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All too often I am met with limited vision and thinking by people who have been in the NHS all their lives. This lack of vision is demonstrated in the discussion above thinking that moving in and out of different NHS organisations is a change. Having worked in a number of NHS organisations, I find them worryingly similar. I think there's greater value in potential leaders having experienced a wider range of employers than NHS organisations which although vary with management styles of their leaders, perform roughly the same function - all PCTs and all hospitals are broadly the same. Try thinking outside the NHS for a while - it might open your eyes.