Gerry Robinson took on the challenge in a major documentary this week, Peter Mount CBE, Chair of the NHS Confederation, former Chief Executive with Thorn EMI and chair of an NHS Trust in Manchester, gives his view of what needs to change.

Gerry Robinson knows how to run a business. So when he took on the NHS, we sat up and listened.

He concluded we must mend relationships between consultants and managers, pay managers more, persuade clinicians to be managers and get chief executives down on the shop floor more often.

But is his prescription the right one?

The evidence shows that heroic individuals at the top are not enough on their own to make all the difference. And NHS management is already of a pretty high quality. Gerry Robinson said: '...the thing that struck me was just how good some of the people were. I was very pleasantly surprised by the calibre of people, particularly on the management side.'

Huge results in terms of reduced waiting times, improved services and absorbing the ever increasing needs of an aging population have already been delivered. How much we pay chief executives is therefore probably not the issue.

I have run a large private company and am now chair of the largest NHS trust in Manchester. I know that there is something about managing health that is uniquely difficult. This is backed up by the fact that the problems facing NHS organisations are found in many other health organisations around the world.

The biggest difference between NHS organisations and conventional firms is the people we employ. The NHS has its best educated, intelligent and most expensive staff - the clinicians - on the shop floor. This is challenging. The clinical ethic stresses individual freedom to make decisions.

Until relatively recently the idea that management should have any involvement in clinical issues has not been accepted. But it is in clinical issues, not bureaucracy, that most of the money is spent.

The culture is changing but will take time. Progress is hindered by the lack of clinicians in managerial posts. In most professional organisations a substantial proportion of leaders and managers have a background in the area. In healthcare this is not the case.

The pay and status differences and the vilification of managers don't help but the reasons run deeper. Medical managers often joke that they are seen by peers as having 'crossed to the dark side' and find themselves holding their colleagues to account. Something that is quite new in medicine.

A further problem is that successful organisations require freedom and autonomy to deliver real change. But when management has to look upwards to the Department of Health, the targets set from on high or the mysterious Prime Minister's Delivery Unit, focus is diverted away from the patient. We need to see real local freedoms for managers, clinicians and patients to lead and manage their own affairs.

The sheer size and complexity of modern healthcare also makes management a daunting task. Some of the largest Trusts in the UK have over 10,000 staff and budgets of hundreds of millions.

Finally, managers are so vilified and the culture of blame within the service itself is so bad, that often good people simply don't want the top jobs. Tackling this must be the highest priority.

Managing healthcare is one of the most difficult managerial jobs there is. Gerry Robinson had a lot to teach us. The problems we face affect countries across the world and an over simplistic diagnosis won't help the NHS, managers or most importantly, the patients.