Ray Rowden's intriguing comments on civil servants running the NHS Executive ('If I may be so bold', page 29, 2 March) omit one important element. My 14 years in the Department of Health inclined me to believe that NHS managers and professional health staff generally know bugger all about supporting ministers in their wider departmental responsibilities.

Alas, life in Whitehall does not consist solely of high-level advice sessions and keynote speeches.

It is the civil servants who, with immense skill, keep the whole ship afloat with their daily work on briefings for parliamentary questions, details of legislation, responses to thousands of letters from MPs and the public, and drafts of consultation documents.

But I'm at one with Ray Rowden in his views on the deadening effect of departmental culture. Ministers and mandarins pay lip service to encouraging creativity, but it is they who are the first to scream (and I mean this literally on occasion) when a civil servant gets it wrong.

So yes, let's turn the DoH from a museum to a business. Let's recognise that ministers are, quite legitimately, interested less in impartial advice than in people who will deliver their modernising agenda.

I particularly like the suggestion of 700 policy advisors (though don't tell the Daily Mail - it's some£25m extra a year of taxpayers' money).

Simon Lawton-Smith Department of Health 1979-93 Cabinet Office 1994-96 London SE13