across all of its services. what do you think is at the heart of the problem is? what do you think needs to happen to bring about improvement? that to happen to bring about improvement? to happen to bring about improvement? to happen to bring about imrovement? ., ., improvement? at the heart of the roblem improvement? at the heart of the problem is improvement? at the heart of the problem is culture improvement? at the heart of the problem is culture with improvement? at the heart of the problem is culture with senior- problem is culture with senior management, and the way the trust is set up, it covers such a large geographical area. we have had chief executive after chief executive put in and the reality is that means that nhs england and nhs improvement have failed and cannot turn distrust around so what needs to happen now is that nhs england need to sit down service users, patients, carers and groups that represent them and campaigners, to actually work out what the chang