Letters

Your comment (page 19, 7 September) gave me a wry smile. The NHS has got itself into the usual 'we'll make a proposal then everyone will tell us what's wrong with it' mode. We have forgotten to check what the question is.

In unpacking what CHCs do and proposing a cluster of different arrangements in their place, it would be timely to ask what the objective for each element would be. By defining service standards, quality and expected outcomes, perhaps we can work backwards to determine how these can most effectively be achieved.

CHCs were set up in response to public concern that abusive treatment of patients in a longstay hospital had been inadequately dealt with by NHS managers. We need to satisfy ourselves that any new arrangements will be robust and effective.

In times when partnership is a duty, it is worth reflecting on the value of having a 'devil's advocate'. I hope NHS colleagues would recognise that I am doing my job of questioning, testing and challenging.

In an organisation the size and complexity of the NHS we can never hope to get it right all of the time, and there may be a conflict between the personal, professional and political perspective.

That's why, so often, views or concerns unofficially expressed by NHS insiders add to an overall local picture and help give a balanced view of what might be in the public interest. If an independent and informed NHS challenger goes, will the democratic system be the best alternative or will it be using a sledgehammer to crack a walnut?

So let us find out in the public interest what the outcome from each element of the proposed new structures needs to be, and work back from there.

In the meantime forgive a bit of stroppiness - it probably comes from trying to serve the interests of several hundred thousand local people with an operational budget of£500 a week.

Kay Wong Barnet