1. NHS productivity outstripped rest of economy (public or private in recent years)
2. NHS management costs (although could be lower with a removal of purchaser provider split and the transaction costs) are much lower than in many global health systems

3. NHS on various global comparisons does well on equity of access, cost/efficiency, % of people denied healthcare due to £ etc
4. we need to differentiate management roles that are inherently useful and would be in any system with any organogram from those adding less value

5 The ones that arguably add low value are largely the creation (see for instance King's Fund animation on structure or Nuffield trust "never again" series) of constant re-organisations which are politically led (e.g. Lansley reforms) rather than being intrinsically beneficial