The fall-out from Sir Gerry Robinson's TV programme on NHS management continues, and this week two very different commentators address the central issue of what is holding back managers and clinicians from working together properly.

The fall-out from Sir Gerry Robinson's TV programme on NHS management continues, and this week two very different commentators address the central issue of what is holding back managers and clinicians from working together properly.

SHA chief executive Mark Britnell makes the point that too often the argument around reform 'describes some means to an end and not the end itself÷ ²¥form has become a byword for bungled, time-consuming and energy-sapping reorganisation' (pages 18-19). He then sets out what that end point looks like, in a way that can be understood and backed by both NHS staff groups and the public.

Just as importantly that is intended to be the basis for the kind of charter around which the NHS could rally. The underlying argument is that the NHS cannot win the case for less interference from politicians without articulating its own clear vision - otherwise a vacuum is created which will be filled by others.

It is a point underlined by HSJ's new columnist Dr Anna Donald. She argues that doctors see their employer not as an organisational system with shared values but as a collection of independent cells (page 17). The practical result is that responsibility for making things better becomes hazy. As she says of Sir Gerry's temporary home: 'Where authority was unclear, committees - the algal bloom of bureaucracy - thrived.'