Leadership and management

The need for management and leadership in the NHS was recognised soon after it was established, highlighted by the publication of a series of reports. In the 1960s, quality of management was in the spotlight,  and the Salmon report in 1966 focused on the need for a senior nursing staff structure, raising the profile of the nursing profession in hospital management. This was followed in 1967 by the Cogwheel report (First report of the joint working party on the organisation of medical work in hospitals)  which encouraged the involvement of clinicians in management.

The idea of bringing general management into the NHS came from the Griffiths report in 1983. It found that the NHS had no coherent system of management at a local level and lacked any continuous evaluation of its performance against normal business criteria. During the 1980s, general managers were introduced into health authorities and hospitals, along with management budgets and management training and education through the NHS Training Authority. The introduction of general management ended the health authority's district management team (DMT) and the philosophy of ‘management by consensus'.

The focus has now shifted slightly from management, and leadership has become a priority for the NHS. The NHS National Leadership Council was established in 2009 after being announced in Lord Ara Darzi’s NHS Next Stage Review. The Council's vision is that ‘world-class leadership talent and leadership development will exist at every level in the health system to ensure high quality care for all’. Chaired by David Nicholson, the Council oversees a number of workstreams: Emerging Leaders, Top Leaders, Inclusion, Board Development and Clinical Leaders.