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The last two contributors miss the point - people who speak their mind in the NHS, even reasonably, find their career options closing down. My perception is that nearly everyone is working hard in terms of long hours but effectiveness is limited by culture and organisational processes. It really is obvious if you think about it - the last year has been disastrous for the NHS on almost every level - so managers are bound to be caught up in the mess and need to ventilate before getting on with the job.