Dear Mr Milburn

I was surprised and concerned by your comments in the press about 'fat cats' and redundancies among senior NHS managers.

Broadly, our members are dismissed for two reasons. First, we are once again facing wholesale change which leads inexorably to redundancies, often of senior managers who don't want to leave their jobs or the NHS.

The reorganisation of trusts is handled very badly, with no serious thought given to how to support the 'casualties'.

Second, we are still seeing 'political' dismissals. These include instances of medical staff passing votes of no confidence because managers won't bend to the agenda of small and self-selecting groups opposed to the government's changes - instances when managers have received little or no support at national or regional level.

Motivated and committed senior managers are vital if the government's reforms are to succeed. But if ministers don't support managers against bullying by medical staff and the vagaries of non-executives and others, or avoid the easy rhetoric of 'fat cat' managers, then greater demoralisation will set in. And if the top people are unhappy, their discontent will trickle down to all staff for whom morale is tenuous: if they are treated badly, other staff will fear the same.

The simple fact is that contracts have been properly authorised and reflect the precarious position of senior managers. There are no golden handshakes. Most settlements give no more than a year's pay when the contract is terminated early. Some members also receive early payment of their statutory pension rights, over which trusts have no choice.

No one wants cash to go into redundancies unnecessarily but the answer lies in a coherent framework for handling reorganisation, not an attack on contracts. Is there anyone really working on redeploying staff?

I would be grateful to learn more about how you intend to deal with the immediate problem of displacement and keep good managers in the NHS. What longer-term framework do you see for the careers and reward of senior managers?

The First Division Association does not want a return to a command, hierarchical structure, but there must be a balance between this outdated approach and the fragmentation of today, with the senior teams of 500 or so trusts divorced from one another. The FDA looks forward to a constructive dialogue about a way forward.

Jonathan Baume

General secretary

First Division Association

London SW1

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