Between 1999 and 2004, Sarah Mullally, the current Bishop of London, was director of patient experience for NHS England. One complaint dominated the feedback she received from inpatients: everyone hated the undignified hospital gowns that gaped open at the back. Mullally identified this as an issue that could be addressed easily and cheaply. Later on, the designer Ben de Lisi even worked with the Design Council to develop a better gown with side fastenings. Yet if you are unfortunate enough to have to stay in hospital today, you will almost certainly find that you are offered the old draughty gown. It turns out that in an organisation as large and complex as the NHS, with dispersed decision-making and obstinate staff, change is not as simple as identifying a problem and proposing a solution. 

On 28 January, Dame Sarah Mullally will be clothed in the medieval vestments of the Archbishop of Canterbury. She takes the mantle at a moment when the Church of England has its arse hanging out. In towns and villages across the country, clergy are exhausted and demoralised. Parish churches continue to do much good work, but congregation numbers are declining and many dioceses are broke. The General Synod rivals the Westminster parliament as a forum for tribal warfare. According to the ecclesiologist the Revd Dr Paul Avis, there is ‘a pervasive sense of organisational incoherence, dysfunctionality, dishonesty and betrayal’. The C of E, he says, has not been in ‘such a bad place for centuries’.

Mandatory retirement at the age of 70 means that Archbishop Mullally........

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