Letters: The NHS must not be broken up by stealth We are reaching a tipping point. If all parts of the NHS are not subject to similar oversight, with common standards and effective monitoring, then our NHS will slip away. And by the time we realise what we've lost, it will be too late. There are ways to make the NHS viable without breaking it up under the guise of improving quality. We need to pursue them before we throw away the thing that makes us British and keeps us alive. Marlene Winfield, London NW5 Insiders (my daughter and son-in-law) and users (myself) are not surprised to read (6 July) that NHS England is "about to run out of cash in a very serious fashion." This year the service costs £109bn - serious money - and yet will need at least £30bn more by 2020. On the very point of his departure Sir David Nicholson (highly paid chief executive of NHS England) warns of a choice between "managed decline" and a "radical new strategy." It should now be obvious to public, politicians and press alike that our beloved NHS has become unmanageable, insatiable and unsafe. As "managed decline" is hardly an option, three reforms far more radical than any in current circulation are essential. The first is to break NHS England up into manageable, human-scale units answerable, say to county councils; highly specialised services, such as child heart surgery and treatment for rare cancers would be organised on a regional or central basis. Second, to avoid heavy tax rises, significant new money must be brought in through payment for many non-emergency services (e.g. GP appointments, hospital hotel charges, IVF, cosmetic surgery, treatment of non-citizens). Third, NHS management should be returned entirely to professionals with first-hand experience of the job, as was the case in pre-NHS days; furthermore, all who work in hospitals should be NHS employees under direct supervision of the management. David Smith, Clyro, Powys While attending a hospital appointment yesterday I became unwell (I have MS -not at all heat friendly). At my request my appointment was cancelled with no fuss or recrimination and I went home to cool down. Within three hours I was contacted by the hospital trust appointment service who rescheduled my appointment into August and made it for an earlier time "when it might be cooler." All this happened in the much maligned Morecambe Bay Hospitals Trust. By all means draw attention to, and put right mistakes and ill-thoughtout practices but don't assume that all our hospital staff are uncaring ill-trained robots. Brenda Lynton-Escreet, Crag Bank, Lancashire Fracking destroys one man's dream I'm afraid David Winter will be disappointed in his dream of high-speed water from the north coming down to the south via a pipeline alongside the HS2 line (letter, 18 July). Any spare water will be used in the north in the shale-gas fracking process which will extract huge volumes of gas, thus ending the "energy crisis," and it therefore will take priority. Charlie Coultas, Wokingham, Surrey As the G20 announces a global crackdown on tax-dodging multinationals and Mr Cameron insists that such firms in the UK must pay their fair share, his Chancellor announces huge tax concessions for the benefit of companies involved in fracking. Just what has Rowling suffered? It might be a nice legal question for the Solicitors Regulation Authority to decide how "disappointed and angry" JK Rowling (report, 19 July) could be compensated for her solicitor's indiscretion, given that she has "suffered" a substantial financial benefit in terms of increased sales of The Cuckoo's Calling, without any damage to her reputation. Ken Cohen, London NW6 Funny education Your cartoon of a child being tested on her first steps (20 July) reminded me of the educator Herbert Kohl's claim (facetious but effective) that if schools taught walking and talking we'd have as many children struggling with those skills as we have with reading and writing. Now it just feels prescient. Sue Clapham, Huntly, Aberdeenshire Biden's bid If Joe Biden is worried about having enough energy to run for election in 2016, then perhaps he should copy the British way and stand for election instead. Heated question You report that a "thermal event" in a lithium battery was behind the recent Boeing 787 Dreamliner fire at Heathrow (19 July). Should we now refer to the serious conflagration of 1666 as The Great Thermal Event of London? C Sladen, Woodstock, Oxfordshire Transport ideas need to be less London-centric I am astonished to read your ill-informed criticism of the HS2 project (leading article, 20 July).The premise underlying your whole argument, namely that we can have either new airport capacity or a new railway, is misconceived at the outset. This country requires infrastructure to meet expected future needs, which must include both. Applications to start new services on West Coast Main Line from Euston have just been turned down - because the route lacks the spare capacity needed to accommodate them. There comes a point where it is futile to go on attempting to upgrade 19th-century infrastructure for 21st-century conditions. Better to start from scratch. That's what countries in Asia, Europe and Africa are doing. "Boris Island" is in the wrong place for a national hub airport. What a shame the people in positions of power are incapable of thinking in any terms other than London-centric. Birmingham, at the country's geographical heart, is keen to expand its airport into a hub to rival Heathrow, Schipol, Dubai, etc. The necessary expansion could be done in under 10 years if the will were there. Dave Kruger, Nantwich, Cheshire I cannot think of another major advanced economy where activity is so concentrated in one location. What is Germany or the US's equivalent of London? Manchester saw off competition from the Millennium Dome to host the first super-casino. This was rejected in the House of Lords. Our national football stadium could have been built at a central location in Birmingham for a fraction of the cost. Lord Adonis suggested that the House of Lords should be relocated to Salford. My point is not that none of these things have happened, but that the London-centric decision makers really do regard these ideas as too ludicrous to contemplate. I am surprised you are so willing to abandon long-term political thinking in the face of a short- term (new runway for London) economic dilemma. Brian Carratt, Cheadle, Cheshire Your suggestion that the rail network should continue to make do with incremental upgrades while proposing a major airport replacement is hypocritical. The "third runway" solution is good enough for the trains, but not for Heathrow? And why should the cost of the new airport not spiral in the same way that that of HS2 has? Furthermore, suggesting that HS2 be abandoned in favour of a replacement of Heathrow with a new airport in the Thames estuary fails to account for the impact this plan has on the rest of the country. Heathrow has many users outside the M25 and its location close to the M4/M40 makes it highly accessible from much of the country. Finally, could somebody explain how the prediction that passenger numbers will treble has been arrived at? In an era of dwindling oil reserves, increasing fuel prices and global warming this strikes me as a fantasy. Tim Williams, Birmingham Demonisation of the poorest Yasmin Alibhai Brown has - yet again - found the words to express the feelings that I, and doubtless millions more, have about this wretched Government (15 July). My wife and I are volunteers for Norwich Foodbank, and we have been moved to tears by the plight of local people for whom the food bank is all that stands between them and destitution. We have listened as well-off friends have dismissed our efforts as merely giving to scroungers, and wished that those friends could stand with us as we hear the desperate stories of those for whom the food bank is literally a life-saver. This uncaring Government has achieved a remarkable piece of propaganda. It has somehow convinced the "average working man and woman" that the problems confronting our nation are due to the greed of "benefit scroungers." I seldom hear ordinary people talking about the disgraceful tax-avoidance and evasion of big companies, and the super-rich - whose tax contributions, if fairly paid, would dwarf benefit "scrounging" - probably by a factor of more than 20. W P Moore, Norwich A suitable remedy for greedy bankers In the light of recent promises of action by the Government against the future frolics of errant bankers, I find that case law already exists for dealing with people who damage our financial structure. One has only to scan the Anglo Saxon Chronicle for the end of the year 1125 when King Henry "bade that all the mint-men that were in England should be mutilated in their limbs and each should lose their right hand and testicles." Apparently they "had undone all the land with the great quantity of base coin that they all bought." They were all invited to Winchester after Christmas on Twelfth Night, no doubt thinking they were up for a jolly, and returned home slightly lighter after the King's instruction had been carried out. I am positive the same deterrent would improve banking practices. Graeme Hastie, Edinburgh