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Here is the mechanism by which this happens.

I was lucky enough to participate in the local Aspiring Directors development programme. Having completed that programme, I started secondments which were part of the programme which would give me hands on experience and, hopefully, lead to a substantive Director post.

Then "The Announcement" came. All PCT managers were to be sacked. All development stopped. Any existing Directors sat still and didn't move so they could either make sure they got a job in the new model or got a pay off.
Then clustering happened, only SUBSTANTIVE Directors and Chief Execs could apply. Then CCGs and CSSs and NCB postes started to appear. Only SUBSTANTIVE VSMs or SHA Band 9s could apply.
As a substantive 8D I have not been able to apply for any of the senior roles yet advertised.

But I am a white man. What has that got to do with equal opportunities? The point is that the make up of the cohorts going through the development programmes, both the general and those aimed at under-represented groups was considerably more diverse than existing incumbents.

The newly developed and more diverse cohorts have never been given a chance because the selection process has been based first on incumbency and only secondly on talent.

Now, I don't mind pitching for jobs on the basis of skills and ability. I am glad that the talent pool is being expanded through better inclusion of people previously excluded on the basis of their race or gender. If they are better than me and get the job, I at least get a better leadership and therefore a better NHS.

I do mind that people are being prefered to me because they were an incumbent in a job and a role that no longer exists. I have no chance to pitch a fresh offer against their "experience"

If I feel like this coming from a group that has traditionally benefitted from the old institutionally racist and sexist NHS, I can only begin to imagine how those who thought they might finally be given a fair crack at the top jobs might be feeling.