Times letters: Tying hospital funds to patient satisfaction

Times

7 hours ago

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Sir, There is a big difference between motivation and financial incentives ('Hospitals' funds tied to patient satisfaction', news, Jun 28). Most health and other professionals are primarily motivated by wanting to make a difference in the world and have an impact in their chosen field. They are not indifferent to money, but are far more likely to be demotivated by lack of money than motivated by financial rewards.
Improved technology and better systems are vital, but the NHS is essentially a people-based service. The new NHS plan will only succeed if the people who have to implement it are personally committed to doing so — providing the extra discretionary effort and passion that money can't buy. The NHS plan of 2000 was similarly far-reaching: it enjoyed enormous support from many NHS professionals and organisations and kickstarted the major improvements of the following years.Lord CrispChief executive of NHS England and permanent secretary of the Department of Health 2000-06
Sir, It's hard to see how cutting the income of a poorly performing NHS trust will result in its treating its unfortunate patients better: the reverse is far more likely. A fairer and more intelligent policy would be to replace the managers of badly run trusts with others who have a track record of serving the public competently.Richard ParlourLincoln
Sir, Too often elaborate and expensive plans are made without any patient involvement. If the ten-year NHS plan is to be successful then patient representation on every single 'change' project should be encouraged. The patients' voice needs to be clear and loud, so as to have a real impact on future services.Professor Mabs ChowdhuryConsultant dermatologist, Cardiff
Sir, To achieve success during the 20-plus years that I was a clinical director in an NHS commissioning group, I spent my life explaining to the non-clinical managers why their initial ideas might not work for clinicians. Labour's suggestion will only work if the managers are willing clinicians who know the system; to think otherwise is folly. One need only look at what happened when the pandemic struck, and managers abandoned ship to the doctors and nurses, to realise this.Dr Shelley HaylesOxford
Sir, You report that patients will decide how much hospitals are paid by rating their treatment and that an improved NHS app will give patients more choice over who treats them and where. On the first issue there has never been a problem with staff motivation but there has been a perennial one with facilities provided (namely, operating theatres, beds and equipment) — which is hardly the responsibility of those providing the care. On the second issue there have been many studies to show that patients prefer local treatment, where any complications can be dealt with promptly by the same team and overall travel kept to a minimum.
These proposals will be ineffective and wasteful. Instead we need to eliminate inefficiency and provide adequate facilities for a professional workforce that should be trusted and not treated like difficult teenagers.Neil ThomasRet'd consultant orthopaedic surgeon, Itchen Stoke, Hants
Sir, I enjoyed Ben Macintyre's account of Anglo-Iranian relations ('Iranian distrust of the British runs deep', Jun 28) but I fear he is too accepting of some of the propagandist claims regularly made by the Islamic Republic. He omits to mention British support for the Constitutional Revolution between 1905 and 1909, particularly the role played by the extraordinary Philo-Persian Cambridge scholar and activist Edward Browne. He might also have recalled Lord Curzon's intense interest in the country. He cites British support for Reza Khan in 1921, but after the chaos of the previous ten years many Iranians welcomed the stability he brought.
Macintyre claims that Mohammad Mosaddegh was 'left-leaning'. He was certainly reformist and nationalist, but he came from an old Qajar family and had been a high functionary in the last days of the dynasty, suggesting paternalism rather than socialism. We and the Americans were certainly involved in his overthrow. But that would not have happened if substantial elements in the army, the religious establishment and the population at large had not supported the Shah. Finally, the present regime is well aware of the decline in our international influence. They shout loudly about us not because they believe we are really capable of damaging them but because it is helpful to them in rallying nationalist sentiment.Sir John JenkinsFormer British ambassador to Syria, Iraq and Saudi Arabia; Matfield, Kent
Sir, Ben Macintyre's article brought back memories from the late 1960s, when an Iranian student friend told me that in Iran, should someone trip over a stone, you could be sure that an Englishman had put it there.Richard AlbrightRottingdean, Brighton & Hove
