Your correspondent, Dr Maybelle Wallis (NHS’s culture of denial allowed Lucy Letby to keep killing babies, 21 AugustLetters, 21 August), reflecting on the Lucy Letby case, correctly pinpointed Margaret Thatcher’s introduction of “general management” as a pivotal moment in the culture of the NHS. The idea was that senior managers from the private sector should be brought in to run local hospital provision, which would be increasingly based on local trusts competing in the “internal market”. My local health authority was headed by someone with no NHS experience who had previously run a biscuit factory.
The great pity is that, despite no mention of them in the 2001 election manifesto, New Labour’s introduction of foundation trusts from the following year sought to further institutionalise the fragmentation of the NHS into competing local units, following this “business” model. While some of the most detrimental elements of the initial proposals were fought off, the end result has still been an increasingly inward-looking, defensive management culture with an instinct towards concealment if reputational damage is a possibility.
