Published: 15/01/2004, Volume II4, No. 5888 Page 22 23

I agree with Roy Lilley's letter on public health and the NHS (page 22, 4 December 2003).

On reading the appointments section each week, I see a growing number of highly paid jobs within the NHS that are related to smoking cessation or drug action programmes. I have, however, yet to see one specific to food intake management.

Each job advertised will eventually become part of a larger team, as need is identified and demand for the services increases.

The key point is that these problems impact severely on the NHS, but they should not be viewed as its responsibility.More should be done by the government to make individuals take responsibility for their own actions.

Making it more difficult to access cigarettes, alcohol, drugs and high-fat foods has to be the starting point. Following that, improved public education programmes might go some way to managing the situation.

By giving the NHS the limited budget and responsibility for these problem areas, it is inevitable they become embedded in the service commissioning process. The result is increasing competition between true NHS service demands, and what are in reality health-related - rather than health service - projects.

Linda Kennedy Independent management consultant (former NHS clinician and senior manager)