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I am not sure this report makes a very compelling argument, probably because the question posed if the wrong one. The question of whether the NHS is over or under managed is almost irrelevant. The question ought be is the NHS well-managed. And we have to be honest and say that in many parts its not. If the NHS had the number of managers it does and it delivered strong outcomes, no-one would be complaining. But the sad fact is that day in and day out people continue to have frustrating experiences of care - jammed GP lines, poor access, cancelled appointments, lost medical notes, re-referrals from one place to another, delayed care due to CAS systems with no evidence base. Instead of looking to the centre and criticising, perhaps its time we looked at ourselves as a profession and asked if we really are up to scratch.