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This is interesting stuff. Having worked at very senior manager level in the NHS my experience of most CEOs and Directors is that they are intellectually capable and good politically and good at networking. Where they are often lacking is the ability to create cohesive teams (management skils in this area are often near Klingon and encourage competition between direct reports and consequent tennis playing over accountabilities). Anyone who has ever done Myers Briggs for Boards will know that there are too many ENTJs and similar types and not enough diversity. But we need to remember that the fish rots from the head; the DH has always been a toxic place to swim and we should not be surprised when we fnid that the NHS' many local rock pools are similarly dysfunctional.