Where significant change has been achieved in services, for example, the delivery of diabetic services in Salford, it has been as a consequence of bringing together a number of organisations, creating partnership. Many of the embryonic learning mechanisms within the NHS focus on learning between trusts and between organisations. There need to be mechanisms for learning across and between services. Work currently being undertaken by the BAMM in association with Cranfield University attempts to explore this issue. A number of key points can perhaps be made.
Clinical staff learn much of the world from the example of their peers.
We need to work on both ends of the puzzle at once and try to introduce concepts and opportunities into the undergraduate curriculum whilst acknowledging that they will need reinforcement through positive examples from role models. Much of this work is excellent but there needs to be a greater engagement between the NHS and this fragmented grass-roots cottage industry. Just as clinical care is moving towards national guidelines and national strategic frameworks, so the development of leadership understanding in clinical staff within the NHS needs to be supported by national frameworks. Seeking to harmonise the continuing professional development requirements of the professional bodies concerned and to ensure a recognition of the leadership issue would be an important component of this. The NHS needs to be clear about what is required to create a climate in which individuals and teams can lead.