Pilot reviews by the Commission for Health Improvement have shown the importance of healthcare managers, CHI director Peter Homa told delegates.

In a debate with Chris Woodhead, chief inspector of the education watchdog Ofsted, Mr Homa stressed the importance of leaders in a healthcare setting. The four pilot reviews had also shown 'a general poverty in adequate measures of clinical outcomes' and the 'importance of training staff to improve services'.

The BBC's Niall Dickson, chairing the debate, reminded Mr Homa that he had often distanced himself from Ofsted's approach to inspection. Mr Homa replied that he knew, and staff knew, that 'you can't do improvement to people, you have to help them to do it'. But this was 'not inconsistent' with being tough, and making sure deficiencies were addressed.

Mr Dickson asked Mr Homa if he would identify 'x-thousand'doctors, nurses - or managers - who shouldn't be in their jobs.

Mr Homa replied that 'where we have evidence and are confident in the quality of our assessment', this could happen. But he would not 'play to the popular appetite' for 'suggestion and innuendo'.