'Rather than PCTs being helped to consider and work on weaknesses in a supported way, they are in effect invited to merely record what they already know.'

There is no more important criteria when judging any kind of change programme, large or small, than fairness. The basis for making judgments has to be perceived to be fair both in theory and practice.

That is why the fitness for purpose programme for primary care trusts is failing. There is anger, resentment and in many cases the hollow laughter of ridicule. The specific criticism is that any developmental potential has been lost in a forest of tick-boxes. Rather than PCTs being helped to consider and work on weaknesses in a supported way, they are in effect invited to merely record what they already know. Time, attention and money is consumed with little apparent benefit.

The latest HSJbarometer of PCT chief executives, which we will publish next week, shows that opposition to the fitness for purpose programme has hardened over the last couple of months. Now fully half of respondents gave it a confidence score of 3 out of 10 or less, compared to about 40 per cent in June.

The situation is made worse by suspicions that the parallel recruitment of PCT chief executives also falls down on fairness. Even successful candidates believe that posts have been artificially kept vacant to create space for 'new thinking' - meanwhile consigning good candidates to limbo.

Combined, there is little evidence of a genuine commitment to fairness. The result is a sector in which many senior managers are preparing for new roles with hearts already heavy.

Without specific measures to repair that damage, resentment will poison the well at the worst possible time.