An article in last week's HSJ following the resignation of two London trust chief executives gave 'false comfort' to 'people who seek to excuse poor performance rather than rise to the challenges', NHS London chief executive Ruth Carnall has said.

Her remarks in a letter to HSJ this week follow criticism of the strategic health authority, with senior figures branding it "intolerant" and "Stalinist" after the sudden departures of two chief executives at struggling hospitals.

A draft of Ms Carnall's letter was circulated to London chief executives with a note saying it was hoped everyone could stand by it.

Poor communication

But a London acute trust chief executive expressed dismay that NHS London had not taken the opportunity to solicit managers' feedback and offer reassurance, saying: "It would have been nice if there had been some attempt to have discussions with individual chief executives about how they were feeling."

The chief said a phone call from the London provider agency would have been welcome given that 12 of the 20 trusts named by HSJ as likely to miss the application deadline for foundation trust status were in London.

A London insider said: "There has been surprise that there hasn't been stronger communication with trusts." The silence only added to speculation over whether there were plans to axe other chief executives, including those from primary care trusts, the insider said.

Ruth Carnall's letter to HSJ

"Over the last two years, NHS organisations in London have developed a clear strategy for improving health and healthcare in the capital. It has been a profoundly collaborative venture, engaging boards, chief executives and clinicians. Primary care trusts have worked as a team to consult on and approve dramatic changes, at the same time as overcoming serious financial challenges. This has required courageous leadership.

"The culture NHS London has created to deliver these results is a million miles away from the one you describe. There are significant performance challenges and we are determined to tackle them as they have not been tackled before in the capital. I make no apology for this. We are letting too many of our patients down. Most of my colleagues share this determination.

"Tackling short term problems at the same time as making progress on a 10 year strategy is a complex leadership challenge. It requires vision, ambition, tenacity and the ability to make tough decisions tempered with humanity. There are many leaders in London who have these qualities in abundance. They will not welcome your articles and the false comfort they give people who seek to excuse poor performance rather than rise to the challenges."