The ‘front-line’ of the NHS is supposedly safe from cuts, yet huge swathes of management will go. Are we finally grasping the nettle of clearing out ineffective administrators, or are we cutting into the bone of managing a complex system without designing cost out? Can we finally shake off the top-down nannying of the Service that has fostered a comfy slippers culture of weak accountability and careerist managers? This is a golden opportunity to look hard at your own activities - what is your organisation redesigning in order to take cost out? If you want to lead this process, rather than have it done to you, give us a call.