No-one ever argues with the case that clinicians at every level are integral to successful service reform. But it is a truth observed more in the intention than the action. It is therefore welcome, although a little late in the day, for the government to wheel out two national clinical directors to make the case for reconfiguration.

No-one ever argues with the case that clinicians at every level are integral to successful service reform. But it is a truth observed more in the intention than the action. It is therefore welcome, although a little late in the day, for the government to wheel out two national clinical directors to make the case for reconfiguration.

There is no doubt that Professor Sir George Alberti and Professor Roger Boyle - the emergency services and heart disease czars respectively - will be compelling ambassadors for change. Sir George's report begins with a personal story about the difference between dog bites and heart attacks and goes on to make the case for why the closeness of a unit labelled 'A&E' is not the central criteria for patient safety and quality.

This is exactly the diagnosis that the people around the prime minister believe was not sold strongly enough to the public before setting out the solution. The concern will be that it does not herald a real change in attitudes.

The worry is not helped by the fact that, as we report elsewhere this week, Professor Sir Liam Donaldson was effectively excluded from the ill-fated Commissioning a Patient-led NHS document until literally the final hours. The rushed references to public health have, he admits, resulted in promises that have been hard to keep.

Government supporters will say this is digging up a past that has now been rectified. That - and the case that there is now for genuine inclusion of clinicians in designing and delivering reform - has yet to be proved.