I support Mark McDonald’s submission that the Thirlwall recommendations will lead to more blame and suspicion in the NHS ( 17 October ). We often hear of hospital scandals where trusts are intent on preserving their reputations, internal inquiries go nowhere, defensive clinical staff deflect blame on to others, non‑disclosure to patients of errors and “lessons learned” rhetoric that is quickly forgotten. There is also an industry of ambulance-chasing lawyers. None of this is conducive to a no-blame, honest, open culture in healthcare. The Thirlwall recommendations of more surveillance will make it worse.

There is an alternative. Most of my professional life as a hospital consultant, clinical director and deputy chief medical officer has been spent in New Zealand, whose publicly funded NHS is the same model as the UK’s – but with a major difference.…