Times letters: NHS to prefer homegrown doctors and nurses

Times

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Sir, As a hard-working British medical student who will have benefited from six years of taxpayer-funded investment and education at UK medical school, I welcome the government's commitment to give priority to British doctors for NHS jobs (reports, Jul 1). Reform to relieve the bottleneck in access to specialty training programmes is long overdue. The plan recognises that solely pledging to increase the number of medical students is not enough to sustainably bolster our workforce. International medical graduates play a crucial role in supporting the needs of a desperately understaffed health service, but this should never come at the cost of stifling opportunities for homegrown talent.Nilay SahUCL medical student; Warwick
Sir, The suggestion of placing work coaches in GP surgeries will be met with dismay by many in primary care. Although the idea of supporting patients is to be applauded, how is space to be found for these coaches? With the rise in other supporting roles, including physiotherapists and pharmacists, over the past few years, practices are already struggling — and that is without any funding for the necessary increase in consulting space. Perhaps the only solution would be for doctors to undertake more remote working from home to free up space, reducing the number of face-to-face appointments — something that might not go down well with patients.Dr Jeremy SK Phipps MRCGPWothorpe, Cambs
Sir, I represent the industry that supplies four out of five NHS medicines and welcome the news that the UK's two drug regulatory bodies (the Medicines and Healthcare Products Regulatory Agency and the National Institute for Health and Care Excellence) will collaborate to improve efficiency. Crucially, their task force must enable more patients to access appropriate medicines, regardless of whether the drug is new. As a result of competition, prices typically drop by up to 90 per cent when a drug's patent expires, saving the NHS more than £18 billion last year and meaning that the UK has the lowest drug prices in Europe. About 250 medicine patents are set to expire during this parliament, which, if adopted without delay, could save the NHS an extra £3 billion a year; just a day's delay in licensing an off-patent medicine can cost the NHS millions. Meanwhile, Nice continues to focus on high-cost, patented drugs because its funding model depends on fees from evaluating them. This structure is fundamentally unsuited to the generics sector that supplies most NHS medicines. Officials across Whitehall and NHS England are working hard to realise the full benefits of off-patent medicines, but looming budget cuts now threaten these very roles.Mark SamuelsChief executive, Medicines UK
Sir, Your news report might give the impression that overseas qualified doctors are being employed in preference to UK-trained doctors. This could not be further from the truth (bar a few exceptions). Your article rightly notes the rising number of unemployed British graduates. This is entirely the result of the increasing practice of employing physician associates to undertake jobs that should be done by resident doctors.Dr Arun BaksiEmeritus consultant physician,Wootton Bridge, Isle of Wight
Sir, I totally agree with Robin Allum's letter (Jul 1) on Martha's Rule. I am a retired consultant radiologist, also with 50 years' experience in the NHS. During that time I was, for five years, responsible for the medical training and welfare of 150 junior doctors. In 1998 I was on a government committee to advise on the application of the European working time directive to junior doctors and their training. The government did not listen to a word of our advice . Thus a young doctor could fulfil all the 48 hours allowed over a weekend shift and have no hours left in the week for essential training on ward rounds, in theatre etc. The young doctors became very disillusioned and did not work as a team, as they had previously. Continuity of care was lost and also the camaraderie involved in teamwork. That working directive changed the face of medicine. Previously doctors had a separate dining room; they could eat a sandwich together and discuss various difficult-to-diagnose patients. That has all gone. As Allum says, the medical profession should be very grateful to the Mills and James families for the pressure to apply Martha's Rule. How sad that it has become necessary.Carole Luck FRCRAscot, Berks
Sir, Michael Johnstone (letter, Jul 1) may congratulate himself on asking for a table for two in full knowledge that he will be dining alone, and thus ensuring he will not be given an inferior table. But it is dishonest. And it denies the restaurant the chance to use that table for a genuine party of two and to increase its income in these difficult times for the hospitality industry — rather like paying for one train seat and then using a second seat for your luggage and denying a paying passenger a chance to sit down. His tactic may work once but he may well find himself, deservedly, asked to move right out of the restaurant the next time he tries it on.Rafael NeubergerLondon NW11
Sir, Further to Michael Johnstone's letter, I always feel it adds credence to my table for two if I order two glasses of wine on arrival. The second rarely goes to waste.James WilliamsAston Rowant, Oxon
