Published: 01/04/2004, Volume II4, No. 5899 Page 24

HSJ's news story refers to to the analysis by Patricia Day and Professor Rudolph Klein of yet another flawed central initiative to improve quality and safety in the UK health services, and to the tensions between the Commission for Health Improvement and the government (page 4, 4 March).

The story implies that, if CHI had been free to adopt its own methods instead of ministerial direction, it would have done better.

During the past few years, there has been much publicity in the UK about failures within the health system and its regulatory agencies. Indeed the UK must be the world leader (challenged perhaps by New Zealand) in breast beating and public agony over the state of healthcare.

But this model of transparency comes at a price: it has undermined public confidence in the system and compromised the morale not only of front-line staff but also of the managers and regulators who suffer the criticisms and an abundance of non evidence-based targets.

The UK NHS has more regulatory agencies than any other country in Europe, perhaps the world. These have the authority to steer the NHS into the paths of righteousness - clinical governance, controls assurance, clinical negligence, patient safety, technology assessment etc. If they can't make things work, why not and who will?

Ifeach were allowed to learn from experience overseas, to adopt principles and processes which have been shown to be effective (here and abroad), and to be free to run the show, might they do better than being told by government what to do and how to do it?

Governments in general are less inclined to learn from past experience - here or anywhere else - than to pursue short-term political rather than social gain.

The Royal Commission on the NHS recommended in 1979 that a special health authority be set up to co-ordinate and supervise standards of service.

A similar proposal was mooted and widely supported by professional and voluntary bodies prior to the 1989 white paper which excluded it.

Eventually CHI appeared, and now the Healthcare Commission.

In most countries the portfolio of the health minister is high risk, high cost and high electoral profile - especially in a predominantly public-funded system.

Ministers deserve credit just for taking it on and should be forgiven the temptation to dabble a little in the micromanagement.

But there comes a time to authorise competent managers and regulators, and to let them get on with the job. Good luck, Health Commission.

Dr Charles Shaw Independent healthcare adviser Brighton