•At last an article which does not simply focus on the search for scapegoats (be they managers, doctors or nurses) or the idealism of providing a health service to appease the social consciences of a few to the detriment of the many who rely on the NHS (Faith healing, July 24). This idealism is often the thing which blinds so many to the shortcomings of a large monolithic service which, despite all the rhetoric, simply cannot be flexible enough to meet the needs of local populations.
As a former director of nursing, I have seen how the system mitigates against the provision of much-needed services, as this invariably requires more staff and more resources. We cannot make genuine progress on the best way to build a modern health system in the UK until we understand the need for real local control of hospitals and healthcare. The longer we allow politicians to use the NHS as a political soap-box, the longer it will be before this country can enjoy health care that befits a so-called developed nation.
It would be wonderful to see the trust put back into the relationships of patients/clients and their carers. Trust is the one thing that invariably has been lost or destroyed. Nurses for example now no longer have the time to care because too many management gurus and consultants were drafted in over the last 10 to 15 years to lecture us on the inefficiencies of the caring relationship when compared to commercial industry. We are indeed in a mess.
Mark Darley
South Bank University
darleyma@sbu.ac.uk
•Many thanks for an excellent article, which supports the dismay many of us felt at the attempt to run the NHS like a commercial organisation. However, I am sad at the use of the phrase "balance of power between patient and doctor", which suggests competition of doctor against patient, rather than of patient, doctor, nurse and many other staff together against disease.
Dr Richard Gunstone
Rugby, Warks
