John Murphy of Hounslow community health council raises important points when he questions the notion that most local government councillors would have 'the time, inclination, knowledge or ability to effectively monitor the NHS' (letters, pages 22-23, 18 January).

The NHS plan's idea that a council scrutiny committee could play a meaningful role in holding the local NHS to account is flawed.

If, for instance, the board of Tesco were to call in the chief executive of Boots twice a year to pose questions on the performance characteristics of geographically adjacent shops, it might make for an interesting chat or even argument.

Neither board would have any power of governance over the other organisation, however. Just so with the plans for local government and the NHS.

A weakness that runs right through the NHS plan, with its extra quangos and committees, is failure to tackle the management within each organisation.

Increasing the number of bodies to which individual units of the health service are meant to report and respond is likely to lead to extremely inefficient use of public funds - although the quangocrats (including some councillors who have been bought off ) enjoying the fees from their new positions and status might not agree.

The example of the government having to tell managers to keep hospitals clean is akin to an airline board having to remind pilots to check for the effects of icing.

They do not have to; there are already systems in place to ensure that professional aircrew follow adequate and sensible procedures routinely.

Poor management should be tackled within an organisation - directly, not passing the buck to some new quango, committee or other public body such as a local council.

Unless this is acknowledged soon there will be further waste of millions of pounds of public money on new 'initiatives', talking shops and the bureaucracy of ensuring all these new bodies are communicating with each other.

Geraint Day Former chair Swindon and District CHC