Another area which needs reform is the culture / power within the organsiation wielded by senior consultants. I know of a case where a consultant on a 50% contract was deliberately blocking the appointment of another consultant to help clear the massive backlog of operations piling up because there was insufficient allocation of resource to the area for a number of years. The operation waiting lists were such a disgrace that the trust was having to pay the consultant to do the work as a private consultant on his private rates - all while he continuously blocked the Trust making appointments to cope with the backlog of operations.
I would like to think that situations like this are very rare and this example is an exception to the rule, but any system that tolerates shit like this needs to change.