Last week's BBC2 programme, Can Gerry Robinson fix the NHS?, may not have fixed anything by itself but has certainly got the NHS talking. Inevitably there is a range of views about both the diagnosis and cure put forward by the business guru during his stint at Rotherham foundation trust.

Chief executive Brian James certainly feels the trust and his own work have been misrepresented by the programme. As he argues on www.hsj.co.uk this week, initial attempts to use spare theatre capacity to bring down waiting lists were thwarted by safety issues and lack of primary
care trust affordability - instead the makers concentrated on adversarial relationships between some consultants and management 'with both sides presented as stereotypes'.

That is true but the quality of these relationships in many trusts does indeed conform to stereotype and is an impediment to making even simple changes. That is at the root of the frustration felt by many of the HSJ readers who have responded to the programme and Mr James's article.

And despite his concerns Mr James also says he learned from the experiences, most notably the need to avoid becoming isolated from the workforce and instead personally embody national reform processes at a local level.

Fairly or not, the programme did give the impression of a chief executive not able to fully imprint his vision on an organisation - which takes more than just walking the floor. Any foundation trust that appears not to be able to use the freedoms it has been given will face big challenges in future.

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