Tom Dolphin’s excellent article on the failings of NHS management made sombre reading (The Letby inquiry report makes one thing crystal clear: too much NHS management is scandalously poor, 16 September). Yet I believe that most of our public services are thoroughly over-managed, with frontline professionals neither listened to nor respected by their institutional superiors, and at risk of damaging their careers if they speak out about poor decisions, excessive workloads and impossible targets or “performance indicators”.
Like so many of our current woes, the rise of managerialism can be traced back to the public service reforms of the Thatcher governments in the 1980s, and the mantra of “management’s right to manage”. As professionals were supposedly self-serving vested interests, the transfer of power to managers was supposed to increase efficiency and responsiveness to service users.
Yet, in many cases, the long-term result has been the rise of excessive, remote and unlistening senior management, and the parallel marginalisation or exclusion of professionals from decision-making in their spheres of expertise, coupled with plummeting morale.
Pete Dorey
Bath
Dr Tom Dolphin’s article on the failings of NHS management raises some important points about whistleblowing and the regulation of non-medical managers. Hospital board members do have responsibility for their overall management, but how well they exercise their responsibilities depends very much on leadership and the creation of a culture committed to patient care, as well as excellence throughout all the systems delivering that care.
One of the essential assurance measures along with risk management and clinical governance is the promotion of a whistleblowing policy that encourages reporting of concerns to board level without fear of repercussions and with certainty that action will be taken if necessary. If there are still any hospital management teams out there without a clear protocol for raising and pursuing problems, confidentially if appropriate, that should be a matter for urgent action.
Michael Barrett
London
Yvette Cooper states: “This must be a turning point for the NHS”. The cry always goes up: “Lessons must be learned”. But the carefully considered, evidence‑based recommendations made by those who have conducted public inquiries or by coroners are invariably ignored. There is a shelf in government that’s high up – in other words, fairly inaccessible – on which every such report is placed to gather dust. So the lessons are not learned.
Frances Kirkham
Birmingham
In the wake of the Lucy Letby inquiry, the NHS will no doubt face a barrage of criticism. But we must also remember what a wonderful institution it still is. Earlier this month, after two agonising days and nights, my daughter died in the intensive treatment unit at Leeds general infirmary.
Throughout, the service we received was wonderful – not just the medical expertise, but the kindness and loving consideration of all staff, from the consultant to the ward clerk. We were always kept fully informed about what was happening, and in the end we were consulted on the final decision to turn off the life support.
By all means, criticise the NHS for its shortcomings. But let us also treasure its strengths, and its potential to help us through some of the most difficult times of our lives.
Jenny Webb
Chichester, West Sussex
