It is at the front line where the drive for financial recovery overwhelms any opportunity to invest in the means to change the dynamics

Ian Smithis treatise about the state of NHS management (HSJ 4 January) is an elegant critique of much that we can identify as weaknesses in our NHS today.

His call for a fundamental shift in the way we see change management is laudable but prone to renewed failure if the managers in the front line are not supported through intensive personal and organisational development. It is these very managers who have been the most mauled over recent times through constant reorganisations.

It is at the front line where the drive for financial recovery overwhelms any opportunity to invest in the means to change the dynamics he so adroitly espouses. This may be tenable in the short term but disastrous in the medium to long term. Organisational and personal development must be affirmed as a key part of our values as employers. Managers as leaders will want to seize that opportunity not just in their own organisation but across many for patient, carer and staff benefit. Those who do will reap the benefits for years to come.

Dr Gerry McSorley, president, Institute of Healthcare Management