The recommendations of the Bristol inquiry (news and news focus, 19 and 26 July) mean managers have re-opened the debate about 'management governance'.

Readers may recall that we wrote in HSJ about the need for a more professional approach to managerial regulation almost two years ago ('Governing the guv'nor', 2 December 1999).

Our proposition was that increasing responsibilities and powers were being assigned within a national framework.

At the time, we suggested that the Institute of Directors had developed an effective working model for accrediting 'chartered directors' that possibly could be adapted for use in the NHS.

The Bristol inquiry, coupled with the increasing trend towards more central direction of the service in order to remove local variations in quality, have reinforced the argument since our original article.

The Institute of Healthcare Management has suggested that it may be the body to develop such a framework, but has so far made no firm proposals.

In the absence of anything more closely resembling an 'association' of chief executives and senior managers, now is the right time for the institute to take the lead in collaboration with the national leadership centre, learning from the other top bodies such as the Institute of Directors.

We are confident that chief executives across the service would be keen to contribute to this work.

Peter Coles Chief executive Whipps Cross University Hospital trust;

Neil Goodwin Chief executive Manchester health authority