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Very little to add to Helen's thoughts except to pick up on her references to bad management being a barrier to the development of leaders. "Positive Action"is necessary not only in selecting individuals for development to ensure diversity to match the society we serve and the full range of clinical backgrounds but also to ensure that those parts of the NHS which are mired with self-interested, incompetent middle management are dealt with in order to free the potential leaders that are being suppressed. Latent talent is there. Releasing and developing it is essential. Doing nothing about those who fear or (worse) actively manage against leadership talent is scandalous.