Comment: Pointing the finger at managers means pointing it at ministers, too

So managers are to blame for lengthening waits in accident and emergency departments - at least in health secretary Alan Milburn's view. But this is folly on two counts.

First, anyone who understood the nature of the problem would realise it is far too complex to lay at the door of a single group of NHS employees, even one perceived not to be very popular with the public. What is more, today's managers cannot be stereotyped as the grey suits of yesteryear - many are clinicians too, especially in A&E departments.

Second, Mr Milburn himself is the architect of the NHS's management structure, and he sits at the centre of the highly centralised system he has created. He is, in effect, the real chief executive of the service. Therefore, attempting to shift blame in this way can only rebound upon himself.