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So many questions..... I agree this is a mess and that HR is muddled. NHS experience is essential as is commercial acumen, but then many of the big 4 and others have already headhunted people who took MARS. If you just look at the management costs per head of population then it doesn't look commercially viable, but that's if you're thinking at cluster/ CCG level. I think the DH are thinking on a bigger scale, as are those advising them. Will there be a return of FESC2? Either way, my heart goes out to the poor people stuck in the middle. It might be about changing attitudes and better communication styles, but it's still a crap way to treat people and implement change.