Streeting must demand accountability at all levels of NHS management

Plus: Free speech faultlines; pension pot pooling; Aden evacuation; calculating the overall costs of assisted dying; and homes for hens

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SIR – I welcome the news that Wes Streeting, the Health Secretary, intends to get tough with failing NHS managers, who will be sacked if they drop down hospital league tables (report, November 13). However, I hope he will also get tough with those managers’ managers, who will have been tolerating and protecting those below them. Yes, accountability is the word – throughout the organisation, and right to the top.
Mike PowellQuorn, Leicestershire
SIR – Having managed health care services in the for-profit sector in America, I can confidently make the following observations.
First, it is clear that chief executives of any organisation in the commercial sector, who were consistently failing to deliver agreed objectives or meet their budget, would not remain in their jobs for very long, and would be held accountable by a board of directors.
Second, no one mentions the chairmen and non-executive directors of NHS trusts, of which there are 215, plus 42 Integrated Care Boards. May one ask what they are doing to hold their officers to account, as any board of directors must, as part of their non-executive duties?
The NHS is spending an enormous amount of money each year on an ineffective governance system – which one might deduce is the reason the CEOs have not been held to account.
Stuart VereLondon SW19
SIR – Advocates of NHS league tables believe they stimulate competition and patient choice. Such comparative, tool-based improvement will occur through adopting “best practice”, with the quality and cost-efficiency of services thus improving.
Unfortunately, we have been here before. Hospital league tables were introduced in the mid-1990s, followed in 2001 by the “star” ratings system, later jettisoned after having had no discernible effect. We have also tried them in education, the Home Office and local government. They didn’t work then as a method for improvement, and won’t work now.
This is yet another example of what is labelled “policy-based evidence-making”.
Hamish DibleyEversley, Hampshire
SIR – Wes Streeting has announced that “there will be no more rewards for failure”.
Meanwhile, you report (November 13) that Sue Gray may be considered for a peerage despite losing her job as Sir Keir Starmer’s chief-of-staff, having been accused of “not planning well enough for the party’s return to government” and “miscalculating the level of access to Downing Street given to Lord Alli”.
No wonder the Prime Minister has the “two-tier” sobriquet.
Dr Richard A E GroveIsle of Whithorn, Wigtownshire 
sir – The blame for the police turning up on Allison Pearson’s doorstep on Remembrance Sunday (“Police accused of ‘appalling’ attack on free speech with probe into Telegraph journalist”, report, November 14) lies with our legislators, rather than the police themselves. It is Parliament alone that has created the Alice-in-Wonderland world in which we now all live.
Ms Pearson’s alleged offence is reportedly being investigated under Section 17 of the Public Order Act 1986, relating to material allegedly “likely or intended to cause racial hatred”.
The Crown Prosecution Service defines a racist hate crime as “any criminal offence which is perceived by the victim or any other person to be motivated by hostility or prejudice based on a person’s race… perceived or otherwise”. They agreed this definition with the National Police Chiefs’ Council, in order “to identify racist incidents/crimes”.
That pretty well empowers anybody, anywhere, to allege anything, anytime against anybody, so long as the “victim” mentions the word “race”.
Yet on November 2, Dawn Butler, the Labour MP for Brent East, re-posted indisputably racist comments on X that described Kemi Badenoch’s election as the Conservative Party leader as a “victory for racism” and offered “tips for surviving the immediate surge of Badenochism (ie white supremacy in blackface)”.
Nothing was done in response – Ms Butler didn’t even have the whip withdrawn.
Richard LongfieldBasingstoke, Hampshire
SIR – A social media post expressing racial hatred is not “free speech”. Whipping up such hatred led to the awful riots we saw in Southport, with people trying to burn hotels housing refugees. Inciting violence is against the law and, as we have seen recently, can lead to jail.
Do we really want to live in a country where, in the name of “free speech”, social media posts are unregulated, with sites descending into cesspits of vituperative abuse?
Michael MillerSheffield, South Yorkshire
SIR – I served on board the aircraft carrier HMS Hermes in 1967, and the ship was tasked with evacuating the last remaining British families from Aden (Letters, November 14). They were in mortal danger from the insurgency forces, and we were their last hope. The ship was at considerable risk, with divers checking the hull for mines on a regular basis.
The evacuation took place over Christmas and New Year, and the families concerned were relieved and proud to see us, just as we were proud of being able to assist.
