Dr Howard Stoate sets the record straight, showing that David Cameron was wrong, as well as patronising, at PMQs (Response, 29 April). However, Dr Stoate's explanation goes much further in undermining the justification for the health and social care bill, which is claimed to be that of giving a bigger role for clinicians in deciding the services which should be provided. What he and his colleagues in Bexley have been doing over the past few years is being replicated in many other parts of the country, showing that we do not need this costly and disruptive upheaval to achieve it.
The real reason for the bill is to allow unfettered access for the private sector, turning an integrated service into one where competition on a commercial basis is the driving force. There is no evidence that this is what the people of this country want so the bill must be opposed, not cosmetically adjusted, by all who value the concept of a National Health Service.
Peter Fisher
President, NHS Consultants' Association
• On Friday, as part of my royal-marriage avoidance strategy, I looked again at Hayek's The Constitution of Liberty to see if I could gain any insights into the coalition's plans and policies. In chapter 8, Employment and Independence, page 125, Hayek writes: "The very recognition that there are needs which the market does not satisfy should make it clear that the government ought not to be the only agency able to do things which do not pay, that there should be no monopoly here but as many independent centers as possible able to satisfy such needs."
Here is the origin, in a classic neoliberal text, of the "any willing provider" clause in the NHS bill, and indeed of the plans to contract out a new range of local government services. The same chapter contains a hymn of praise for the role of wealth in the promotion of innovation and culture. Neoliberals have no problem with Friday's surfeit of pomp and deference. The market state is an ordered state.
Paul Smith
Research fellow, Keele University