Letters

Published: 26/02/2004, Volume II2, No. 5894 Page 22

NHS management has an organisation that fights strongly and passionately on its behalf, and it is misleading to suggest that the NHS Confederation leaves one of its core roles to other organisations (news focus, pages 10-13, 12 February).

A key part of the NHS Confederation's role is to speak up for management, and the fact that we represent organisations is not a significant constraint. The interests of managers and their organisations are bound together; if managers are attacked, the NHS suffers. But fundamentally, we believe management is crucially important and its practitioners deserve not just defence but active promotion.

Every incident of managerbashing in the media is challenged directly with the journalist concerned and by letter.We have been working our way round the health and political correspondents and leader writers, and generally we get a good response, most recently from The Sun and The Times.We have been fighting a similar war of attrition against the 'more managers than beds' claim from Conservative spokespeople and newspaper columnists. Some of the more rabid columnists are often beyond rational argument, but we still try.

We also work to get the messages to MPs and other opinion-formers and give them the chance to meet NHS managers. In June last year we published Management Matters to explain the contribution of NHS managers, aimed at this group.We have established forums for chief executives to meet and discuss policy and other issues with opinionformers, in a safe setting.

We have stressed the need to look after senior managers better and identified the problems of high turnover and the way in which chief executives in difficulty are dealt with.We have succeeded in introducing for the first time exit interviews for chief executives.

The attack on managers is unfair and corrosive and designed to damage the NHS. I am afraid it is working and the public seems to believe the idea that the extra money has gone into bureaucracy. Fighting for managers and management is entirely consistent with fighting for the NHS and we intend to keep doing it, and we hope that managers in our member organisations will continue to do it with us.We need all the help we can get.

Nigel Edwards Policy director NHS Confederation

As a life member of the Institute of Healthcare Management, it is with some concern that I have watched health service managers dwindle into civil servants.

Allowing their code of conduct to be commandeered by the Department of Health, and in the process requiring obedience to their employer (ultimately the health secretary), was just one of the more significant false moves.

HSJ's news focus was right: health service managers now have no public voice - or at least if they have, they do not use it.

They suffer in silence.

It is time managers resumed their status as public servants underpinned by the principle of serving the public good.

Andrew Wall Visiting senior fellow Birmingham University health services management centre