I work as a consumer advisor in mental health (that is someone who has been a "consumer" - patient in plain english - who is employed to advise management from the "consumer" point of view). Managment needs to be advised to tick a box - they don't need to actually act on that advice. There is the same sort of pull towards rhetoric over reality in our service. I just try to do what I can, initiate projects that are actually useful and might win a prize which is what some of the staff are motivated by. You do an incredibly useful job, and you are helping by doing that job. there seems to be little we near the bottom of the food chain can do about the absurdities of the system - however I'd say that whatever that is that can be done you are doing - both by doing your job and by writing this blog. Well done and thanks and please don't get disheartened you do a lot of good.