What is culture? Is it possible to change this by direct action, or does it develop its own life? Our NHS healthcare has developed characteristics none had planned or now wish to be identified with. We have a crisis of depersonalisation: patients frequently report shocking failures of humane care, while staff are unprecedently demoralised and weary. Serial experts sound reassuring and resolute, then fade away. This book makes another kind of offering: a collection of letters and submissions from a long-serving frontline medical practitioner. In missives to newspapers, professional journals, politicians, senior managers and colleagues he describes his experiences and conundrae, his understanding of these, and then his remedial suggestions. From his long view David Zigmond attributes many of our current welfare problems largely to a seminal folly of our industrial age: that we can produce and manipulate complex human care and welfare as if they are manufactured objects. But such procedural manufacture then supplants our relationships, and the language, skills, imagination and emotional life that make these possible. The writing is challenging and demanding but it is rewarding with insighted, incited and incisive wit, unusual and substantial ideas and evocative human descriptions.