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Of course Nicholson has a deep knowledge of the system-how could he not given his position and years in the machine that is the NHS? The key thing is that he holds a degree of personal responsability for Mid Staffs (not all of it but some nevertheless) and he has fostered a very unhealthy managerial culture. He needs to go because with people like him at the top of the organisation there is no real chance of fundamental and much needed change.