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Should anyone wonder about the precise nature of the pressures that impinge on the lives of NHS chief executives and other senior managers (see above), they need look no further for enlightenment than HSJ 's ow n Management Challenge.

In the telescoped time-frame of this one-day simulation exercise, teams had to cope with a whole gamut of wicked problems (see news focus, pages 14-15). The pace was furious, passions ran high and the only way to survive was collaboration, collaboration, collaboration. Just as in real life, the imperative for partnership working pervaded everything. And just as in real life, there were times when most team members felt themselves flagging under the weight of responsibility for staff, services and resources.

Some taking part will no doubt one day be responsible for dealing with such situations in real life. No-one inside or outside the NHS should be under any illusion about the toll exacted on managers by the nature of their work and the environments in which they have to operate. The steady stream of long-standing, high-profile managers now leaving the service could attest to that.

If exercises like the Management Challenge help them prepare for the rigours of their role, they, the NHS and the public can only benefit.