Sir, As a teacher I found that gaining the trust and support of parents whose children who were a threat to good order in school was enough to resolve the problem. Jenni Russell's comment piece ('Fear of knives is destroying the social order' Jun 28) reminds us that the more young men carry knives, the more others feel forced to do so. When teenagers appear in court charged with knife crimes their parents are not obliged to attend. These are the people who have brought these young people into the world and have engaged with the responsibility of bringing them up. Owners of dangerous dogs can appear in court; why not the parents of dangerous teenagers? Then courts could demand their co-operation and support.Peter InsonEast Mersea, Essex
Sir, I was much impressed by Jenni Russell's views on the disturbance of social order by petty crimes. Perhaps two days in supervised stocks might provide an effective solution; why waste money on incarceration when the low-cost public shame and indignity of this suffered by offenders might well make them mend their ways within a very short time?Peter HardymentCobham, Surrey
Parliament's lingo
Sir, The proposed 'inclusive' makeover to parliament's 'outdated' language must be resisted ('Division bell rings for 'confusing' parliamentary terms', news, Jun 28). Such an unnecessary change is likely to be irreversible, and is yet another damning example of the Labour government's contempt for tradition and also its utmost uninterest in maintaining high standards of literacy for the future.
The perverse logic underpinning this decision will no doubt have deleterious ripple effects in the education sector further down the line. The literary canon will not be taught in schools on the grounds that the 'confusing' language in these texts 'alienates' students; resultant successive generations of university students will be less willing and able to read; and the longer-term ability for students and academics to engage critically with literature — let alone write about it elegantly — will decline and fall. Edward Gibbon will be turning in his grave.Dr Edward HowellOxford
Two-tier justice
Sir, Lord Hermer, the attorney-general, describes the claim that there exists a two-tier justice system in this country as 'offensive' (Jun 28). But there is indeed a two-tier system, as justice is available only to those eligible for legal aid and those to whom the cost of it all is immaterial. The great majority of the population comes into neither category. Lawyers are fond of repeating that justice delayed is justice denied: it is also the case that justice too-expensive-to-be-afforded is also justice denied.John Davies-HumphreysChester
Sir, Tim Davie's advice to employees to avoid conflict with friends and family over Gaza is no doubt well intentioned ('BBC staff told not to fight with family and friends over Gaza coverage', Jun 26). Given the BBC's Glastonbury coverage of Bobby Vylan's chant of 'death to the IDF', why should employees feel unable to defend their employer? If they are uncomfortable doing so, should they not seek to change the organisation from within — or alternatively consider whether they should change their employer?Andrew LeslauHenley-on-Thames, Oxon
Sir, If, as reported (Jun 27), disability benefit changes will now apply only to new claimants, it is questionable whether the same criteria should not have been applied to the imposition of VAT on school fees, thereby preventing the enforced displacement of thousands of pupils.Keith WellingsHalesowen, W Midlands
Sir, Further to your report ('Give 65-year-olds MoT 'to keep them living at home' '), as a 67-year-old who plays hockey and cricket at club and international age group level, erects the marquees for the village fête, cleans the local church using an extendable ladder and goes mountain biking on Salisbury Plain, am I allowed to question the age criteria of the proposed care home assessment?Mark BanhamBeechingstoke, Wilts
Sir, Regarding people dining alone being given a bad table (Notebook), the trick is, when entering, to ask for a table for two and order a glass of wine right away, 'While I wait for my friend'. When it comes, smile apologetically, pick up your phone and say you've just learnt that your friend can't make it and you'll be eating alone. You'll never be asked to move.Michael JohnstoneLondon NW1
Sir, Dafydd Thomas's letter (Jun 28) reminded me of a dinner party in Nashville at which I was the only one of the 12 guests who did not carry a gun. The hostess said that she advised her children when returning home late to shout up 'It's only me, Mother'. Otherwise, she said, 'I'll shoot 'em'.Averil MansfieldLondon W2
Sir, Your editorial (Jun 28) accuses the M&S Red Diamond Strawberry and Creme sandwich of 'desecrating' the legacy of the 4th Earl of Sandwich, thus perpetuating the legend that the Earl created the delicacy. The Romans, among others, might contest that claim. The first Earl of Sandwich, however, whose scorched remains, recognisable only by his clothing and medals, were washed ashore after his ship was set on fire at the Battle of Solebay in 1672, could lay claim to the dubious honour of being history's first example of a 'toasted' Sandwich.Jonathan CooteErith, Kent
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