Has management guru Sir Gerry Robinson fixed the NHS, at least within the confines of Rotherham General Hospital, a year after dropping in with a TV crew for a management makeover show? Unsurprisingly, the answer is no.

He may have helped make some improvements, but his return visit, aired on BBC2 last night, probably brought a smile to the faces of most NHS managers watching.

In the first programme, Sir Gerry, in the spirit of all good reality shows, used his expert knowledge of the private sector to tell mangers what they were doing wrong and how to fix it, using conflict between managers and consultants to titillate viewers. Then he left everyone to it.

A year on, he claims the animosity he saw has receded, although it is unlikely that this was the immediate result of the programme.

Delinquent school

Having witnessed their managers describe their job as 'like running a school for delinquents' and joke 'how old are they behaving today?', the consultants retorted by having T-shirts made with slogans like 'delinquent?' emblazoned across the chest.

On the positive side, more staff seemed to know the chief executive was in charge of the hospital, not consultants, but nobody pretended the 'doctor on a pedestal' culture had changed.

The hospital was more efficient, previously empty operating theatres were 'humming', waiting lists had been slashed and a£1.5m deficit had been turned into a£600,000 surplus. All good television, but how much of this was down to Sir Gerry and how much the hospital management would have achieved on its own is difficult to ascertain.

What makes this second programme really interesting is that rather than just taking stock of his successes, Sir Gerry is forced to accept that saving the NHS is not as simple as managers following private sector principles and ends up arguing against increased commercialisation.

Mad policies

He says the winners under choice and the 'mad' payment by results system will only ever be private sector providers that cream off the easy work, and points out that the 'idiocy' of the government's drive to relocate services in the community will further destabilise hospitals.

Sir Gerry realises that NHS organisations are at a disadvantage because they cannot use financial incentives to attract good staff or introduce radical changes to working practices easily within a public sector framework. They also have to work under the restrictions placed on them by government policies, so are effectively working in a straitjacket.

Sir Gerry asserts that the NHS needs to be removed from political interference because the government knows nothing about management and introduces polices which it expects to just fall into place and then reforms them when they do not. This makes it impossible for managers to do their job.

After the programme, Sir Gerry went head to head with NHS chief executive David Nicholson on Newsnight and told him he sympathised. No doubt Mr Nicholson was not hearing anything he had not heard before and he told Sir Gerry he did not need his pity.

It is tempting to wonder what Sir Gerry is planning next. Now he has identified the fundamental problems that are constraining NHS managers, is he grooming Mr Nicholson as his next reality show victim? It would certainly make amusing television and it would be interesting to see what health secretary Alan Johnson would end up printing on his T-shirt.