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Well said broters and sisters. This may be repeating something that others have put in less plain english. The managers in the NHS are managing a system which, for the most part, they did not design. It is not their fault that politics, structures, policies, approaches, priorities, workload of the bureaucracy change or are just plain wrong. They are trying to make it work despite these things. However as with all organisations there will be good managers and those who struggle, that just how it is - lets concentrate on the patients!