Your extensive and outspoken coverage of the Healthcare Financial Management Association s bruising experience, following its warning of a looming deficit in the NHS, was welcome (news, news focus and comment, 9 December).

This incident illustrates the dilemma facing all of us who aim to be listened to by a government that, like its predecessors, is sensitive to criticism.

Influencing policy means getting across messages that may be unpalatable to policy makers in such a way that they will listen.

Using the megaphone of the national media is satisfying but often self-defeating, as it can destroy the trust necessary to allow a frank exchange of views.

The HFMA s experience shows that where lobbying is done via the media, more effort is put into rebuttal than to listening.

Speaking out in public is often necessary , and the NHS Confederation s status as a charity gives us the freedom to do this.

Even so, messages have to be properly timed and be set in the context of a carefully planned campaign, not shot from the hip.

Much of the most effective influencing goes on in private, which can create the impression that lobby groups are not as active as they should be. W e find that NHS managers understand this dilemma. The government welcomes our input even when we are delivering some tough messages.

We can reassure members that in our meetings with the Treasury , Department of Health and Number 10, the financial message has been getting across.

We hope the HFMA has not been deterred by its experience. We will continue to work with it and other groups to ensure our members get their messages to the people who need to listen, in the most effective way .

Stephen Thornton Chief executive NHS Confederation