Public hospital clinicians across Australia will relate to the problems described in the Garling report and endorse most of the recommendations to bring the system "back from the brink". Implementation is feasible but requires substantial culture change, which must re-engage clinicians and stem the flow of desertion to the private sector. It must also address the fundamental causes of the current crisis. Key recommendations involve a substantial change in governance, with a transfer of many areas of the New South Wales Department of Health's responsibility into four board-governed statutory authorities, where equal partnership between clinicians and managers will exist. Of Garling's "four pillars of reform", the greatly expanded role for the current clinician-led Greater Metropolitan Clinical Taskforce is a strong indication of the seriousness with which the Commissioner viewed the clinician-manager divide (which he likened to the Great Schism of 1054). The major omission in implementation is a failure to adequately address the loss of local accountability in hospitals since the abolition of area health service boards. Major change can occur without additional funding, but without substantial new money from the Australian Government, the public hospital system will not be pulled back from the brink. A better opportunity for true partnership of such importance between state and federal governments may not come again before it is too late.