Andrew Wall is deluded in thinking the future of this government rests just on the managers in the NHS ('Honour bound', 9 August).

Health secretary Alan Milburn may be blowing hot and cold towards managers because some chief executives and senior managers have not exactly been helpful in recent years over pay rises taken without negotiation.

In 1998, the then health secretary Frank Dobson asked for an individual limit of 2.7 per cent in line with fair pay for all in the NHS. He warned that to take more would lead to demoralisation and demotivation of other health workers and a poor public perception of the NHS. Chief executives took an average of around 5 per cent in 1998-99.

In 1999, the government did not want to see rises being taken out of line with other health workers at around 3 per cent.

Chief executives took an average of around 6 per cent in 1999-2000. And Andrew Wall wonders why Mr Milburn may seem less than warm at times.

The vast majority of doctors take their public servant status seriously. Do all senior managers?

Dr Nigel Dudley Consultant in elderly medicine St James's University Hospital Leeds