In defending Labour’s proposals to contract with the private sector for NHS treatment, Polly Toynbee’s recollection of the Blair government’s similar approach (Don’t panic when Starmer refers to NHS ‘reform’. He is thwarting Tory moves to destroy it, 16 January) is a good deal more positive than the impression some of us gained from detailed scrutiny of the consequences at the time. Yes, overall waiting lists were reduced, but at a significantly higher cost to the exchequer than that of equivalent elective provision within the NHS. The government was actually incentivising those NHS clinicians working part-time in the private sector to build lengthy waiting lists as they were generously rewarded for treating patients from them within their private practice. The complete nonsense of the so-called independent treatment centres (ITCs) was vividly brought home to me by a Wakefield constituent who had spent almost two years in pain awaiting a hip replacement on the NHS waiting list of a local orthopaedic surgeon. He qualified for referral to the new ITC based at a nearby private hospital and was astonished to find himself being treated there within the private practice of exactly the same clinician who hadn’t had the time to see him within the NHS. Labour really should understand that using the private sector for NHS patients directly undermines the service, because the vast majority of private medical providers rely on clinicians who also work in the NHS. One longer-term answer to tackling waiting lists would be to ensure that, when clinical staff are initially trained at considerable public expense, they are contractually committed to subsequent full-time NHS work. The party must consider this. David Hinchliffe Former Wakefield MP; former chair, Commons health committee • There is already a “means of better-off patients making some modest contribution to their treatment” (the words of Ken Clarke, quoted by Polly Toynbee). It is called graduated income tax. What I think Ken Clarke really wants is a means of better-off people not paying more towards other people’s treatment. Jeanne Warren Garsington, Oxfordshire • Keir Starmer’s prescription for the NHS is both vacuous and dangerous (Keir Starmer pledges to tackle ‘bureaucratic nonsense’ to save NHS, 15 January). The major “reform” needed is significant long-term investment to reverse the managed decline initiated by Tory austerity measures. According to the Health Foundation thinktank, the UK spent £40bn less each year than comparative European countries over the decade before Covid; figures show that per capita health spend has been about 18% less in the UK. Instead of castigating GPs and suggesting that patients can go direct to a specialist or diagnose their internal bleeding at home, Labour should first and foremost commit to long-term substantial investment. Promoting primary care and public health, and tackling the social determinants of health, would enrich lives, improve the economy and pay for itself in due course. Dr John Puntis Co-chair, Keep Our NHS Public • To deal with waste and bureaucracy in the NHS, we need to end privatisation and outsourcing. Over the last 12 years, since the passage of Andrew Lansley’s Health and Social Care Act, the NHS has undergone significant privatisation. Independent sector spend by NHS trusts increased by 659% between 2012 and 2021. Privatisation creates waste. Research from the Centre for Health and the Public Interest shows we waste £4.5bn on managing the internal market created by NHS privatisation. Meanwhile, a recent Oxford University study has linked the preventable deaths of 557 people to the outsourcing of NHS services. It is clear that we need to reinstate the NHS as a fully public service. Johnbosco Nwogbo Lead campaigner, We Own It