I think at this point it needs both, remembering that the Lansley reforms have now set up a number of internal structures that were not there before and subsequent to that various fuckeries have been implemented so that the whole caboodle wouldn’t collapse right away leaving the current lot of wankers holding the baby.

I think there’s an argument for civilian administrators and managers to free up medically qualified staff to do things they are qualified for, what has to stop happening is the managers being able to dictate medical procedures to those doctors and nurses (and whichever other qualified practitioners there are.)

A similar situation is happening in universities where upper and upper middle class prats are swanning around with titles like vice chancellor and having grand ideas without any actual knowledge of how things get done in the lecture theatre.