I ONCE worked at Wycombe Hospital as a senior purchasing and supply chain manager and I am also a former nurse and a recent graduate of the IHI (Institute of Healthcare Improvement).

In North America where I am studying the art and science of health care improvement, my colleagues often express their surprise and envy at how the NHS treats more patients per dollar than here the US.

However they do not envy the constraints and complexities imposed on UK health managers.

By the very nature and size of the NHS it has been in crisis for years and it is the dedication, commitment and goodwill from its staff and the nation it serves that holds it together.

They deserve our admiration and respect.

Karen Walker, Quality management specialist, St Vincent's Hospital, Bridgeport, Connecticut, USA