It was interesting to read about two major reviews of the NHS (Sequel opportunities', pages 11-12, 18 October).

The notions about earned autonomy for acute trusts that are being pursued by a review team, led by Adair Turner and reportedly involving the Department of Health, are of particular interest to the Institute of Directors.

On grounds of good governance and efficiency alone, the IoD has been advocating for some time that publicly funded NHS healthcare provision should be delivered by self-governing bodies, perhaps set up as mutuals (supporting information can be found on the IoD website at www. iod. com/policy/papers).

That could lead to far more effective ways of managing and motivating nearly a million NHS employees than many of the current attempts, which include micromanagement via hundreds of targets and several supervisory quangos overseeing the delivery of NHS healthcare. This suggestion has also been supported by the efforts of an independent study group, convened by the IoD, which canvassed the views of leading opinion formers in and around the NHS.

Geraint Day Business research executive Institute of Directors