To a man with a hammer, everything looks like a nail. And so John Menadue, Director of the Centre for Policy Development, who has undeniably hit a few nails on the head in his time, continues to bang on for 30 years. I do not want to disagree with everything he wrote in Crikey recently -- some comments are quite fair -- and I certainly have a vested interest in this debate, but some comments just get my goat.

"Work practices that are virtually unchanged from the 19th century"? He cannot be referring to clinical practice, so I assume he was referring to role demarcations and organisational structures. That is, after all, the filter through which bureaucrats see health. Perhaps my job as an intensive care specialist tints my own view of just how much has changed since it became law that doctors actually had a degree, or since the same happened for nurses 80 years later.