I read with interest Kieran Walshe and colleagues' article on clinical governance, and the research report from which it draws.

The Birmingham study chimes with feedback from our grassroots membership, which shows that a fundamental change in culture is essential for the success of the whole NHS plan, not only clinical governance.

However, in our experience, people at every level in the NHS (and beyond), seem unfocused about what cultural change means for them. What specific changes in values, attitudes and most importantly behaviour are required to achieve sustainable improvements?

The New Health Network has started a project which aims to help bring some clarity to the fuzzy concept of 'NHS culture'.

Views on this subject are welcome and can be e-mailed to me at newhealthnetwork@ supanet. com.

Margaret Mythen Chief executive The New Health Network London SE1