I do not fully share the criticisms of health secretary Alan Milburn's visit to Spain to look at the model for privately run hospitals (news, page 2, 8 November).

NHS Confederation policy director Nigel Edwards is right to say that the important question is why health service organisations are so difficult to run. The answer is partly political, because managing in political systems like the NHS is more difficult. It also revolves around management capacity and capability, an issue facing many other large public and private organisations.

Nevertheless, while we continue to debate these issues, time is increasingly against us in creating the sort of NHS demanded by the public.

So looking at alternative management models seems fair game at the same time as improving our in-house management. If incentives can be found, collaboration between NHS and private healthcare managers could reap mutual rewards.

One example is extending public-private partnerships to include the management of diagnostic and treatment centres.

After all, the private healthcare sector's forte is organising and managing elective care. If diagnostic and treatment centres offered treatment for both private and NHS patients, why not seek a more imaginative public-private partnership arrangement for their management? After all, the concept of contracting out the management of services is not new to the NHS.

The development of the NHS as a complex system continues unremittingly, and it could be that general management would need to sub-specialise or subcontract even more than it does currently. Therefore, perhaps, we need to think through more fundamentally what it is that NHS managers should be providing in the future in terms of expertise and value.

Neil Goodwin Chief executive Manchester HA