The root of the tragedy in the NHS (in my view) is certainly weak recruitment why?… because the selection process panders to the industry politically correct norms. Yes this reaches a point of “certainty”, (and an easy fee for the recruiter) but misses the required capability to make a difference. Do the NHS really want to change, is the recruiter really motivated to do so…? From our experience in similar environments banks etc, the starting point with the NHS is 1. accountability and organisational, 2. effectiveness remove NVA, challenge BVA , 3. and lastly technology. Getting 2 and 3 right I would expect you have a 60% efficiency improvement. In the meantime they recruit more senior managers from the public sector / NHS so it will / has never changed. In so doing there is a great opportunity to make these fabulous workplaces too. People in uncertain times will make BAD decisions by revert to more of the same sector experience etc for the sake of reaching certainty, because we cannot process uncertainty. This was the root cause of Barings Bank going bust. Sadly the more uncertain our environment – the worse this gets makes you aware of this and breaks this cycle and business entrapment in the flawed norms.