PERHAPS I could reassure readers that the spectre of Harley Street private practice has never been an issue with the NHS in Scotland, because as David Hamilton (Letters, March 6) suggests, there is a much more measured and responsible culture up here, such that private practice does not impinge on or adversely affect NHS care. If anything it augments and enhances it. The perception that it takes consultants away from NHS work may have been true in the early days of the NHS, but not in my professional life time in Scotland. Having retired from private practice in 2007, I am not in a position to comment on it today, but I know that the consultant contract of 2003 with its job plans is prescriptive, and against the background of the European Working Time Directive, means that consultants, as we are all well aware, work long hours, and often well beyond their contracted hours. Only then, do some in addition, work privately. From 1980, as David Hamilton wrote, all consultants had been allowed to do such work, often in the evenings and at weekends, on top of contributing a full week's work to the NHS. Mistakenly labelled "moonlighting", this was encouraged by the Blair government, which introduced "waiting list initiatives" in the private sector to increase capacity in a failing NHS, and to this day the SNP accepts that the private sector contributes more than seven per cent of the NHS budget.

As always, this reminder can produce a visceral reaction in those who claim that the NHS is being privatised, often making an erroneous comparison with America, rather than focusing on the much more successful European health care systems. However, as with private education, there are many examples of politicians and others on the political left who will justify resorting to the private sector when it comes to their own families, a memorable example being the former deputy leader of the Labour Party, Denis Healy, who stormed out of an interview with Anne Diamond in 1987, when challenged as to why his wife Edna had her hip replacement carried out in a private hospital.

Capacity issues have always been a problem in the NHS, north and south of the Border, and while clearly preferable, my colleagues and I were usually unable to use NHS operating theatres for elective work at the weekends as there was insufficient staff available, through no fault of local managers. The public perception at that time of exhausted and overworked doctors was nascent. Many doctors enjoy their work and find it very satisfying and rewarding in a professional sense. The one gift a doctor can give a patient in a private setting is the inestimable one of his or her time

A survey of American surgeons concluded that the outcomes of surgery performed during the night were no worse than those of the same surgeon carrying out the same procedure on an elective list during office hours. It would therefore seem unlikely that private practice is having a damaging effect on the Scottish NHS.

However, the SNP has to contemplate whether its punitive tax regime for middle class earners is a disincentive. The "land of the mountain and the flood" may appear less attractive to applicants for consultant posts when viewed through the prism of the SNP's progressive tax system.

John Sinclair, retired consultant surgeon,

7, Bridgegait, Milngavie.

I TOTALLY concur with the comments of Dr Simon Hart and Dr Sarah Keir (“Giving stroke patients the best chance possible”, Agenda, The Herald, March 4). It is most concerning that Scottish people are denied this treatment and even before it was withdrawn its use was selective, available only to a very small section of the population.

Soctland’s health and education used to be the envy of many countries, but is in a downward spiral where we are being deprived of treatment, available in the rest of the UK and large sections of the developed world.

Perhaps the First Minister should concentrate more on the day job, rather than spending copious amounts of money on foreign trips, fanciful agendas/projects and urgently make available the funds from her substantial Westminster payments to ensure we all have the best chances of recovery from a stroke. Consequently, this would be cost-effective, saving NHS Scotland substantial amounts in care and rehabilitation.

Moira Downs,

Lochaber Road, Strathaven.