While welcoming Labour’s pledge to clear the NHS waiting list backlog within five years (Report, 28 May), I wish the shadow health secretary, Wes Streeting, would be a little more explicit regarding the proposed use of the private sector in this task. The last Labour government – which did make use of private provision – was able to reduce waiting lists, but the longer-term consequence has been the greater institutionalisation of private practice by NHS staff. The deliberate running down of the NHS under the Conservatives has meant that going private is now the norm far more often, even for patients who can barely afford it. The next Labour government must learn from the mistakes of the Blair/Brown era, when patients on lengthy waiting lists found themselves, in some instances, seen in the private sector by the same consultants who hadn’t the time to see them in the NHS. The NHS rewards doctors who moonlight in the private sector by awarding contracts to the companies they work for, to treat its patients. And they are paid at a significantly higher rate. The result is that we have a system that divests the NHS of key staff while at the same time costing considerably more for treatment. We are effectively incentivising these doctors to build up their NHS waiting lists. Labour’s challenge is to get medical staff working part-time in the private sector to commit themselves fully to the NHS. It will cost money, but rather a lot is being thrown at these private companies and could be used more effectively. David Hinchliffe Chair, Commons health select committee 1997-2005 You report that Labour is planning to clear NHS waiting lists by using private sector staff and creating more appointments. However, hundreds of thousands of hospital appointments are postponed or cancelled because beds are occupied by patients whose discharge is delayed due to the broken and chaotic care system. Now is the time to overhaul adult social care. Successive Conservative administrations have shelved plans to address this issue as too difficult or too expensive. David Cameron’s Dilnot commission, Theresa May’s “dementia tax” and Boris Johnson’s health and care tax proposals have all been kicked into the long grass. Conscientious care workers are struggling to do their jobs well at subsistence wages, but the largely privatised adult social care system is fragmented and disorganised. It is clear that it should be brought back to democratic control. So let’s hear about Keir Starmer’s plan for a national care service. It has the potential to reduce waiting lists, provide better care and ultimately save money for everyone. Norman Edwards Highworth, Wiltshire Wes Streeting is right to be cautious – cutting waiting lists and reforming the NHS will take time, given the state of our public finances. But there is one thing he can do that wouldn’t cost any money yet would make a fundamental difference: restoring the statutory duty of the secretary of state to provide NHS services. That duty was removed by the coalition government’s Health and Social Act 2012. Today, we have the curious situation in which the government funds the NHS, but the latter is not accountable to the former. In 2012, Andy Burnham, then shadow health secretary, vowed to repeal the act if Labour gained power. The party should do the same in 2024. Fawzi Ibrahim National officer, Rebuild Britain