Productivity, waste and new ways to empower the patient

In discussing a new National Audit Office report, you seem to assume that alleged falling productivity is the same thing as saying that "waste in the NHS soared in the last decade" ( Productivity in NHS 'has fallen every year since 2000' , 17 December). But there is nothing to back up the claim about waste; nor is there any indication of what productivity might mean in the health service. Last week I had a routine blood test on Monday to check on, among other things, cholesterol and PSA levels. On Wednesday, soon after 9am, I was discussing the results with my GP. I wonder what the NAO would make of the very short time between test and consultation; the fact that I felt I had all the time I needed to discuss the results with my GP; and that the results were satisfactory, so no action or new prescription were necessary. I felt the process was exemplary; but perhaps the NAO can spot a loss of productivity – because the GP spent too long with me? – and your journalists can detect some "waste" – they might say the health centre wasted its time by calling me in for a test I obviously didn't need. Funny old world. Richard Barnes Windermere, Cumbria • Labour is right to draw attention to the Tories' massive U-turn on "no more top-down reorganisations of the NHS". But let's not forget that if the 1997 election promise to remove the internal market had been kept, we would not be where we are today. As one of more than 50 doctors who signed a call, days before that election, for people to vote Labour for just that reason, I certainly felt betrayed by what happened. In doing just the opposite and entrenching the market system with payment by results, foundation trusts and other aspects of commercial competition, Labour left Andrew Lansley an open goal to complete the disintegration of the NHS. If its opposition to the Lansley plan is to have any intellectual rigour and command respect, Labour's new leadership must rethink the expensive folly of trying to marketise our most cherished public service. Peter Fisher President, NHS Consultants' Association • As your report ( Union shock as Lansley scraps ambulances' 19-minute target , 18 December) suggests, the speed with which ambulances get to all 999 calls is important to patients. The current performance measures have helped create an ambulance service that has improved its speed of response to some of the most rigorous time targets in the world and offers better care than ever before. But it's important to note that time still matters to all ambulance services and will remain an important part of the new performance regime. For some patients, there is great clinical need to transport them without delay. All the government has done is take the sensible and welcome step of replacing a target for less urgent cases that has no clinical basis with a range of outcome and quality measures. Speed of response will continue to be part of this mix, but not the only part. Making sure patients are not only responded to quickly, but also get the most appropriate and highest quality care is a key step in creating an urgent and emergency system fit for the future. Jo Webber Ambulance Service network director, NHS Confederation • The list of last week's harmful government decisions ( Letters , 18 December) omitted a new promise to privatise the NHS by passing funding from PCTs to GPs. On the BBC News of 15 December a young doctor enthusiastically recommended this change. It would, she said, open up new pathways which would empower the patient. I have a vision of myself, old, infirm, lying in a hospital cot, spittle-dribbling and mumbling incoherently. Around the bed stand the stakeholders. "What's he saying?" they ask. The young doctor puts her ear to my lips. She stands, smiling: "He's asking for new pathways so as to become empowered!" Chris Weeks Beaworthy, Devon