Letter: Skills gap in both medicine and management

Sir: Your view, held against the public and professional opinion you report (12 March), that 'health administrators', not doctors or patients, are the 'right people' to make local decisions about rationing of health care is nothing if not independent. But it sadly lacks the credibility that readers have come to respect and enjoy (if not invariably to agree with) in the editorial columns of the Independent.

Health service managers do indeed know what resources are available, but it is not 'they alone' - the information is public. On the other hand, few managers are in a position to be deeply acquainted with 'the details of what medical procedures are possible', not least because many of our new managerial army have not served long in their present positions in the health service and hardly any have had their feet in the mud of the clinical trenches.

And it is not only a matter of the 'possible': non-medical managers are also understandably uncertain about what it is ethically and practically impossible to deny to patients in situations which suddenly present and slowly unfold. Finally, patients are entitled to consider doctors, managers and politicians to be accountable to them. That is not a prescription for an open chequebook, but a right to help shape priorities, if a feasible way can be devised.

We lack leadership in health service management which is rigorously educated in both management and medicine, unlike Australia and the US, where well- established educational and career pathways exist. Which UK university will be the first to go one better and offer a combined MB/MBA degree programme?

Yours faithfully,



London, SW7