From the Revd Hayley Matthews

Sir, - I was astonished that Canon Angela Tilby's comment "If doctors really put patients first, governments might be less inclined to interfere" was printed (Comment, 1 March).

As a priest who regularly attends the annual social event of hospital doctors, I am privy to the exhaustion, overwork, and sheer increase in demands that the Government places on medical consultants who have found that the excessive hours of medical practice follow them through their training, in the wake of EU directives to protect junior doctors.

Medical consultants now in their 30s and 40s worked in excess of 80 hours per week as junior doctors, and have found that their long hours have not decreased at all, instead of being a temporary rite of passage. Some registrars are barely competent to work unsupervised. In some instances, consultants are called in to carry out routine medical jobs.

Sadly, in practice, no European directives prevent consultants' being constrained to a work-life balance that would prevent the burnout, heart attacks, divorces, stress, and alcoholism that are probably more pervasive in their profession than mine. Those in my social circle work 12-hour shifts on a seven-day-week rota, and rarely if ever leave within two hours of their "finish".

Furthermore, their time at work is spent in a high-paced situation of life-or-death decisions, in departments that lack staff and financial resources, under the added pres-sure of bed-counters' being consumed with the continual "flow of patients".

As an NHS patient, I have had a potentially cancerous tumour run through an MRI during a Christmas holiday at 8 a.m. by staff who responded to my fast-track situation during their Christmas holiday. This was followed by a fast-tracked major operation that had to take place beyond the surgical list, i.e. in surgical consultants' own time. Benign though my tumour turned out to be, at no point did I find the medical staff lacking. I certainly felt that as a patient I was put first.

I find it impossible, however, to gain an appointment with the Jaguar-driving 30-year-old GP, who regularly leaves early. He sees just into double figures of patients per day from his state-of-the-art surgery. He did very well out of Labour, but that is not to say that he is typical.

The Government (this one or the last) is to blame for the state of the NHS, and the way in which doctors' training and career progression has become highly complex, impracticable, and requires not only full dedication to one's daily workload, but keeping up-skilled.

So, let us not target those trying to work in impossible situations for the good of our health, in the NHS, when they could indeed work abroad or become privately em-ployed. Our doctors deserve our support, now more than ever.

HAYLEY MATTHEWS
Holy Angels Vicarage
Moorfield Road
Salford M6 7QD

From the Revd John Hereward

Sir, - While I found some of Canon Giles Fraser's views challenging, I was never as offended by anything that he wrote as I have been by Canon Angela Tilby. As someone who is married to a GP, and who continues to work part-time as a front-line doctor in the NHS while maintaining my priestly ministry, I found her attack on the medical profession quite galling.

I would like to point her and your readers to an excellent article in the British Medical Journal (23 February) by Iona Heath. This gives a fair assessment of what it is like to be at the sharp end of the NHS, struggling to maintain professional, caring, and competent attitudes. It addresses why having routine care available seven days a week would be a costly mistake.

I take particular exception to the assertion that "GPs, in particular, did well under New Labour when their salaries were increased and their hours were effectively cut." While this might be one way of describing it, another might be that they received a fair recompense for the challenging work that they do.

This also completely ignores the year-on-year effective cut in remuneration and increase in hours which is the norm for GPs now.

May I urge your columnist to think twice before joining the bandwagon of those who wish to criticise a hard-pressed medical profession. It does not reflect well on her own professionalism.

JOHN HEREWARD
St Mellitus Vicarage
Church Road
Hanwell W7 3BA

From the Revd Geoffrey Squire

Sir, - I read with interest Canon Angela Tilby's article on the weekend operation of National Health Service facilities.

When the Government was considering Sunday and all-hours trading some years ago, and despite trade-union objections, it declared that no worker had a right to Saturday, Sunday, or public holidays off, or enhanced payment for working on those days. The result was often seven very long days, opening with a shift-work system, and often without enhanced payment rates for weekend or evening work.

Is it not crazy that you can buy a carpet or piece of furniture any day of the week, or in the evening, but find it impossible to obtain medical treatment, except in a real emergency?

I have recently been in hospital, and have nothing but praise for all the medical and other staff. But I now have to receive kidney dialysis three times each week, and trying to change the occasional time or day, or get dialysed in another place, is virtually impossible. While there are plenty of expensive dialysis machines in the hospitals, they are out of use for one, two, or occasionally more days every weekend, owing to hospital departments' operating "office hours".

The result is that I find it extremely difficult to move from my immediate home area for more than a day, and even that has to be on certain days each week. This is just one among hundreds of instances where the NHS fails to cater for people's needs because of this weekend problem. Of course, if you are very rich, private treatment is available at all hours, on all days.

All NHS staff deserve a decent rate of pay, and they are a truly wonderful lot; but those who work in the Health Service should no more be entitled to weekends off or enhanced pay for weekend work than those who work in retailing.

GEOFFREY SQUIRE
Little Cross, Goodleigh
Barnstaple EX32 7NR