Middle‐managers feel under the weather in the NHS: High turnover and low morale follow reorganization

“We are just a tool in a structure. We are not people any more to those above us… You are kicked from above, you are kicked from below and you are the first one on the line to be dismissed if things go wrong. We all knew that when we took the job. I am not whinging, but I do not feel valued.” These remarks, of a National Health Service (NHS) middle manager, highlight some of the reasons for high turnover among middle managers since the advent of the internal market.