The NHS has lost a great deal of talent in recent years. As a result it's lost much of its corporate memory

How uplifting to read the 14th December section 'Leading on Change ñ ¡ monster challenge'. Here we had some valuable theory and even more valuable practice on how the NHS could improve its performance in the field of change management. The key themes seemed to be engagement, dialogue, support, clarity and process; this compared with the stated NHS potential for establishing fear, concern and trepidation among staff. Who could argue with Ken Jarrold's '10 commandments' (if only they could be), Chris Hannah's 'let's make new mistakes' - or at least learn from our past ones - and Peter Homais listen, learn and lead - particularly lead . All appeared to be set fair for 2007, if the DoH, SHAs and trusts read, reflected and took on board the messages.

Having said that, there were still some concerns apparent, a number of weak spots identified. The framework for implementing the people management implications of Commissioning a Patient Led NHS appears not to have been wholly committed to, with a number of questions left hanging - how many staff feel let down, who did renege on the agreed process, where is there a feeling of the lack of fairness? Alongside that, in change management terms, Professor Paul Bates and the NHS Institute for Innovation and Improvement proposal for a 'step change' and more radical approach - involve the patient. Maybe we should consider a more consistent first step - involve the staff!

However, worse was to come in the 4th January edition and the DoH Pay and Workforce Strategy (PWS) report, a classic case of how not to do it. Now we have all of our NHS consultant, professional and scientific staff rallying to the flag, concerned, fearful or confused. I say this because most staff will not have read the full report; 3,200 too many consultants, 16,200 too many professional staff, sounds like a 'threat' in anyoneis language.

At the same time it is suggested we sever the connection between predicting, commissioning and controlling the supply of staff, via university and other contracts, proposing the NHS just buys the final skill output (as even my children would say...not). Then, to cap it all, suggestions (corporate memory caps on please) about establishing local pay arrangements, providing 'cafeteria style' benefits for staff, using temporary staff and temporary contracts to fill gaps; in addition, for good measure, use unemployment (presumably the threat if it) to create pressure on pay claims. There were of course other points but that's enough to start many thinking.

The NHS has lost a great deal of talent in recent years. As a result it's lost much of its corporate memory and, based on the what we read in the PWS report, much of the knowledge about how to effectively manage change.

To be positive, however, things can only get better. But the NHS needs a lot more change management expertise in place.

Ron Jones, freelance change management consultant