Managing finite resource in an organisation that has to respond to what could be considered an uncontrollable demand is no doubt difficult, but brain surgery and complex cancer treatment is no doubt more difficult. Yet, the highly trained, registered and licensed brain surgeon is subject to the decisions of an unlicensed, unregistered NHS manager whose role requires no statutory qualification whatsoever. The decisions of some NHS managers have caused some serious problems, as I’ve discussed, yet we don’t know of any NHS manager who has had so much as one day’s pay docked, no-one sacked, no-one told to publicly account for their fatal failings.

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