Whilst I’m sure some of what you report is true, many of those roles are created to provide ‘assurance’ to ministers.
As for, recommendations not being acted on, you could come up with a scheme to improve things in all sorts of ways, save heaps of money over 5 years and a myriad of improvements but, they usually involve a period of ‘double running’ and there’s just never any spare cash to do it because the books have to balance every, single year.
The NHS suffers from over interference from government, usually headed by a minister who is either clueless or wants to ‘make their mark’. It then has to put up with local politicians, who will say one thing whilst believing something altogether different and of course, finally, the great British public, who are, understandably, clueless on the benefits of specialisation and, for complex stuff, centralisation.
Finally, even if you could prove you’d save money and improve outcomes by doing X, you’d have to go to consultation and, sadly, most people think having a shit hospital close by is better than a great hospital 40 miles away!
That having an A&E on the doorstep is better than a trauma unit possibly some miles away with a minor injuries unit close by.
If it were run as a business, as is oft suggested, the NHS would not offer universal treatment, it would certainly not have 170 A&E departments, it would join up with social care, it would take decisions locally rather than nationally as one size does not fit all. Most of it would be done outside of hospitals, and people would have to travel for the very best care. And it would be mostly free from government meddling…