I HAVE commented about “the utter folly of the targets culture in the Scottish health service” (Letters, The Herald, November 7). A feature of this folly is that specialist review appointments, that is second and subsequent appointments, are not targeted and are therefore sacrificed (rationed) in favour of new (targeted) referrals.

Thus, clinical decisions to review patients are frequently blocked or overturned by management instructed by politicians. I have retired from clinical work but I remain in the network. If decisions (clinical judgments) to review are blocked (prevented) or overturned (made but cancelled) the doctors who make these decisions are de facto demoted. If advice which is given is followed, doctors giving the advice are responsible; but, conversely, if advice given is countermanded, doctors giving that advice are freed from responsibility. I have not become aware that management and politicians have admitted to assuming responsibility in such circumstances.

Specialist posts are difficult to fill in NHS Scotland, current examples being in cancer services, paediatrics and radiology. De facto demotion of senior clinical staff is not a plus factor in either recruitment or retention. There are adverse financial considerations – senior clinical staff salaries reducing progressively in real terms (purchasing power), income tax increased relative to income tax in England and Wales and compromised pensions.

Senior clinicians are dual purpose: patient management and teaching. These activities decline in tandem, or teaching declines to a greater degree by reason of being of relatively less interest to management and politicians.

Jeane Freeman, Scottish Health Secretary, and her predecessor have highlighted repeatedly that staffing in NHS Scotland is at a record high. Such comments lack substance without a detailed breakdown of who is leaving and who is joining. Cancer specialists leaving are not compensated by cleaners joining, but I willingly concede that the latter group is also essential for a different reason.

I rejoiced when Labour was replaced by the SNP in political power in Scotland but outcomes disappoint across the spectrum. I am older, sadder and wiser. It is time for further change. There are Augean Stables to clean, but where is Hercules? Neither in the leadership nor in the rank and file of the SNP.

Dr William Durward,

20 South Erskine Park,

Bearsden,

Glasgow.