Mr. Leo Kearns:

This is the perception, including that there are too many managers. We must be careful about this as well, however. Most clinical teams need non-clinical people to make them function. If we are looking at, for instance, organising SLAs with multiple organisations, then it is necessary to have people with experience in that area. Healthcare management is tough and it is a difficult gig. Setting up the healthcare system the way we did means pretty much everybody in it has an impossible job. We can see that the system is firefighting and engaging in crisis management all the time. We have not made it a good place for people to work. This is why we mentioned the whole workforce and culture issue in our advice. We must address this situation in the round. Whether someone's role is to be an accountant, the porter at the front door of the hospital, the practice nurse in a GP practice, the GP, the consultant, the junior doctor or whatever, in a complex system there is a need for all these people in all these roles, including the manager of a hospital and the manager of a community healthcare organisation, CHO, etc. While what the Deputy said might be the perception, therefore, I do not think it brings us forward that much really.