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It is extremely difficult to speak out as an individual senior manager when tied to corporate decsion making which is often just to rubber stamp central directives. Anyone remember the days spent on PCTs assuring the top that they were ready for commissioning that could have been spent actually monitoring the contracts we already had. Constant change and interference does not lend itself to good management. Good managers are constantly stymied in their attempts to impose regulation by the 'excellent leaders' we are supposed to need.

As a clinician turned manager I echo that this is not a role that many would want or be suited to. However clinicians do have to advise and inform managers what would seem to be best for their patients so that in partnership informed decsions may be made.