Your report on the Bristol inquiry (News, page 2, 29 October) highlights the current 'blame culture' of the NHS, which is easily compounded by a tendency towards tribally separated approaches to problem solving.

The article notes 'blame' several times. Blame the 'hospital systems', the Department of Health, civil servants, managers - while apparently accepting that a solution might result from recognising that an 'individual' work culture should be replaced by team-working and a 'more open approach'.

Perhaps the 'individual' work culture extends to individuals in other groups as well. Perhaps the 'team' which would enable practitioners (nurses and professionals allied to medicine as well as doctors) to be 'more receptive to the concerns of patients and their families' in fact includes individuals from the named blamed groups. Without doubt all these groups need to change some part of their process in order to enable more effective accountability and governance - but this is unlikely to be achieved in a reactive environment which does not monitor daily process but waits for activity/poor outcome indicators as pointers.

We all need to turn the blame culture into a learning environment. We work in a constantly changing, constantly more informed healthcare environment. 'All-groups' team-change based on good information and knowledge-based best practice is essential and only possible if we turn every pointer about practice into an opportunity to learn a better way.

Supported investigation of process and outcome in order to enable us to constantly do things better helps us to learn. This is a recipe for the future, the former a recipe for entrenched attitudes. We need a learning environment which recognises and values the whole team.

Bernice Baker

Freelance nurse consultant

Horsham

West Sussex