Published: 26/05/2005, Volume II5, No. 5957 Page 22 23

Linda Kennedy, e-Health innovation professionals group of IHM, ASSIST and BCS HIF

Dr Robert Hodges states 'the NHS [should] be given political independence' (news, page 11, 28 April). I have long held the same view but never openly voiced it until now.

After 35 years in the NHS, first as a radiographer and then as a general manager, I have become increasingly interested in how we can deliver a better and more efficient health and social care service by taking advantage of new technologies that are now so much part of life outside the NHS. While working as a general manager, the task in hand always took precedence over more creative thinking. I do not think that much has changed.

Clinically the world moves on at a rapid pace. The government has invested in more in diagnostics to meet cancer targets, but there are still not enough trained staff to operate the equipment.

And then there is the 'superbug' problem: those of us with long experience of the NHS know how this came about. The internal market of the early 1990s pushed trusts for greater efficiency. We closed beds to deliver the savings demanded, but increasing pressure on doctors caring for acute medical patients meant that they needed access to more beds. We moved patients from ward to ward to ensure that doctors were not searching all over the hospital for their patients. Open visiting became the norm for all patients and so the risk of relatives bringing 'bugs' in with them increased. Uniforms that no longer needed high-temperature laundering were introduced.

Laundry services were outsourced and the turnaround time for uniforms increased. Staff became frustrated and started wearing their uniform to and from work.

I look back and realise just how wrong some of our collective assumptions were and how shortsighted we became when trying to meet the individual financial and clinical targets of our trust. A similar scenario is likely as payment by results brings further changes to the way that we count and cost the services that are delivered. Financial pressures will ensure that decisions are taken that might not be in the long-term best interests of anyone.

Now that the election is over, I want a rational and open debate about what we, as present and future patients as well as being clinical and managerial colleagues, really need from the service. I want to look at new ways of working and new technologies that can really deliver the best clinical service while increasing the efficiency of the whole system.