MY recent comment that “there is little currently at fault in our NHS that could not be solved by hiring more staff and giving them better facilities” (Letters, October 13) produced the expected negative responses that the NHS costs too much and there are too many administrators. In response to NHS costs I would point out that a recent major international survey analysing costs and outcomes of health provision suggests that our comparatively excellent standards of care and outcomes are produced for budget-level costs. Comparisons with former levels of administrators fail to acknowledge that the NHS, which is the largest employer in Scotland, has since its inception been transformed from what was initially essentially a collection of consultant-led fiefdoms to a national institution debatably subject to increasing political monitoring and interference.

The current travails of the new Southern General Hospital (the name change being symptomatic of the disease) is a case in point (“New hospital apologises for worst A&E performance since opening”, The Herald, October 14). Rationalisation of A&E services as well as the centralisation of medical and surgical specialties, no matter how the decision is dressed up, was driven by the ethos of “a bigger bang for fewer bucks”. It now appears that the anticipated “bang” in A&E is nowhere near as loud as it needs to be. What should be of greater public concern and interest rather than how long an A&E patient waits to be treated is just how much time clinical staff are able to devote to each patient compared to other locations that are meeting government targets.

Sometimes bigger is not necessarily better. Sometimes what looks good on paper does not transfer to reality. Nurses walking miles during a shift, internal transfer of patients taking longer and emergency theatres where anaesthetists can find themselves working with surgeons they have never met before, never mind having previously worked with, are all problems of scale, a scale created to reduce costs.

We never hear of the private medical sector complaining about lack of funds, staff shortages or government interference so don’t tell me that lack of resources is not a major NHS problem.

David J Crawford,

Flat 3/3 131 Shuna Street, Glasgow.

THE Queen Elizabeth University Hospital has apparently recorded its worst Accident & Emergency performance since its opening in May. You might be forgiven for supposing that a bad performance would be characterised by poor clinical outcomes for patients. Not so. Managers and politicians are exercised by the fact that for the week ending October 4, the emergency department disposed of 77.2 per cent, rather than the target 95 per cent, of its patients, in under four hours.

In the opening concert of its new season in Glasgow on October 3, the Royal Scottish National Orchestra performed Mahler's Symphony No 2, Resurrection. My programme note tells me the duration of the symphony is 80 minutes. Imagine if The Herald's distinguished music critic Michael Tumelty had written: "This is the worst performance of Mahler 2 I've ever heard. It took 85 minutes." This obsession with emergency department waiting times is as insane as that.

I note that in June a "team of experts" were sent into the emergency department to improve waiting times. Exactly what was the team's expertise? I bet you it wasn't medicine or nursing.

Managers with their clip boards and stopwatches, and politicians who seek to make political capital out of this "shocking state of affairs" need to be told, politely, where to go. They are not the solution; they are the problem.

Dr Hamish Maclaren,

1 Grays Loan, Thornhill, Stirling.

AS the SNP conference commences, we learn of record A&E waits at Glasgow’s new Queen Elizabeth University Hospital.

It’s a rare week when the Scottish Government’s target for the country of 95 per cent of patients seen within four hours is met and a performance level of only 77.2 per cent in Scotland’s newest hospital raises serious question about the quality of decision making and resource allocation by SNP Health Minister Shona Robison.

Naturally Ms Robison has recently questioned the validity of performance targets. After eight years in government, data of this kind will make uncomfortable reading for her and her party.

As winter approaches, we must hope Ms Robison puts forward a more coherent plan of action at the conference to tackle such serious levels of underperformance than she has hitherto.Otherwise it seems like Scotland’s elderly and vulnerable will face extended waiting times over coming months in our hard-pressed A&E departments.

Martin Redfern,

Royal Circus, Edinburgh.

A SPOKESMAN for NHS Greater Glasgow and Clyde states that management of the Pauline Cafferkey, the nurse fighting Ebola for the second time, and the clinical decisions taken, were “entirely appropriate and based on the symptoms she was displaying at the time” (Ebola nurse has been let down, says family”, The Herald, October 12). The patient had telephoned NHS24 to be told that a nurse would be in contact within four hours; but she decided it was an emergency and went to the New Victoria Hospital general practitioner out of hours service, where she was discharged after being examined by a doctor.

Some years ago an acquaintance telephoned NHS24 because she was bleeding heavily after an operation. She was told by the call handler - responding to a computer “algorithm” - that her situation was not urgent. Luckily, after some delay, a doctor intervened and on admission to hospital she was transfused with four pints of blood. NHS24 said that the case had been classified as not urgent because the patient was, at the time of her call, not experiencing symptoms other than bleeding. And recently a friend who took his daughter to the new Victoria out of hours unit found it impossible to explain her underlying condition because of the doctor’s limited understanding of English.

These three cases illustrate barriers to communication between patient and health professional: by interposing computer-generated questions from call handlers and failing to ensure that locum doctors have adequate command of English. Also, patients should not have to decide for themselves, as Ms Cafferkey did, whether or not their situation is an emergency. Nor should they have to respond to algorithms of unknown provenance generated by a computer. Their first contact should be with an experienced nurse, able to provide the reassurance needed by some and the action necessary for others.

Yet NHS24 is spending an estimated £117 million on implementing a new IT system - beleaguered by a series of weaknesses relating to procurement, programme management and governance (“Watchdog concerned by finances of three NHS boards”, The Herald, October 9). Even if the system were available almost for free, what evidence is there that it would be safer and more acceptable than providing immediate contact with a nurse? Almost certainly none.

John Womersley,

1 Woodlands Avenue, Kirkcudbright.