You report that chief executives feel they have become a 'socially excluded minority frozen out of policy-making and subject to rigid control from the centre' (News Focus, page 14, 1 October). You have also reported in recent weeks that a teaching hospital has found itself 6m in the red without knowing why, that plans to cut costs through the controversial closure of an accident and emergency department realised little of the predicted savings, and that the NHS is failing to manage the year 2000 issue effectively.

Do these highly public failures explain why the views of managers are not being sought? More important, how do we find ourselves in these difficulties? Consider the following questions:

How many NHS managers have access to information systems that tell them what is really going on?

How many trusts have sufficiently robust financial systems to alert them to problems before they occur?

Are there enough management resources to allow for anything other than reactive management?

Few managers have access to the tools to enable them to operate effectively. This results in a lack of professionalism which is not the fault of NHS managers. It is the fault of the system that consistently undervalues the importance of managers in running one of the most complex organisation in the UK.

It does this by appearing to support the view that investment in management and IT takes money away from patient care; by unrealistic management cost targets; by failing to pay private sector salaries in the areas that are directly competitive with the private sector (finance and IT); and by failing to provide career development for all managers.

Managers can't perform without appropriate training and resources any more than doctors and nurses. If the NHS can't or won't provide the basic facilities that managers need to carry out their jobs, there is little hope of the NHS ever being run effectively.

If managers were valued and given the appropriate tools and encouragement to manage effectively, everyone in the NHS would gain. This is the task on which the organisations representing the NHS and NHS managers should focus.

Daniel Elkeles

Epsom