letters

The discussion around the apparently separate needs for clinical and management governance illustrates for me - as a nurse - a chief problem of the NHS management mentality. We need to ask what business we are all in.

Tesco is successful because it knows what its customers want, and delivers it effectively and efficiently in a user-friendly way. It works at integrating and monitoring all those involved in a seamlessly organised customer-focused value chain.

In the NHS, frontline professionals find themselves in a myriad of different face-to-face human interactions, trying to keep abreast of evidence-based knowledge with little time to find it.

In another bunker of the organisation, managers have traditionally measured their success in financial terms since they have great difficulty in accessing or inputting directly into the frontline clinical reality. Yet it is here the business is delivered.

We need to focus governance on what we do in our combined, multi-professional service to produce a 'right first time' seamless pathway for the client. This will not be achieved by different tribes regulating in isolation.

It's visionary management leadership which unites, enables and orchestrates shared regulation that we, the patients and the business desperately need. It's a huge challenge that won't be achieved by navel-gazing.

Bernice Baker

Horsham

West Sussex