Panorama's programme about the state of mental health services features problems in Norfolk and Suffolk as perhaps the worst examples of a national disaster. Cuts to funding in 2013 and poor management have devastated the service and families are paying a very high price.

We are increasingly seeing what underfunding can do to the other parts of the NHS and social care provision as well, with difficulties seeing GPs, long waits in A&E, delayed surgery and big problems arranging care in the community.

Finding ways of reducing deficits is the top priority set by NHS England and the message from our PM is that the problems can only be solved by everyone working harder and longer as she has no intention of providing more money from the centre. Graciously, we will be allowed to raise council tax, a hopelessly flawed tax and once again, the wealthy will pay much less than the poor as a share of their income.

This is the backdrop against which the Sustainability and Transformation Plan Executive Board for Norfolk and Waveney is trying to work out what to do to put their plan into action. They are doing this in private.

Although there will be meetings with stakeholders, the public cannot listen in and it seems likely that there will be no meetings for the public before the summer.

Given that other parts of the country where this process has got further down the track have listed a range of cuts and closures it is not unreasonable to fear that the same will apply here.

Despite all the problems with health and social care services, most people have not heard about the STP and fine words about engaging with the public are meaningless. Only 64 people responded to Health Watch's request for opinions on the STP. The intentions are mostly laudable but utterly unachievable without investment and there is no mention of how the deficits will be cleared first.

Which brings us back to money. Don't be fooled by the talk of health tourism being a big part of the problem and that a change in the law will deal with it. At most it is 0.5pc of the care costs and much of that relates to maternity costs for women struggling with immigration issues, many of whom are eventually granted leave to remain and have no money anyway.

Also note that the sound of people proposing charges and insurance as the solution is increasing in volume again.

Despite the damage caused by introducing market mechanisms, funding through direct taxation will always be the most efficient way to pay for health and social care.

What does need to be debated is how much as a society we value these services and thus how much tax we will be happy to pay and how to stop ever-increasing amounts of funds flowing out into private pockets.

Dr Sue Vaughan, Mill Lane, Little Melton.