A SURVEY of all 152 primary care trusts in England found one in ten are restricting joint replacement operations for obese people (Echo, Oct 1).

When I attended an orthopaedic out-patients department at North Tees hospital recently, the specialist and his team had 20 people to see that morning. The patients, many of them elderly, were having to wait two hours past their appointment time and then not being seen by the specialist but one of his team.

As a patient, you should be able to be seen by the person who is on your appointment card. The average waiting time to see a specialist is three to six months on the NHS, but if you can afford to pay £100 you can see the same specialist in a few days.

Junior doctors should be learning in the presence of the specialist, not seeing patients in separate rooms.

By throwing more money at the health service, the Government has created a two-tier health service, with the vast majority of the public who cannot afford to pay having to tolerate a second-class shabby service of the NHS.

Keith Dewison, Billingham.