If murmurs of a re-jig after Sir Alan Langlands' resignation are correct, we seem to have missed an opportunity (news, pages 2-3, 24 February; news focus pages 13-15, 2 March).

Much talk is made of a management board with what is described as 'frontline' staff, which indicates well-respected leading clinicians in their field. Such a development is a step in the right direction, but not at the expense of the expertise of senior civil servants and their knowledge of the political machine. There must be a 'third way'.

And infrastructure must be developed to ensure that knowledge from the 'real frontline' staff (staff nurses, administrators, and junior doctors) is gained.

As a younger NHS manager, I have never learned so much about problems with services as when I have discussed them with colleagues working with patients day in, day out on the wards or in the community.

It seems that it is not senior civil servants who need 're-jigging' to speed up modernisation, it is the way we learn about the constraints to modernisation, for which frontline staff may just provide some answers.

Simon Barton London NW1