Roy Lilley's broadside at Sir Alan Langlands (letters, 9 March) could be viewed as characteristic of a displaced trust chair, heckling from the sidelines and perhaps waiting for a change of government before he is at the helm of some NHS quango.

Ignoring the political undertones to his letter, I have some sympathy with the shortcomings of the NHS which he identifies, except that they are selective and, if truth were known, a virtually endless list of unsatisfactory services and displeased patients could be cited.

We go round with an ever more sensitive magnifying glass finding more and more, because our love for bad news and scandal is undiminished, and we have no appetite for good news and success stories.

NHS funding was never in the gift of civil servants; it is a parliamentary vote.

If income tax were raised by 1 per cent maybe the NHS information technology revolution Roy Lilley calls for could be funded (assuming we don't try to make a silk purse out of a sow's ear).

If clinical governance arrangements were effective, maybe the actions of individual mavericks and backwoodsmen would become less common.

Compared with the private sector, and given the number of organisations, professions, disciplines, systems and processes involved to produce the NHS 'widget', the health service is regarded as highly complex. Not all ofthat machinery is justifiable, and certainly not all of it works effectively.

But endless engine rebores and tinkering have made the NHS look like a Dagenham production line in the 1950s: too many cooks with too many recipes for change.

Complacency, intransigence and knee-jerk reactions are unacceptable, as is scapegoating and stoning those whose major sin is that they genuinely tried to improve things for the better and were not always successful.

Dr Adrian Turrell Senior research fellow Trent institute for health services research Sheffield University