Comments on Gerry Robinson's contribution and the programme in general seem to reflect comments in almost any discussion about 'NHS' and 'management'. The issues are so emotional for so many people that it's difficult to overcome bias. As a change manager, with some experience of the NHS, my bias will be towards what I know management canachieve.

Comments on Gerry Robinson's contribution and the programme in general seem to reflect comments in almost any discussion about &Quot;NHS&Quot; and &Quot;management&Quot;. The issues are so emotional for so many people that it's difficult to overcome bias. As a change manager, with some experience of the NHS, my bias will be towards what I know management canachieve.

The NHS presents so much complexity, so many problems, and so many cultural histories, that it is difficult to pin down causes and solutions. Managers get hit by so many initiatives that all have to be done, that it's no wonder that few are pursued effectively. And it's no surprise that initiatives requiring disagreeing groups of professionals to cooperate are often not pursued with tenacity.

Brian James was indeed courageous to invite in such high profile 'help', and to learn in front of millions. Gerry, as I'm sure he would agree, represents hundreds of managers in the NHS who do pursue effective change with tenacity. The lesson might be one learned time and again; if you want something done give it to one person and make it their sole responsibility. This forces you to really prioritise. (NB. giving things to someone who's already busy doesn't work so well in the NHS, as everyone is busy.). The Good Hope Hospital case that Clive mentions, and many others in the NHS, show what can happen. No doubt, in a 'transformed NHS', such excellence will happen more as the norm rather than the exception.

Gerry (and Brian) had six months to make something happen and learn from it. This I think they did. I felt the comparison to a John Harvey Jones 'failure' was rather selective and weakened a generally good article.

I'd like to read more about the 'reality' of the programme. The meetings and comments of individuals seemed very real and reflected some of the reality of the NHS and the fact that most people in it really do want to provide excellent services. The dilemmas of managers who were not sure how far their discretion could go and were not used to extending it also felt real.

Paul Knutson, Managing Director of Paul Knutson Ltd.