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How about a licence to practice backed up by a Code of Conduct for Healthcare Management? Regulation perpetuates the command control mess that is the current NHS, with the connotations of policing. We desparately need nurturing, encouragement and rosy glow management. This requires embedding a Positive Work Culture into the NHS based on wellbeing and performance. Managers with a licence to practice can be tested regularly on their ability to build trust and commitment between themselves and their staff - essential for high quality health care. If they follow the revised Code of Conduct for Healthcare Management (see www.ihm.org.uk) the public will be reassurred and we will start to see managers effectively managing people.