Managers' willingness to take a bashing hurts their local credibility

No naming and shaming stories this week - can it be mere coincidence that Alan Milburn is on holiday? Hardly - and that raises questions about how managers should respond once the media's diet of stories about 'red lights' and 'hit squads' resumes.

Nigel Edwards, policy director of the NHS Confederation, takes issue this week with HSJ 's l e ad e r on the recent naming and shaming of seven trusts facing big increases in demand for outpatient appointments (see letters, page 22). Mr Edwards says the confederation did not welcome 'red lighting' or 'hit squads'. Which is true. He also says neither actually exists. Which is also true. But what HSJ found 'astonishing' two weeks ago was the lack of condemnation for the spin inevitably put on the 'support' being offered to trusts by the national patient access team.

Mr Edwards has cogent arguments for not objecting to every set of headlines generated by the government. Ministers, he says, like to see national organisations squeal - it makes them look tough. And the public, he argues, will have little sympathy for NHS managers if they ape the teaching unions - opposing all change, no matter what. In short, this is the real world. Managers will talk tough. It is more important to look at the reality.

Very cogent arguments. But the danger of accepting them, surely, is that managers will be left publicly unprotected. Whatever the government is really doing, the public is being told that managers are being bashed. And on the ground that is more than a matter of form. Individual managers are exposed to hostile national comment. Their organisations are hauled on to the pages of local papers that keep cuttings and rehash them mercilessly.

'This is the real world' also comes uncomfortably close to 'we can take the hits, the government loves us really', which sounds uncomfortably like the cry of people trapped in abusive relationships the world over. And as people trapped in abusive relationships discover, finding the right moment to speak up or get out becomes more and more difficult as their circumstances start to seem normal.

What this issue really demonstrates is the poor state of public life in this country. The government panders to focus groups and opinion polls on a whole range of issues, unprepared to lead the electorate or respond to vocal sections of it. Professionals apparently feel compelled to follow the line, even though they might have views that should command attention - or votes as well, for that matter. Is it too much to hope for better? In a country obsessed with quick fixes, easy choices and a cultural life revolving around Big Brother , it probably is. But caving in will not help.

Meanwhile, stand by for more thumping in the papers. Try not to take it too personally.