26 1GM Monday August 3 2020 | the times
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1 London Bridge Street, London SE1 9GFhad a five-week wait for the result,
demonstrating the strains on
pathology services. But my GP
practice used texting, phone calls and
electronic consultations very well.
However, as such methods are used
more, there must be enough skilled
staff to do consultations and follow
up. There must be morbidity and
mortality studies. And provision must
made for patients who do not have IT
skills and are unlikely to learn them.
Dr John Searle
ExeterSir, Your leading article (Doctor
Zoom, Jul 31) highlights the lack of
access to GPs, but offering telephone
or videocall appointments as you
proposed would risk more diagnostic
mistakes and a fall in recruitment.
Remote diagnosis lacks one of the
most important parts of assessment, a
physical examination. Face-to-face
consultations are also vital in
psychiatric diagnosis, as body
language and behavioural clues will
be lost even by video. Mistakes would
be inevitable; insurers warn that
many lawsuits arise from failing to see
and examine patients.
Turning primary care into call
centres will put off many youngFox in the House
Sir, Claire Fox will not be the first
revolutionary communist to join the
House of Lords (“Son of KGB agent
and Johnson’s brother handed seats
in the Lords”, Aug 1). That
distinction belongs to Wogan
Philipps, who succeeded his father
as Baron Milford in 1962. Having
joined the Communist Party in the
1930s, Philipps served as an
ambulance driver during the Spanish
civil war and stood, unsuccessfully,
as the Communist candidate for
Cirencester & Tewkesbury in the
1950 general election.
In his maiden speech in the
House of Lords, Philipps called for
the abolition of the upper chamber. I
trust Baroness Fox will do the same.
Dr Alison McClean
BristolSir, It seems we are going back to the
days of mass peerage creations, begun
by Tony Blair and continued by David
Cameron who nominated 639 people
(including me) between them. Over
their premierships new arrivals in the
Lords averaged nearly 40 a year, a
volume seen before only during
Harold Wilson’s second term, from
1974 to 1976. By contrast David Lloyd
George, widely thought of as
recklessly profligate, created peers at
the quite modest rate of 16 a year.
Theresa May’s government brought
restraint with 43 creations in three
years. But in one year Boris Johnson
has now added 57. His new list takes
the Conservative total in the Lords to
263, against Labour’s 179. This would
have to be rebalanced if Labour
returned to power as it would need a
large influx to get its legislation
through. The prospects of stabilising,
let alone reducing, the overall size of
the House of Lords do not look good.
Lord Lexden
House of LordsBone-shaking ride
Sir, If shifting body weight off the
ground with a series of jumps and
jolts strengthens bones (“Everything
you should know before you take up
cycling”, Times2, Jul 29), Dr Hind
might want to repeat her bone density
research on non-elite cyclists who
thump our way round the Thomas
Muir railway path near Glasgow. It is
criss-crossed by tree roots pushing up
through the tarmac and I challenge
anyone to find a bumpier ride. As I
judder along I remind myself of the
wrist bone strength I must be
developing.
Virginia Braid
GlasgowMan and wife
Sir, Whatever you think of her
politics, it is sad that Theresa May
was not given her own title, in her
own right, for her own services.
Instead she has been given, in effect, a
courtesy title reflecting her status as a
married woman who, by the rules of
society, adopts her husband’s status.
Pip White
Kettering, NorthantsPlaying by the rules
Sir, I live in Chester, a conurbation
with English and Welsh-administered
areas. Yesterday I visited my English
local pub and drank inside, and wore
a mask to go to a supermarket. Today
I went to my Welsh local, where I had
to drink outside, and needed no mask
to go to the supermarket next door.
Chris Speke
ChesterCorrections and
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Feedback, The Times, 1 London Bridge
Street, London SE1 9GF
Virus spreading
Sir, The test and trace system, by the
admission of those who run it, relies
on people knowing those with whom
they have been in contact (“Tough
new isolation rule to stop virus
surge”, Jul 30). Contacts in shops and
on public transport are not traceable.
It seems likely that the claim that
most transmission is due to contact
between households has arisen
because the other contact data is not
there. Without an effective app it is
dangerous, and divisive, to conclude
that not mixing with other households
is the solution to local outbreaks.
