The NHS can't afford to lose able managers who tell the truth

Squish. Kaput. A combination of union bullies and cowardly colleagues managed to get rid of a leading hospital trust administrator last Friday. Since effective hospital trust chairmen are as close to extinction as certain blue butterflies, this is not progress for the NHS - though it is certainly a politically correct moment. Goodbye, Barrie Blower, MBE, chairman of the three-star Walsall hospital trust, who resigned last Friday.

About once a week, we read of a hospital horror. The wrong kidney is removed from some poor bloke, who is left on dialysis for life. A large clamp remains inside a patient after surgery.

Mistakes are made in all sorts of jobs; it's just that, in the world of medicine, the mistake can kill. Most hospital chiefs prefer an administrative Valhalla, where they don't have to answer questions from families of patients. They can issue an anaemic statement apologising for any concern caused. The matter is "under investigation".

Mr Blower appears not to have been like that at all. When Tracey Davies wanted to talk about the death of her mother from lung cancer last December, Mr Blower made himself available. And not just for a 10-minute chat: for three hours.

Later, Mrs Davies, 41, would say: "My mother was terminally ill, and there has never been any question about the nursing staff being negligent, but we felt we needed more information about the time she died." She was not allowed to speak to the nurses who were on duty at the time and Mrs Davies wanted to hear about the last hours of her mum.

Some post-mortem it turned out to be. For Mrs Davies was wired. She secretly recorded her conversation with Mr Blower on a tape recorder, either under her clothes or in a James Bond handbag.

She says that, after getting the run-around from two lower-level hospital managers, she wanted to prevent Mr Blower "going back on anything he said". Fair enough, though that doesn't quite explain why the tape leapt from her hands into those of Carlton Television.

This is what Mr Blower "couldn't take back". In speaking of agency nurses, he said: "It's an awful set-up. We advertise in the Philippines and in India to attract nurses to be attached to the hospital, to try and get rid of these agency people. They kill more people than they bloody save, these do. It's an awful bloody set-up but we've got to have them." Newspaper leaders were apoplectic. Unison, the public service union, called for his resignation.

Mr Blower's remarks were certainly intemperate and reckless and he has apologised fully for them. But was the outrage because those remarks were untrue? Were they ill-informed?

If dependence on agency nurses compromises standards of care, then, even if they don't kill more people than they save, the importance of what he is saying dwarfs any problem of intemperance he exhibited. And we should be grateful that, far from resigning, he had the courage to finger a problem that is potentially a matter of life and death for every one of us.

Walsall Hospital has looked at its records and sees no relationship between complaints and agency nurses. The hospital uses fewer agency nurses than many trusts, and its use of them has been declining. The larger issue remains, though. Agency nurses are the supply teachers of the medical profession. They come in to fill a vacancy. Sometimes they fill in for a shift, sometimes for a couple of days.

A few years ago, when I was a regular patient at a London NHS hospital, the agency nurses would occasionally be assigned to wards in which they had no particular expertise. Some were good. Some were bad. In this, they matched the normal ratio in nursing, or any other job.

But common sense suggests that there is a fundamental difference between the history supply teacher who fills in for a geography class and the paediatric nurse who is assigned to the trauma floor.

Hospitals do their best to fit nurses to the job for which they are qualified. I'm fairly certain no hospital would allow an inexperienced nurse to assist in the operating room or intensive care unit. But a lot of damage can get done in much less dramatic settings.

The best nursing care comes from the nurse who is not only experienced but has some continuity with both patients and hospital. Continuity of care ought to be a high priority.

Agency nurses can have all the training in the world, but they aren't Socrates and Mother Teresa combined. Dropping nurses into constantly new settings is like putting a pupil in a new school each time. They don't get what's going on.

One of my agency nurses was unfamiliar with the idiosyncrasies of the doctor's handwriting and the routine I was on. When there was no senior nurse around to help her, she hooked up another bottle of my unfamiliar and rather viscose infusion at a speed that would have burst my bad veins in short order.

After she had left, I changed the volumetric pump to a slower drip, having learnt that the safest thing in hospital is to learn how to do things for yourself. Easy enough for me, but not so easy for the very ill chap on the same floor who got hooked up to the wrong tube for a nasty few moments.

The nursing profession is in crisis. In the grim old days, women seeking work had fewer choices than they do now. The grim thing today is the working conditions of nurses and so, understandably, fewer women choose to go into the profession.

Health care is crumbling under the costs of our ageing society. The standard market solution - solve shortages by competitive salaries - is not possible. Importing nurses from overseas, which Mr Blower sees as the solution, creates its own problems.

The six-month period of "adaptation" is sometimes more honoured in the breach: language and body language between foreign nurse and British patient are often unsatisfactory.

According to studies, some "English-speaking" nurses speak English all right; they just don't understand local English very well - which may be why the on-line Hindustan Times accused Mr Blower of "racism" when his remarks were quite the opposite.

Some foreign nurses see the request for painkillers as unnecessary, given standards in their homeland or the rather reticent behaviour of the British in pain.

At any rate, the NHS is now short of one skilled manager. Mr and Mrs Davies are said to be distraught that their actions caused this situation. "I haven't slept for three days," says Mrs Davies. We wish her a good night. A lot of patients may lose their sleep for far longer.