I was pleased to see Terry Philpot's letter (8 November).

He picks up very well the point that I was trying to make: many frontline staff have a great deal to offer in terms of how matters might be improved.

This appears as a consistent message in many parts of the NHS (where most of my career has been spent, often on the front line) and the public sector generally, including government departments.

The experience in accident and emergency that night was particularly compelling, which is why I chose to write about that example, but it happens a lot elsewhere too.

The important questions are how to harness this knowledge and how to turn it into tangible improvements. There seems to be an emerging view that managers or clinicians - or both - might be to blame; this is not only wrong, but over-simplistic. My article spoke of some ways in which I had seen it done successfully in the public sector, and with considerable impact. When I worked for the Department of Health, I was always impressed by the increasing number of frontline staff being seconded in, or working in an advisory capacity like me, involved in policy-making.

Dr Dilys Jones Old Windsor Berkshire