of leadership that can turn the Cinderella service that is “A & E” into the true specialty of Emergency Medicine.

Dr Hamish Maclaren,

1 Grays Loan, Thornhill, Stirling.

MARTIN Redfern (Letters, December 26 can’t help himself, can he? Any excuse will do to put the boot into the SNP – this time an attack on Health Secretary, Shona Robison. Mr Redfern should check how the NHS in England and Wales is doing compared to its Scottish counterpart – not great I understand.

Scotland’s NHS was on life support prior to the SNP victory in 2007. Then Health Secretary, Nicola Sturgeon, reversed the trend established under the previous Labour/Lib Dem administration. Otherwise our NHS would have been in a much worse place than it is today.

Ian Baillie,

1 Tudhope Crescent, Alexandria, Dunbartonshire.

PHILIP Adams (Letters, December 28) seeks to convince that addiction is a behaviour rather than illness.

I wonder if the evidence that 50 per cent of addiction reflects a genetic predisposition is familiar to him. Environment, parenting, expectations and effect of the drug have a further effect. We reckon that these substances rewire the brain as does stress in early life - the first three years. Vulnerability, some due to abuse in earlier life, leaves people exposed to the risk too. Not all who might become patient addicts are represented by the above descriptions but very many are.

There is much reliable evidence for substitute prescribing (often methadone) as a treatment, lowering several risks and assisting the client to change behaviours and in favour of recovery. I will concede that in my nearly 30 years of providing methadone-assisted treatment to my own general practice patients, for very few, recovery has gone as far as safely and consistently stopping all substitute prescriptions. That is sad and represents a burden on the NHS but not that different from other chronic conditions such as chronic obstructive pulmonary disease, often due to smoking.

I pay tribute to organisations such as Signpost Recovery in Forth Valley who work over long periods with addicts at a behavioural level, supporting, guiding, motivating and challenging patterns which have become entrenched.

Philip Gaskell,

Woodlands Lodge,

Buchanan Castle Estate, Drymen.

SCIENTISTS have been advocating the legalisation of psychedelic drugs such as LSD and magic mushrooms as they have found significant improvements when these drugs are given to people with depression and similar conditions. Also, the use of medical cannabis with many conditions including Parkinson's Disease has shown very significant benefits. Surely the time has come for our politicians and lawmakers to reassess their policies on the criminalisation of drugs. After all the "war on drugs" has been a monumental failure which has had the sole effect of putting drug supply in the hands of criminals.

I do wonder if some politicians are ahead of the game. Every time I hear David Davis make a speech about Brexit I am more convinced that something is taking him to an alternate reality.

David Stubley,

22 Templeton Crescent, Prestwick.