Letters

Published: 13/12/2001, Volume III, No. 5785 Page 22 23

It is disappointing to see how the NHS has gone downhill in the three years since I left, but more money is not the answer.

My prescription is to appoint consultants as trust chief executives, on the premise that they know what goes on at the sharp end and consequently have knowledge and credibility.

Look what happened at Railtrack because no-one on its board was an engineer.

Trust chief executives would be paid as in the private sector, with substantial bonuses based on achieving measurable improvements in quality and service volumes, and their lack of management skills would be supplied by a competent team of executive directors. Only nonexecutive directors with real ability would be appointed to trust boards, rather than local worthies with time on their hands.

The thorny problem of consultants' contracts will need to be addressed, so that consultants can be properly managed as employees, and the inflexible and incompetent fired quickly through a process which does not take 10 years.

Finally, patients need data to easily determine which are the good hospitals and doctors, so we can take our medical problems to those offering good clinical quality and speedy treatment. Poorly performing trusts will wither away as patients vote with their feet.

RT Donkin Former executive board member Royal Berkshire and Battle Hospitals trust