LETTERS

David Hunter correctly questions the (new? ) government's (old) methods of bringing about changes in health. Numerical targets and management by objectives are indeed less effective in tackling complex processes than 'leadership and support for people making difficult decisions'. Expecting health workers to 'occupy the dissenting vanguards that are needed' is equally unrealistic in the face of constant threats from established interests.

That is why the role of independent advocacy is vital in developing public policy and practice. Dissent should be welcomed - throughout central government, the NHS, local government and voluntary sectors. Constructive criticism is essential in a healthy society.

John Nicholson Manchester