Leadership is a curious quality. Job advertisements often call for applicants with strong leadership skills. It is an ability that can apparently be learned on management courses.
Management is often defined as achieving objectives through the work of others. So a good manager is perhaps also a good leader - although it is not clear whether leadership is a component of good management or whether good management is a facet of good leadership.
The quality of being a leader is certainly not something which is simply acquired - like a large desk, for example - with a managerial appointment. Being a leader is primarily a personal characteristic.
Leadership is in fact little more than the ability to dominate others. And it is an ability more often innate than acquired. Natural leaders are most frequently found among so-called alpha males. Men are often able to dominate social groups, not least because of their physical size, which can both consciously and unconsciously intimidate others.
Being neither male nor large is not, however, a bar to leadership. Personality plays its part. Large men who are temperamentally disinclined to lead make ineffective leaders, whereas women and less physically imposing men can use their 'strength of character' to impose their will on circumstances and people.
All other things being equal, it is relative strength of character rather than physical might or mere intelligence which ultimately characterises a potential leader.
What turns the potential leader into an actual leader is when that potential coincides with the desire and chance to dominate: the means, the motive and the opportunity.
The main problem with leadership is that good leaders are not necessarily good people. Leaders inspire others to follow them - for good or ill. Troops of the Light Brigade followed Lord Cardigan into the Valley of Death without a second thought. The most charismatic leader of the 20th century, Adolf Hitler, 'successfully' led his entire nation to ruin. When natural leaders are wrong, both they and their followers are blind to it.
Management textbooks are filled with the lives of military heroes, ranging from Julius Caesar to Norman Schwartzkopf. Historically, a feature that great leaders commonly share is that large numbers of their followers get killed.
In the 19th century, Napoleon, the greatest leader the French ever had, threw away the lives of hundreds of thousands of his countrymen - yet those who lived still cheered him. In the 20th century, Stalin may well have killed more Russians than the Nazis, yet the people still followed him.
Those leaders who are morally 'good' are often so full of themselves that many who work for them would gladly spit in their eyes. Was the world really made a better place in the 16th century by such pious miseries as John Calvin and John Knox? Their great moral crusades probably led to as many deaths and more unhappiness than the original crusades had done four hundred years earlier.
Leadership skills unfortunately tend to be used to dominate and influence the lives of others in pursuit of the leader's own aims and obsessions. Those aims are seldom altruistic. The desire to dominate others can, in extremes, even become a pathological condition. Sadism is the ultimate manifestation of taking pleasure from control over others. It's the far end of a spectrum that can begin as innocently as the desire to be a member of the local parent-teacher association.
Politicians normally think of themselves as the natural leaders of their communities. Although they purport to represent their constituents, they are notorious for loudly and relentlessly thrusting their own views and opinions on everyone else.
There are two kinds of politician: those who believe their own words and those who do not. The former, the so-called conviction politicians, such as Margaret Thatcher, seem to attract the greatest odium - perhaps rightly so. No 'profession' is so reviled as that of the politician, especially by fellow politicians who themselves wish to be 'leaders'.
There are those who see the parliamentary system as offering just punishment to those who are sufficiently self-opinionated to want to be there in the first place. What could be closer to hell than to have to spend one's working life closeted with hundreds of other MPs equally determined to lead everyone else? And what better way to protect society from them than to set them at one another's throats in Parliament, while the public - the people they would like to lead - can safely watch from the wings with the same kind of fascination with which 17th century spectators might have observed public executions, dog fights and bear-baiting.
Some skill at leadership can be a valuable characteristic in a manager. Strong leadership can, however, easily take undesirable directions. Born leaders often become egotistical, careless of their subordinates, ruthless and self-serving. The worst - charismatic demagogues and natural orators - can, with consummate ease, sell themselves and their ideas, no matter how foolish, to their innocent followers. But even the greatest of leaders is only as valuable as his or her personal aims.
The NHS, like all other organisations, needs people to lead the way - but first and foremost it needs good managers. Raw leadership is too much of a double-edged sword for any part of the NHS to risk placing its trust in any leader - or in those who are sufficiently egotistical to even aspire to such a dubious accolade.