Jill Holden
Radlett, Herts
Sir, Iain Martin is right to suggest that
apocalyptic predictions are “seductive
and exciting” but usually overcome by
scientific innovation and human
ingenuity (“Greta’s message of doom
is religion not reality”, Jul 31). The
18th-century godfather of such
predictions was the Rev Thomas
Malthus whose Essay on the Principle
of Population in 1798 carried the
religiosity ascribed by Martin to
Extinction Rebellion. Moreover,
Malthus’s dire warnings about
exponential population growth were
tackled effectively by human
innovation in the form of increased
agricultural and technological
productivity.
We now possess the advantage of
hindsight and a sense of social
responsibility to avoid the excesses
of the Industrial Revolution, and we
have the technology to succeed.
Bernard Kingston
Biddenden, KentSir, Iain Martin is happy for global
warming to run its course because
“with intelligent use of technology
and mitigation measures, mankind isGreta’s message
more than capable of adapting to
warmer conditions”.
No doubt more fuel-efficient air
conditioning and more green spaces
in cities will improve the experience
for those living in urban Britain, but I
fear they will be of little help to the
tens of millions worldwide whose
lands will be inundated by rising seas,
or those who are already enduring
prolonged periods of extreme heat
(“Temperatures in Middle East top
50C every day for a week”, Jul 31).
Kate Winning
Baldock, Hertsfrom the times august 3, 1920BANK
HOLIDAY
RAIN
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address and daytime telephone number.
The August Bank Holiday of 1920
will long be remembered to its
discredit. Thanks, apparently, to the
divergence of a cyclonic depression
from its normal fields of exercise
over Iceland, and its choice of an
exceptional south-easterly course,
the chief outdoor holiday of the year
has been visited by one of the most
widespread and sustained
downpours of this ill-starred
summer. It is the popular sentiment
that if rain must fall anywhere on
the first Monday in August the
proper place for it is in the Faroe
Isles, where the depression was
centred on Sunday, or in any other
quarter where British Bank Holidays
are not recognized. A wet Bank
Holiday and Bank Holiday week are,
indeed, a national misfortune, for
the loss of fresh air and projected
outings to some millions of day
excursionists is only equalled, if not
excelled, by the unhappy plight of all
those in camps or under canvas. The
pleasures of gipsying are singularly
dependent on fine weather, and one
of the first and greatest benefits of
civilization is a watertight roof, with
the right to remain beneath it.
But unless a change of weather
should at once come, the dampness
of holidaymakers will be far
outweighed by the ruin of the cereal
crops. Every day the prospects of the
harvest grow worse, and the loss
already inflicted on the rain-beaten
cornfields grows greater. After a
generation in which England has
mainly been fed from abroad, there
is a too general tendency to regardthe farmer’s losses as the farmer’s
affair, and to regard an abandoned
cricket match as of more importance
than a ruined wheat field. The loss
of any serious proportion of this
year’s home wheat crop would be an
incalculable disaster; for even if our
full crop is secured, in face of the
deficiency of the world’s supply we
are likely to have difficulty in feeding
ourselves before the harvest of 1921.
Unless the weather changes not only
rapidly, but completely, at best a
fraction of the harvest will be saved
by utilizing every hour when it can
be cut and carried. Those Labour
representatives who aim at rigidly
regulating the working hours of farm
labourers may fairly be invited to
regulate the hours of rain and fine
weather also, for their projected
timetable will be unworkable
without this further reform.Doctor Zoom and the importance of contact
Sir, I am an enthusiastic supporter of
technologically driven change in how
medicine is practised, but the
centuries-old practice of taking a
history and examining the patient
before ordering investigations should
not be forgotten (“Zoom medicine is
new normal, Hancock insists”, Jul 31).
If 90 per cent of consultations are by
Zoom, only 10 per cent will involve a
clinical examination to help confirm
or reject diagnosis based on history
— a necessity in deciding which
expensive investigation may be useful.
I trust that the health secretary will
engage with his academic clinical
advisers to see how well this practice
works. Many doctors will remember
the maxim about rectal examinations
— “put you finger in before you put
your foot in” — and the same applies
to many parts of clinical examination.
