Presumably they get it for being ladies in waiting to HMQ etc or being on the letterhead of umpteen charities!

Like the civil service personal service to the monarch gets its own order (Royal Victorian Order) so the whole "buggins turn" issue is irrelevant to the discussion in hand.

Most countries have awards systems, admittedly without such anachronistic labels. Why do Brits get so uptight about it? We don't see perpetual complaints from Americans about who did or did not get awarded the National Medal of Arts or about the very existence of the Presidential Rank Awards.