In response to Donald Monro’s letter of August 16, although in principle the NICE recommendations are guidelines, NHS England and clinical commissioning groups must “provide clear reasons for any general policy that does not follow NICE guidance”.

So in answer to your question, the Department of Health doesn’t really have any choice about whether to follow the recommendations and would have to undergo and complex and expensive legal challenge to reverse one of their decisions.

In respect to your comments on foreign aid, the UK spends less than one per-cent of national spending on international aid, which is among the lowest in the world and cutting this is likely to in the long term lead to more international conflict and outbreaks of diseases such as Ebola.

The NHS could save money by getting rid of the highly paid managers with no medical experience who are running it and getting rid of the tendering process where more and more services are been privatised, which in itself is an expensive procedure.

Gareth Oliver The Groves, York.