Stephen Dorrell, chairman of the Health Select Committee, wants to stop the NHS enforcing "gagging clauses" on former employees. He's more correct than he knows. The issue here is not just one of freedom, but of life and death.

I say this because of something Joseph Hallinan says in Why We Make Mistakes. He points out that whilst the accident rate for aiplanes has fallen sharply since the 1930s, the rate of medical misdiagnosis has declined more slowly (pdf), so that - in the US - well over 30,000 people a year die as a result. A big reason for this difference, says Mr Hallinan, is that:

ORs are typically hierarchical places, with the surgeon on top; cockpits are not...When it comes to pointing out potential errors, everyone [in a flight crew] is considered equal (p194).

Hierarchy inhibits feedback: nurses don't challenge doctors; junior doctors don't challenge senior ones, nobody challenges managers, and so on.

But feedback is essential for improvement.If a musician couldn't hear what he was playing, or a golfer couldn't see where his shots went, do you think either would get better? This point is emphasized by Matthew Syed in Bounce. Feedback, he says, is "the rocket fuel that propels the acquisition of knowledge". Good feedback "is the reason why mankind has progressed." Geoff Colvin agrees:

We've examined at length the importance of frequent, rapid, accurate feedback for improving performance. Most organizations are terrible at providing honest feedback...Tet nothing stands in the way of frequent, candid feedback except habit and corporate culture. (Talent is Over-rated, p131-2)

It's in this context that "gagging orders" are - literally - fatal. They limit feedback. Sure, the feedback might be noisy - an outgoing employee might have questionable motives, but a noisy signal is (probably) better than none. Whistleblowers are essential to progress.

Of course, nobody thinks that removing gagging orders is sufficient. Matthew Green says: "To implement any kind of change in the NHS means challenging a whole mass of entrenched hierarchies". And Paul advocates weekly meetings between management and staff. They are right. Improvements come from feedback, which requires openness and a sufficiently egalitarian atmosphere that encourages junior staff to speak honestly.

Why, then, could anyone possibly oppose this? Simple. Feedback challenges the self-image of the powerful; it tells doctors that they are not godlike experts, and managers that they are not running immaculate organizations. Alex Massie decries the narcissism of the left. But that is merely irritating. The narcissism of the powerful can be fatal.