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Mr Manning is of course quite correct. Trouble is that NHS management continues to operate by maniacal central control and strict lines of adherence to current political whims. Which change so often it is near impossible to keep up. Clinical growth has to take place on an evolutionary basis with plans made, then executed over long time frames. I.e. stability, not constant 'revolution'.

The worst thing I ever did was take on a high profile clinical/managerial/leadership role. Ruined my life. Frequently had to engage with DH personnel: took a while to work out that these people, who had such power over local affairs, were in fact all management consultants employed by PA Consulting or the like. But this was carefully hidden by titles suggesting they were civil servants. The only time ever saw this tribe really rattled was when the issue of NHS managerial bullying was raised: then there was vehement, indignant, quite comical denial. And there is the rub: the lionised heroes of NHS 'leadership' such as Nigel Crisp and Ian Carruthers [to name only 2] are unreconstructed bullies. The system both encourages and protects bullies and constantly undermines clinical leaders who try to resist the crazier aspects of political whim. Mid-Staffs happened because clinicians were too frightened, worn down or both to blow the whistle. Once bitten twice shy potential clinical leaders will try again. The system will reap what it has sown.