Livre d'Or

You are absolutely right – Florence Nightingale's major achievement was to single-handedly replace an organisational shambles with effective administration, though this does not in any way diminish her success in raising the standards of "frontline" nursing.

I wholeheartedly agree with everything you say about the importance of proper management and administration. However there is a caveat, if I may act as devil's advocate for a moment. In a large and complex system there is a strong tendency for Parkinson's Law to apply. Unfortunately, the NHS is a working example of the creation of multiple layers of management and of an environment of management for its own sake overriding clinical judgement. Your example of A&E is only one aspect.

Southernwood