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Not sure Nick gives sufficient weight to the self preservation and imperialistic motivations of the management cadre led by David Nicholson. Andrew Lansley has hardly had Nicholson and colleagues marching for him except when their interests coincided over the coalition programme for government. As a result, we end up with a more centralised rather than devolved structure and alleged political interference is replaced by increased management power. One hopes the ability of the NHS to thwart the will of democratically elected governments will be noted and addressed at last.