Autonomy is key to applying lessons from private sector

The prime minister is becoming increasingly impatient about the rate of public sector reform - and believes the NHS must have more courage and imagination to learn from the private sector.

On Tuesday he hosted a meeting at Downing Street of representatives from foundation trusts and FTSE100 companies such as Tesco and Cable & Wireless.

The mentoring initiative that will flow from it is intended, he said, to 'break the myth' that public sector values are at odds with what he called 'proper business management techniques'.

Do NHS managers really believe that 'myth'? Most don't, although some will have memories long enough to recall that it was the report by Sir Roy Griffiths, then managing director of supermarket giant Sainsbury's, which launched the concept of NHS general management in the mid 80s. They will also know that the history of the NHS being fed lessons from the private sector is mixed at best.

So although the enthusiasm of the trust chief executives and chairs at Number 10 was clear, the Foundation Trust Network initiative will also be challenging.

For a stagemanaged public event, the company directors were surprisingly blunt about their concerns. They wanted to know what was in it for them (and learning about the NHS's staff loyalty and motivation is a good answer), how it could be made sustainable - but most importantly they wanted to be sure they would make a difference.

On the last point, more than one voiced a concern that is a lesson in itself - namely that they had been dismayed by the lack of autonomy available to NHS managers below board level.

Without freedom to innovate deep in the organisation, they said, all the board development in the world would not achieve real change. Failure by ministers to grasp that nettle will create fatal frustration on all sides.