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NHS senior management like to be seen as senior executives of large businesses even though the majority would go bankrupt in a year if they were. Top NHS management pursue these schemes because it is an easy answer to opposition government ministers and the media when they ask what the NHS is doing to improve the quality of its executives. They could have used Agenda for Change to do it, but the DoH had too many plates spinning at the same time to notice. The only way a scheme like this can work is by completely changing the way management employment contracts are executed in the NHS. Not an attractive prospect for Nicholson or anyone else.