Letters

Sir Alan Langlands' forthcoming departure should be mourned for two reasons. First, the health service will be deprived of an able and honourable leader, and managers will be diminished by his departure, particularly if his replacement is a stooge. Second, it might herald further centralisation and 'political' control.

There are managers who have great ambition to succeed and those who have the chance of success thrust upon them. Sir Alan was fortunate in his promotion. In 1990 a temporary assignment at North West Thames regional health authority led to his confirmation as regional general manager.

It is no insult to him to say that probably five or six North West Thames district general managers would have had equal credentials to take on his role, and there were perhaps 50 more in the NHS. But Sir Alan had the talent to take advantage of his fortune.

As NHS chief executive he succeeded in leading as well as implementing the policies of two different governments, and we should thank him for insulating the service from politicians' whims and knee-jerk reactions to short-term crises. No doubt the gap between potential demand for health services and supply is no narrower than it was when he took up his post. But maintaining the position on the treadmill is no mean achievement.

The other Alan is not one to wait for success to be thrust upon him.

But health secretary Alan Milburn should be wary of staking his political career on his ability to eliminate adverse media stories by increasing personal control.

No doubt it is frustrating for politicians to find civil servants countering ministerial initiatives with caution, while doctors and nurses can catch the public's support with simple solutions to specific problems.

Former health secretary Kenneth Clarke succeeded in forcing radical change on the NHS by separating purchaser and provider - but only because he nailed his flag to the mast and was supported by a very professional management cadre. He was not diverted by a spate of unfavourable headlines. If Alan Milburn wishes his political career to continue to flourish, he should think hard before reversing this policy and accepting the responsibility which inevitably goes with centralised control. It was reassuring to hear him acknowledge that Sir Alan would be a hard act to follow. Let us hope his successor will be a professional manager, and not a puppet on a string.

Lorne Williamson Chair Raftbrand Group Director Pioneer Health Centre Ltd