Since thefirst intake of the NHS Management Training Scheme in September 1956, the content, location
and impact of management and later leadership development in the NHS has undergone regular
transformation (Table 8). Although terminology has changed, the core aim of these programmes remains
consistent: in 1955, the aim was to provide the NHS with‘well-trained administrators who would be
competent tofill senior administrative posts in years to come’87(p. 37, © Queen’s Printer and Controller of
HMSO 2012, Talent Management in the NHS Managerial Workforce). In 2012, the newly formed NHS Leadership Academy set out as its aim to equip managers from across the different professional backgrounds in health care with the skills needed for leading and improving their organisations in ways
that were still consistent with the values of the NHS.88
In the intervening period, the responsibility for producing these administrators, managers and, latterly, leaders has oscillated between the regions and more central NHS bodies. There has also been a notable shift in the basis of professionalisation of NHS managers represented by the shift in terminology from
administration, to management and then to leadership.28,89Before exploring these very different
orientations in greater depth in Chapter 4, it is useful to note briefly this shifting emphasis in management
training and development initiatives.
THE INSTITUTIONAL AND ORGANISATIONAL CONTEXT FOR NATIONAL HEALTH SERVICE MANAGEMENT
22
The NHS Management Graduate Training Scheme (MGTS) broadly retains the structure set up in 1986, combining formal education [leading to a Master of Science (MSc)] with a rotaring series of placements and internships in NHS organisations that give prospective managers direct experience of a range of health-care management situations together with formalised education and training. Other than the MGTS, most of the important current management/leadership development programmes were established as part of the Modernisation Agenda in the early 2000s, including initiatives promoting diversity in
management, including Breaking Through (for black and minority ethnic employees), Gateway to Leadership (to develop senior managers from outside the NHS) and the Athena Programme for Executive Women. Such initiatives were underpinned by the creation of the Leadership Qualities Framework (LQF) in 2004 by the NHS Leadership Centre. Details of these programmes are summarised in Appendix 10.
In 2009, the Department of Health published Inspiring Leaders.90Reflecting the strategy set out in The
Operating Framework for the NHS in England 2008/09,91the Inspiring Leaders report explicitly devolved
responsibility for leadership development to regional employers, requiring SHAs to produce talent and leadership plans by the end of July 2009. In line with the principle of subsidiarity, these plans were to be cascaded down to the local and individual level, guided by the overarching activities of the newly formed NHS Leadership Council.
Any potential impact of this was, however, curtailed by the change of government and the Health and
Social Care Act of 2012,85which set in train the abolition of the bodies charged with overseeing
TABLE 8 Summary of key NHS management and leadership training programmes
Year of
commencement Key management training programme Agency responsible
1956 Management Training Scheme Regional Staffing Officers (RSO)
National Staff Committee for Administrative and Clerical Staff (NSCA&C)
Standing Committee on Management Education and Training (SCMET)
1983 National Management Training Scheme NHS Training Authority
1986 GMTS
1993 National Management Training Scheme NHS Training Directorate National management development programme
2002 GMTS NHS Leadership Centre
Breaking Through Gateway to Leadership
2009 Top Leaders NHS Leadership Council
Emerging Leaders Inclusion
Clinical Leadership Board Development
2012 Foundation programme
(award: post-graduate diploma)
NHS Leadership Academy
Mid-career programme (award: masters degree) Executive/senior leadership programme (peer assessed)
leadership development.92The new arrangement to ensure continuity in this area took the form of the replacement of the short-lived NHS Leadership Council followed by a new NHS Leadership Academy (formed in April 2012). The principle of subsidiarity, whereby responsibility for leadership development would be cascaded down to regional and local organisations, was rejected. Instead, the NHS Leadership Academy was formed (1) to ensure a more centralised strategy, reducing duplication, fragmentation and discontinuity by providing a single national structure for leadership development and (2) to set in place
a more bottom-up approach to development by giving employers‘greater autonomy and accountability
for planning and developing the workforce’55(p. 40, © Crown Copyright 2010, Equity and Excellence:
Liberating the NHS). The intention was to ensure that an integrated national approach was established that made better use of resources by rationalising and standardising what had previously been very
localised and fragmented training for leadership.88
The NHS Leadership Academy sets as one of its primary tasks the need to professionalise leadership in health care. Associated with this would be greater expectations of health-care managers to be more
proactive in taking responsibility for performance.88Citing recent research reports,93wider academic
research and widely cited instances from the private sector (e.g. General Electric), the NHS Leadership
Academy briefing makes strong claims regarding the ability of leadership to make a significant difference
to the performance and outcomes of organisations. Although still at an early stage of development, the Leadership Academy has set out three core programmes that are to be established:
1. The foundation-level programme is aimed at aspiring leaders with some experience of managing people
and leads to a postgraduate certificate.
2. The mid-career programme is aimed at those who manage team leaders, for example, and who seek a broader leadership role. This programme leads to a Masters degree.
3. The senior leadership programme is preparation for an executive, national or other senior leadership
role. There is no formal qualification; instead, individualised, bespoke programmes will include
academic support, coaching, peer review, self-management and self-direction.
If we also consider the managerial framework developed in Chapter 2, it is clear that, quite apart from these general initiatives, managers face a considerable variety of forms of formal education, training and
development associated with their distinct career pathways into management.80,94A well-established
pathway of clinical training and development is likely to underpin not only medical staff who move into management positions (and medical science staff), but also nurses and allied health professionals (AHPs),
whose development into management roles is likely to take a more experiential learning route.95–97
Similarly, many functional experts are likely to follow quite distinct paths of professionalisation (e.g. in finance, HR, marketing, law) that may or may not coincide exactly with health service experience or with
progression into health-care management roles.31,32General managers in health care are, of course,
expected to be a more diverse group in terms of their background, training and experience.98The question
becomes,‘How do different types of manager in different types of trust access and develop their
management knowledge base in order to help them become effective managers?’.