THE governance structure of the NHS in Scotland is not fit for purpose.

The scandal of the new, but flawed, Edinburgh children’s hospital has produced demands for the resignation of the Cabinet Secretary ("Call for inquiry as new fears hit troubled hospital site", The Herald, August 5). But this misses the point. It is one thing for the Cabinet Secretary to ensure patient safety by delaying its opening. It is quite another to penetrate the complex governance and management structure of the NHS to establish who is actually responsible for this mess. Recent publicity around bullying at NHS Highland and senior sackings at NHS Tayside are further indications of major failings in governance and accountability.

NHS Scotland absorbs around £14 billion of funding, which is more than 40 per cent of total government spending. Who carries the can for ensuring this money is properly spent? Who is directly responsible for the delays and overspend at the new Edinburgh hospital? If it is the chief executive of NHS Scotland, he is remarkably invisible.

Sir Ewan Brown, St Andrews.

OVERSIGHT of construction of the new Edinburgh Children’s Hospital is and remains the responsibility of NHS Lothian. The contractor had previously been found wanting in another contract for inadequate ventilation yet the problem in Edinburgh was only flagged up at the final inspection prior to handover. At that stage the Health Secretary decreed that it could not open until the fault was rectified. It appears, from the back story, that others wanted it to open anyway. Can you imagine the furore and screaming headlines if she had allowed the hospital to open with defective ventilation in a critical area?

This whole farrago is a political game designed for political advantage and perhaps in an attempt to shift blame from where it really belongs, with those that run the health board and the contractor.

D.S. Blackwood, Helensburgh.

WHAT is it about Scotland and hospital building that has gone so wrong? The new Sick Kids in Edinburgh, to be based at the newish Royal Infirmary, has problems with ventilation and drainage which have delayed its opening, and the Queen Elizabeth University Hospital in Glasgow has had to close a cancer ward because of water-borne bacterial infections. These water-borne infections were already an issue at the Royal Hospital for Children in Glasgow in 2018.

The embattled Health Secretary, Jeane Freeman, has ordered an independent review into the design, build, commissioning and maintenance of the Glasgow hospital. Why is it that we are worse at creating safe hospitals than we used to be? Ms Freeman is unlucky to have been parachuted into her post at a time when the Scottish health service already had serious problems. Perhaps we should have an independent enquiry into the conduct of the health ministers who were in post when the new hospitals were being designed and commissioned, namely Nicola Sturgeon and Alex Neil?

Jill Stephenson, Edinburgh EH14.

THE rising incidence of inflammatory bowel disease (IBD) is concerning ("Bowel diseases will soon affect one in 100 Scots", The Herald, August 1), not least the effect it can have on young lives. As a chronic condition but with serious flare-ups which come unannounced, ulcerative colitis and Crohn’s disease can disrupt life, work and relationships badly.

Collaboration between patients, physicians and Crohns and Colitis UK (C&CUK) has this year produced flare information and pathways for care and treatment which should mean earlier and better treatment in primary and secondary care.

Two aspects are worth highlighting. C&CUK has campaigned recently to make the point that individuals using disabled toilets may appear unhindered – but frequent urgent diarrhoea is a nightmare to manage, especially in a public place. Challenging someone emerging from a toilet is short-sighted.

Good medical and nursing support and empowering patients with such difficult diseases to get the best from the NHS, requires easy accurate communication – which includes patient and carer. The Chief Medical Officer has backed the need for specialist out-patient letters to be copied to the patient or indeed written to the patient with a copy to the GP. This is common practice in England but we seem to be well behind in Scotland. This is an urgently-needed change.

Dr Philip Gaskell, IBD Clinical Champion, Scotland, RCGP and C&CUK, Drymen.