Letters

As the prime minister has clearly discovered, people do not like change. But evidence suggests those in the public sector have had to sustain a higher level of organisational change than the corporate sector.

There have been sweeping changes in healthcare in the past 20 years: new and better ways of delivering care and treatment, massive increases in hospital productivity with higher patient throughput and reduced length of stay.

During the early 1990s we marched to the tune of a Tory government intent on turning the NHS into a marketplace. Then came a Labour government determined to abolish all this. Again we faced the prospect of organisational change just as radical, but at a much faster pace.

Despite what the prime minister might have been thinking in his darker moments, the vast majority in the NHS are on board with what he wants. But he must not underestimate its radicalism and complexity.

In all large organisations those at the top often express frustration over why those elsewhere do not embrace change with the same vigour and enthusiasm. There is growing research evidence about what is needed to transform organisations.

This does not include public criticism of the workforce for exhibiting an inevitable resistance to change.

A wealth of latent talent and goodwill is waiting to be tapped. The NHS has a cadre of top managers, including clinicians, ready to implement change and transform the service. All the prime minister need do now is keep repeating his vision, set out the goals and - above all - trust us and empower us to get on with the job.

Stephen Thornton Chief executive NHS Confederation