As a Labour voter and GP, I was baffled to hear comments from the shadow health secretary (Wes Streeting says NHS uses winter crisis as excuse to ask for more money, 10 December) that the NHS is “using every winter crisis and challenge it faces as an excuse to ask for more money”, and that “waste and inefficiency need to be addressed”. In comparison with other OECD countries, the UK has vastly fewer hospital beds. Furthermore, the UK has what the King’s Fund called “strikingly low numbers” of clinical staff. Presumably Mr Streeting’s adversarial comments are an attempt to show the general public that Labour can be fiscally responsible, given that many voters have concerns about Labour’s economic policies dating back decades. There are areas in which the NHS could be more efficient and less wasteful, but that is the same of every huge organisation. However, saying that the recurring winter crisis is an “excuse” is ridiculous. Patients are waiting months for operations, up to 12 hours in A&Es, and struggling to see their GPs because of chronic underinvestment in clinical staff and infrastructure. Efficiency will not mean that we can squeeze three patients into one bed, much as resilience cannot compensate for one clinician doing the work that should be done by several. Since becoming shadow health secretary, Mr Streeting has repeatedly demonstrated a limited understanding of the reality of what the healthcare service is facing, and a combative approach to clinicians that he calls “tough love”. I’d propose he spend more time listening to the people who provide the services that he wants to amend. Given he has never worked in healthcare, a good place to start would be to shadow an A&E doctor or triage nurse for 12 hours in an overwhelmed department, preferably several times. He would then get a better idea of some of their “excuses”. Joseph McFarlane Horwich, Greater Manchester Unpopular as this is going to make me, I mostly agree with Wes Streeting. I am a partner in an efficient, well-run GP practice with good access and good patient satisfaction. The NHS generally, however, is a monolithic, bureaucratic, rigid institution that – for the most part – stamps out innovation and wastes money as if it’s going out of fashion. If we want an affordable, sustainable NHS, things are going to have to change. As a one of Douglas Adams’ Vogons once said, “resistance is useless” – it must be, otherwise the NHS will die. Clive Elliott Madeley, Shropshire