Published: 05/09/2002, Volume II2, No. 5812 Page 12 13

The media, as the 'fourth estate', acts - in theory at least - as a democracy-strengthening check on, and counterbalance to, the authoritarian tendencies of government.

In its role as champion of public interest, the media must offer a lively participatory arena for social communication and debate.

Newspaper letters pages create the closest connection between the publication and its readership.

If further proof were needed of the NHS's place in the public consciousness, this week's letters pages provided ample evidence.

In just one day, the Daily Mail printed six letters covering issues ranging from the availability of, and decline in, NHS spend on dentistry through to the introduction of treatment charges for overseas visitors.

Two paramedics challenged the public perception that their jobs are of less value and less skilled than others employed in the public sector such as nurses, teachers, police officers and council workers.

As one explained: 'As 'first on the scene' treating road traffic accident victims and removing sick or injured patients from home, we give immediate treatment that is often unique, thanks to our training and the equipment we have.'

In The Times , carers argued that the vital but often forgotten role they play in looking after the nation's sick and elderly - saving the UK£57bn each year - is unrecognised and leaves many of them unemployable and living in poverty.

More sympathetic awareness of their plight is necessary and, as one correspondent suggested, a carer's charter would ensure this.

A letter in The Daily Telegraph drew an interesting analogy between hospital conditions and the airline industry.

'I doubt, 'wrote the correspondent, 'whether a pilot is required to take to the skies daily with a plane grossly overloaded with passengers, with its safety systems either out of date or disconnected awaiting investment needed for upgrading or repair... but with a cheery reassurance from the ground crew that they will probably make it.'