Sir, If Bobby Vylan's racist diatribe had contained the n-word or the P-word, we can be sure that the BBC would — rightly — have pulled the plug ('BBC boss left Glastonbury death chants on livestream', news, Jul 1). The BBC's apology is necessary but insufficient. The key point that requires both investigation and personal (not just institutional) responsibility is why a stream of anti-Jewish invective didn't trouble a single pair of ears within the large BBC production team at Glastonbury.Lord Wolfson of Tredegar KCShadow attorney-general; justice minister 2020-22
Sir, In his excellent comment article ('What's Starmer's big idea? He needs to tell us', Jul 1), William Hague says that 'the prime minister could stand up after a year in office and explain the world he has now seen'. Given that the gift of the gab may be not one of Sir Keir Starmer's sterling qualities, which communication channels would Hague suggest to the prime minister, in a world in which adults spend more time on their phones than watching television and reading newspapers? A prime ministerial broadcast monthly or quarterly perhaps? It must be more difficult getting messages and ideas, sometimes complex, across in a world of soundbites on social media.Alan ChapmanLondon SE1
Sir, The letter from IH Piper (Jun 26) illustrates one of the core problems in maternity care: the belief that women's health issues can be fixed with a scalpel and a bit of surgical bravado. Forced episiotomy and repair are not the silver bullets he imagines. In fact, they sit among the reasons women feel traumatised and ignored by the very system meant to care for them. Those who think the answer to maternity failings is 'cut more, stitch better' have not been listening — to clinicians, to evidence and, most importantly, to women. His throwaway line about non-qualified staff also reveals the deeper rot: the devaluation of women's health, where under-resourced services are patched up with cheap fixes and the myth that technical interventions can substitute for compassion, time and trust. We don't need 'birthing technicians'. Rather, we need to support obstetricians and midwives, whose expertise in holistic, safe and respectful care is too often sidelined or undervalued.John Dalton MRCOGLeeds
Sir, You report that players and spectators are struggling to hear Wimbledon's AI line calls ('Players call out whispering AI judges', Jul 1). I suggest a Dalek is employed at each court to announce the calls, as their distinctive diction is easily understood. Also, and to emphasise that they have called out, the Dalek should waggle its forehead-mounted exterminator. The umpire could be issued with a sonic screwdriver to adjust the volume as needed.Mark RileySandhurst, Berks
Sir, Your report on healthcare advice in the Middle Ages ('First catch a lizard: beauty tips from the Middle Ages', Jun 30) calls to mind the writings of the Benedictine nun Hildegard of Bingen (1098-1179). She suggested recipes for healthy eating, with recommendations that 'Butter should be eaten in moderation by those who are fat lest his weak flesh becomes fatter' and 'salt is good but not to excess' (Physica, Book 2), which seem ubiquitous in guidance on modern healthy living. Hildegard also extolled the benefits of camomile, but her advice to 'drink water with the dried liver of a lion as an aid to digestion' did not seem to catch on. Her recipes for 'boiling hedgehog with wine and cinnamon recommended for a good healthy supper' and 'earthworms mashed to a paste with wine, vinegar and flour for scrofula' are less appealing. She said slugs could be used if there were no earthworms to hand (Physica, Book 7).Dr Valerie ShrimplinSt Albans
Sir, Further to Joanna Williams's comment article (Jun 30; letters, Jul 1), communications to clergy from our diocesan office seem more interested in net zero, church buildings and community events than in sharing the Gospel. Nationally, the fact that many of our bishops seem content in debates to jettison Christ's teaching suggests a lack of personal conviction about the core truths of Christianity. Inevitably, this leads to decline. But those churches that unashamedly teach Scripture — however counter-cultural this is — are bucking the trend, being attended by many of all ages. This is not down to great talent on their part, but simply the truth and power of the good news about Christ.Alasdair PaineVicar, St Andrew the Great, Cambridge
Sir, I read with interest Lucy Cavendish's article about Mounjaro and how it affected her family (Times2, Jun 30). I lost three stone over a couple of years using Dr Michael Mosley's advice simply to eat less. I followed a normal healthy diet involving fresh ingredients such as meat, fish and vegetables and ate less each day — eg, instead of two pieces of toast for breakfast, I ate one. I ate a light lunch such as soup and a sandwich and a normal evening meal. It was very easy, and as I cooked for my family they had larger portions. I avoided puddings and ate fruit but had a piece of dark chocolate with my coffee after supper. Much easier than taking Mounjaro and I am still three stone lighter.Diana NaylorWivenhoe, Essex
Sir, Researchers in Canada report that eating cheese in the evening may disturb your sleep (Jul 1). Charles Dickens, then, was ahead of his time when, in A Christmas Carol, Scrooge encounters Marley's ghost and tells him he doubts his senses, stating: 'A little thing affects them. A slight disorder of the stomach makes them cheats. You may be an undigested bit of beef, a blot of mustard, a crumb of cheese, a fragment of an underdone potato. There's more of gravy than grave of you, whatever you are!'Stephen BussSeaford, E Sussex
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