There are three reasons for reading this article. The first is that it describes a health service stressed to its limits, which is very naturally a matter of wide concern. The second is that it is beautifully and perceptively written, as is everything which Charlotte Augst writes. And the third – which is what brings into the scope of strategic reading – is that it is a fascinating description of a failing system and thus of how systems fail. Failure of a machine or of a business is often obvious and binary. The engine starts, or it doesn’t; the shop is open, or it has closed. An organisation – or rather and entity – such as the NHS degrades to failure in a very different way. Understanding that difference, and recognising when it is happening is a necessary precondition to influencing its trajectory. Not all Cheshire cats end with a smile.