LOOKING at the increasing shortage of hospital consultants (“Scotland needs an extra 100 children’s doctors”, The Herald, March 5) there is a pattern. It relates to the presence or absence of private practice in the specialty or in the geographical region.

A while back, all consultants in Scotland were paid on the same salary scale, and if you wished to do private practice, then you took a 10 per cent cut in income. Hence, working full-time in the Highlands, or the less popular specialties, or in research, meant no financial loss, and all consultant posts were equally attractive.

No longer. The Conservative Government then allowed all consultants to do private work, without any salary cut. This favoured working in the cities and in specialties which offered the chance of private practice. In the referendum on this unfortunate proposal, the Scottish consultants bravely voted against it, but the Harley Street lobby in the British Medical Association prevailed and allowed it through. The health service in Scotland, particularly outside the cities, is now stuck with the distorting and damaging effect of private practice.

David Hamilton FRCS,

142 North Street, St Andrews.

W applaud Fidelma Cook for giving an honest and moving account of what it is like to live with chronic obstructive pulmonary disease (COPD) (“Lung disease makes my spirits rise and fall with each breath”, Herald Magazine, March 5). Ms Cook’s account of the tightness of breathing that occurs during a flare-up of COPD paints a vivid picture of the daily struggles that lung disease can bring.

British Lung Foundation statistics estimate that 1.2 million people are living with COPD in the UK, with 129,000 estimated cases in Scotland. However, it is widely accepted that this is an underestimate of the actual number of people in the UK living with COPD. Estimates vary, but up to two-thirds of cases of COPD are undiagnosed. There are many more people who, like Ms Cook, find themselves getting breathless doing normal everyday tasks, yet don’t think to go to their GP to get their breathlessness checked out. Getting more people to take a spirometry test when they visit their GP would be a start in getting more people treated for lung disease at a much earlier stage.

No-one should ever have to feel breathless from lung disease, yet it remains the UK’s third-biggest killer. With an ageing population, the public health burden of COPD and other forms of lung disease is expected to increase in the coming years, with the costs of treating COPD alone expected to rise to £207 million by 2030. Although huge progress has been made in tackling the biggest risk factor associated with COPD – smoking – awareness of the impact of lung disease remains low and some types of lung disease are not directly attributable to smoking. We urgently need a plan to raise awareness of the signs and symptoms of lung disease and ensure that respiratory care is given much greater priority by the Scottish Government and NHS Scotland.

Joseph Carter,

Head of British Lung Foundation Scotland,

Baltic Chambers, 50 Wellington Street, Glasgow.

I SYMPATHISE with Jean Morgan (Letters, March 1), having to live with anaemia and the uncertainty of not knowing why, and her recent experience at the Queen Elizabeth University Hospital. She is describing two aspects of current NHS specialist practice. The pathway for a number of suspected diagnoses means that a first appointment is for a procedure such as endoscopy. Nurses often perform these and a report goes to the consultant who has requested the test or direct to the GP as appropriate. This is efficient and safe when there is good communication.

Private firms using NHS facilities provide what is described as extra capacity. So also do local NHS admin, nursing and medical staff providing additional clinics at weekends. Local private hospitals have been used for years along with the National Waiting Times Unit by health boards to reduce the longest waits for first appointments or surgery.

The Scottish Government has now ploughed millions into a three-year plan for health boards to get this (political) problem of excess waiting times under control. Most health boards will be resorting to these strategies. That is the reality but we could decide that these big sums should go to boost social care. Health and Social Care Partnerships (HSCP) are likely to reduce access to care at home from April. This is accomplished by tightening the entry criteria and reassessing to trim patients' total hours. HSCPs are consulting us, their public, at present, without even knowing their new total budget figure. My own HSCP have an impressive enough online consultation but lacking any financial figures or emphasising that trade-offs between different services are required to balance the books. That is disingenuous and disappointing when there are national standards for community engagement (participatory budgeting) which raise this bar well above trying to pin the tail on the donkey.

Dr Philip Gaskell,

Woodlands Lodge, Buchanan Castle Estate, Drymen.