Having been an independent adviser and organisation development consultant in Northumberland and Tyneside for many years - and with Northumbria Healthcare trust since its creation three years ago - the picture painted is biased, partial and unsubstantiated, in the main.

The trust is efficient and effective in its delivery and development of services.

No mention in the article of the innovative and radical changes in services to patients; of best practice in clinical leadership and management; of extensive joint working with primary care and other health and social care organisations.

The leadership is not just with Sue Page but many committed clinical and non-clinical managers.

Of course, like other large organisations, the trust doesn't get everything right. Better communication with, and participation of, staff is a constant concern. Many improvements have helped create a new culture from the previous three trusts and Hexham Hospital, which merged in 1998.

Nick Nicholson Centre for health and social care management York University