The Department told us that when compared internationally, the NHS had one of the lowest percentage spends on management compared to clinical roles, making it an efficient organisation when benchmarked. NHS England highlighted the example of a clinical leadership model in one trust led by a clinical member with a predominantly clinical team organised at service and ward level. However, both the Department and NHS England recognised there was variation across the NHS and that each local organisation would decide how it would be structured.31 21 Qq 52–55 22 Letter to the Committee dated 19 July 2023 from Sarah-Jane Marsh at NHS England 23 Q 112 24 C&AG’s Report, paras 3.20, 3.21 25 Q 112 26 Qq 112, 113 27 Qq 132, 133 28 Qq 131, 132 29 Q 112 30 Q 85 31 Qq 84, 86 Access to urgent and emergency care 11 2 Service performance Regional variation