My principal memories of that time are of everyone involved being determined to make the best of the situation, and I remember that Christmas as the very best of my life.
Fergus NicolsonGowdall, East Yorkshire 
SIR – Judith Woods is right to decry TV-made celebrities who pen or lend their names to children’s books (Comment, November 12). It is not just professional authors who suffer in comparison, but emerging writers who otherwise struggle for exposure and recognition.
In a competitive marketplace, mainstream publishers are increasingly concerned with publicity and turnover, not literary merit.
Douglas ThowHindhead, Surrey 
SIR – The Chancellor wants the local government pension schemes and other pension funds to merge, to enable them to invest much larger sums in, for example, private equity and infrastructure projects favoured by the Government (report, November 14).
This proposal comes from a major employer – the state – with a poor investment record, huge debts and eye-watering pension liabilities, with no fund from which to meet them. The management of pension funds is a serious responsibility, where stability and the protection of the beneficiaries are paramount.
The Treasury’s intentions may be good, but the trustees of pension funds and their advisers should give its proposals the most intense scrutiny.
David PorterPlymouth, Devon
SIR – Rachel Reeves’s mega-pension funds plan shows a lack of knowledge that is worrying in a Chancellor.
Local government pension funds are currently pooled and professionally managed. These funds are sovereign and their trustees have a fiduciary obligation to the fund, not the Government. If the funds under-perform, the shortfall is made up by local taxpayer funding. This is why decisions are made locally and not by central government, which can display avarice towards the funds since it doesn’t have “skin in the game”.
Cllr Nick Chard Vice-chairman, Kent Pension FundMaidstone, Kent
SIR – In 2015, the then chancellor George Osborne proposed pooling local government pension funds – exactly what Rachel Reeves is proposing.
The concern now is the same as it was then. Will consolidated pension funds be able to invest as they choose, or will they be forced to invest in the Government’s pet projects, which may not give a good return?
James JohnstoneWesterham, Kent 
SIR – This Christmas both our microwaves (Letters, November 14) will be used to cook petit pois and to pre-cook carrots and Brussels sprouts for finishing in a wok.
Also in use will be two ovens, five gas burners, one induction plate, an air-fryer, and possibly the gas barbecue.
In future, if Ed Miliband, the Energy Secretary, has his way, I’ll have to hope the sun shines and the wind blows.
Michael BaconBordon, Hampshire 
SIR – We collected two hens from the British Hen Welfare Trust last weekend. They were due to become cat food when they reached 18 months of age.
They are lovely girls but insisted on spending their first night on top of the hen house. After putting them to bed on their second night, they now retreat to their house automatically. We await eggs in due course.
The grandchildren have named them Honey and Marmalade.
Iain MaitlandSherborne, Dorset 
SIR – Wes Streeting has suggested that legalising assisted dying could force the NHS to cut services elsewhere (report, November 14). I am not convinced.
I hope Mr Streeting takes three things into account.
First, the daily cost to the NHS of prolonged 24-hour care – a great deal of which will take place in hospital for up to six months – and not just the judicial and medical costs of being assisted to die.
Secondly, the continuing drain on the public pension purse.
And thirdly, and most importantly, the cost of prolonging pain and emotional suffering for patients and families alike.
Dr John FletcherDundee
SIR – How is a person supposed to self-administer a fatal dose – as Kim Leadbeater’s Bill requires (report, November 12) – if they are paralysed, as a result of late-stage motor neurone disease, for example?
Those in such a position would be among the most likely to wish to make use of the proposed access to assisted dying.
Mike CollardSturminster Newton, Dorset
SIR – Via Age UK, I used to help people fill in advance decisions.
As the NHS puts it, “the term advance directive [or advance decision] means a statement explaining what medical treatment the individual would not want in the future, should that individual ‘lack capacity’, as defined by the Mental Capacity Act 2005.”
While of sound mind, people in the UK can express, in detail, how they would like to be treated in the event of future mental or physical incapacity – and this includes refusing life-saving treatment.
Yet this very useful document is hardly ever mentioned in the assisted dying debate, so only a relatively small proportion of the population know about its availability or fill one in.
Until assisted dying for unbearable suffering, as judged by the individual, is considered a human right, we won’t have a civilised society.
Yvonne BeaumontMoreton-in-Marsh, Gloucestershire
 
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