Robert Slack, ENT surgeon (ret’d),
Royal United Hospital, BathSir, I recently had an excellent
example of technical innovation in
the NHS. I developed a lump on my
lip and sent a photo to my GP. A
doctor phoned the same day to say he
had sent the photo to a consultant
dermatologist. A week later I saw the
consultant, who took a biopsy. I thendoctors and encourage early
retirement. Far from reducing stress,
assessing a problem without seeing a
patient will add to the worry.
The solution to GP access is an
expanded multidisciplinary workforce
and rigorous triage. Remote contact
should be used only to decide which
professional a patient should go to.
Dr Hugh Savill, GP (ret’d)
Tiverton, DevonSir, James Spence was one of the
greatest paediatricians of our era. He
once observed: “The real work of a
doctor is not an affair of health
centres, or laboratories, or hospital
beds. Techniques have their place in
medicine, but they are not medicine.
The essential unit of medical practice
is the occasion when, in the intimacy
of the consulting room or sick room, a
person who is ill... seeks the advice of
a doctor whom he trusts.”
We in the UK invented the concept
of the general practitioner as it
evolved from the apothecaries of the
early 19th century. If Zoom medicine
is indeed now the norm this service
will become unrecognisable, and will
have lasted for only 200 years.
Dr Brian Posner
London N3Social care unfair
Sir, I cannot see why Deborah
Brooker thinks it fair that her father’s
house should be sold to pay for all of
his care (Letters, Jul 31). Her father
has suffered ill health and disability
and his family will have had the
burden of caring for him and
worrying about him. And then you
lose the house. A triple whammy.
A more fortunate pensioner, in
good health, does not suffer any of
this and their family inherits their
wealth. So if you lose your health you
lose your wealth. If you keep yourhealth you keep your wealth. Where
is the fairness in that?
Belinda Price
Beckenham, LondonSir, Rachel Sylvester’s article (“Social
care could be Johnson’s great legacy”,
Jul 28) was very clear in asking the
prime minister to deliver on his
pledge to “fix the crisis in social care”.
My suggestion, as a pensioner of
69, is that the older generation should
accept that the triple lock on pension
increases must end, and that this
saving to the public purse should help
to fund the nationalisation of social
care. This would allow the health and
social care department to integrate
care and planning for all services, and
avoid a repeat of the situation in the
early part of the Covid-19 pandemic
when infected patients were shipped
from hospital beds to care homes.
If Boris Johnson nationalised social
care he would resolve at a stroke an
issue that has been intractable to
previous administrations, shore up his
party’s support in the “red wall” seats
where social care failings have had
the greatest impact, and leave a proud
legacy as the Tories’ Nye Bevan.
Michael Frazer
BradfordGambling losses
Sir, Your article (“Country told to
make sacrifices and keep resurgent
virus at bay”, Aug 1) suggested that
the reason casinos were prevented, at
the last minute, from reopening at the
weekend was concerns that items
such as playing cards could not be
cleaned regularly enough.
Several weeks ago I hosted
government officials and scientists
from Public Health England at a
Grosvenor casino in central London
to demonstrate our protocols for
coronavirus-secure operations, after
which we were swiftly given approval
confirming that we were indeed safe
to reopen. That has not changed. Our
venues remain very safe.
The only thing that has changed
is that since we were given August 1
as the date to reopen, we started to
put costs back into the business —
only to have the rug pulled out from
under our feet a few hours before we
expected to start welcoming back
our customers.
The rationale for that U-turn had
nothing to do with the social
distancing and other safety protocols
in our venues. For every week that
Grosvenor casinos remain closed we
are incurring net cash losses of
£1.5 million. Moreover, the continued
closure of Grosvenor’s 51 casinos is
costing the Treasury nearly £2 million
a week in furlough payments and a
similar amount in lost gaming taxes.
This makes no sense whatsoever and
it puts thousands of colleagues in the
casino sector at risk of losing their
jobs as the furlough scheme gradually
tapers towards its planned end date,
in October.
John O’Reilly, CEO, Rank Group
Maidenhead, Berks