I am writing this en route to a conference after a busy time consulting stakeholders on stroke care in Somerset and recording radio interviews on 'listening and learning' and the priority we are attaching to stroke care after our local modernisation review.

Today's enduring image has been the procession of highly skilled and motivated medics, nurses, occupational therapy teams, speech therapy staff, physiotherapists, psychology staff and stroke sufferers all offering their views in a desperate yet good-humoured way, hoping that this time they will not have their expectations raised only to be dashed.

We have used the language and skills of service redesign and process mapping to minimise the duplication, wastage, confusion and gaps in complex systems. We have pulled out every stop to enthuse and inspire all partners in a sustained focus through programme boards, steering groups and stroke forums. We have set out timetables and deadlines - often extremely tough ones. But our most recent service and financial framework briefing shows a less than rosy picture. There may not be nearly enough funds to make much impression on the development needs of local stroke services next year.

This is not a case of appeasing a threatened mutiny, more a genuine and passionate plea from an average, beleaguered, health authority middle manager: let's have effective translation of policy, good intention and rhetoric into action that rewards the dynamism and enthusiasm I witnessed today.

George Coxon Principal manager (acute services) Somerset HA