Not all NHS executives are greedy, self-serving monsters and not all lower-paid staff are saints

Andrew Lansley's "market-facing" model for the NHS favours greed at the top – top money for top talent – and need at the bottom, wages minimised in low-wage, low-price areas ("Lansley backs lower pay for NHS staff in poorer areas"). Carrot in front and stick at the back for this Tory hack – until the two ends, both human after all, part company, geographically, socially and politically.

What this drop-dead model overlooks is the power of common humanity: the poor and half-way poor are also greedy, proud as well as necessary, and able to vote with their feet, while the rich, greedy or not, are also moved in other ways, not just to money but to do a good job well.

Some NHS executives, like some bankers, see no further than their own pay cheques. But even in banks, with money as their object, a bonus-blinkered leadership broke down.

Often, in a public service, people want to serve. What's needed for the NHS, across ranks and specialisms, regions and postcodes, has less to do with divisive differentials than with fellow feeling, pride in work, consistency and common sense.

Greg Wilkinson

Swansea

Andrew Lansley's latest venture epitomises the ascendancy of management above clinical practice in the NHS over the last 20 years.

It behoves us to remember that it is a national service and that its raison d'etre is the clinical care of those in need. Shouldn't we be asking whether the priority is to attract and retain high-calibre managers or nurses and paramedics? I know which I'd rather have when the flashing blue light draws nigh.

Dr John Trounce

Hove

Fundamentally inaccurate is the assertion by the health secretary, Andrew Lansley, that private sector pay is set in accordance with local labour markets. Data mined by independent research bodies actually reveal that most large, multi-site, private sector companies have national pay structures.

Therefore, despite the government's desire to justify more attacks on public sector pay – right across the public sector, not just in the NHS – it is important to recognise that the private sector has abandoned the concept of local/regional pay.

The impression conjured up by Lansley is that private sector pay is set by specific local labour market trends. In reality, large, multi-site, private sector companies operate with up to four zones within a national framework. HR directors in large companies openly state that national pay structures and national pay determination provide simplicity and efficiency.

It also needs to be understood that public sector pay supports regional economies. Moving to a system that would widen the north-south divide for generations is unfair, inefficient and makes no economic sense.

If the government genuinely wants greater efficiency, then it should return to national bargaining. It is grossly unfair to pay two employees, working for the same employer on the same grade and doing the same duties, differing pay rates on the basis of the location of their workplace, except for the established case of London pay.

Moreover, the economy has receded into a double-dip recession and needs growth through public expenditure. As a matter of urgency, the government needs to boost demand by increasing public sector pay – and low pay more generally. This will create jobs and increase government revenue streams through increased tax receipts: a virtuous cycle of tax and spend.

Enrico Tortolano

Kingston upon Thames

If regional pay is such a good idea, why not have it for MPs too? That way, we could pay the MP for South Cambridgeshire (Lansley) less than the MP for Tatton (Osborne) but more than the MP for Sheffield Hallam (Clegg) and so on.

Mick Beeby

Bristol