With redundancies on the horizon and the exhortation to “strip out layers of bureaucracy”, what do you bet that we will see the resurgence of “self managing teams” and “flat hierarchy” as the solution to all NHS management ills?

Here is why this is a myth. First, human beings are intensely hierarchical. We must have a leader and if we find ourselves without one, we will manoeuvre relentlessly until we get one.

This doesn’t mean that we like our leaders or even enjoy the process of being led.

The fretting and politicking takes up time that could be more fruitfully used elsewhere - for instance on core services

Normally we will rebel against leaders vigorously because we also need autonomy, but that’s the paradox. Managing these ambivalent feelings is at the heart of why being a leader is so challenging.

Flat hierarchies may create as many problems as they solve. I think here of one client who, poor man, found himself with his management responsibilities increased by 750 per cent when his team went from eight to 60 overnight and six months later he had predictably acute performance problems.

When you dismantle hierarchy, you replace it with something we might call consultus interruptus.

This is the process whereby many dozens of people have to be consulted about everything before a decision is made, thus fatally slowing everything down. Hence the saccharine gloop of endless meetings and project boards - along with taking your eye off the external world.

I once ran an away day for 40 pleasant people who provided specialist services to their organisation. In the final phase of the day, the group had already approved the recommendations of their communication specialists about conveying the findings of the event. Then, lo! Someone suggested circulating a draft to everyone. Nods of approval all round. I remember temporarily losing my facilitator neutrality and letting out an involuntary groan. Why clutter up 40 people’s inboxes when you already have the go-ahead verbally? I was gently reminded this was a “flat” organisation where “consultation” was one of their “values”.

A year later, the host organisation abruptly decided it could outsource the whole operation and most of those nice people lost their jobs.

In most “self managing” teams, what really goes on is relentless politicking. The power vacuum must be filled somehow.

People fret about the performance of colleagues, about getting more resources for pet projects, about promotion, about direction. How is any of this to be resolved if there is no boss?

The fretting and politicking takes up time that could be more fruitfully used elsewhere - for instance on core services.

The theory of flat hierarchy does not deceive us for long. We are not usually deluded about our actual place in the pecking order and know that the organisation chart is a fiction.

Did any of Tony Blair’s government doubt for a moment what Alastair Campbell’s influence was, despite his lack of formal Cabinet responsibility?