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I disagree with the person who says the problem is cultural, clinicians will always have a different point of view than managers. Clinicians see the problems from the perspective of the patient, managers see the problems in terms of hypothetical organisational structures and, of course, they need to be seen to be doing something to make their mark and put it on their CV. Meanwhile managers useless proposals and attempts at undermining how hospitals work most effectively, mean that staff will inevitably be demoralised and services fragmented. As long as managers take the view that their positions are more important than anyone else's, no one will win and hospitals will end up with 12 medical staff, 1 secretary/receptionist and the rest will be managers earning stupid sums of money.