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I am an NHS consultant, getting a bit tired of it all and admittedly thinking about the next stage. I have been a manager. I have worked with excellent managers. I have also worked with people who have caused chaos. The problem is that senior managers are really so far up stream that their impact can be extremely pervasive and the effect correspondingly widely toxic. I mean by this that managers have a capacity to make people ill. It is sad to see that the same hierarchical culture of excessive deference combined with cliquism pervades senior management much as it can the clinical professions. I suppose that everyone needs to feel appreciated and reassure themselves that they have friends. I am not sure what the answer is. Senior managers need to have nerves of steel and the hide of a rhino given the nature and responsibilities of the role, but this often links with other narcissistic characteristics that are less attractive. I try and avoid leaders if I can these days. They are a distraction and often rather alarming individuals. Sorry I have to post anon.