The HSJ Challenge gave participants a series of hair-raising 'problems' to resolve, report Charlotte Santry and Victoria Vaughan

Brave volunteers from around NHS South Central put themselves forward to pit their wits against one another in an implausibly bad day for their local service.

On arrival at a country hotel outside Winchester the delegates - mainly middle managers - were divided into one of four clusters, each representing the fictional Rivergate health system. Teams were assessed on their response to interventions, based on real-life incidents, that confronted them during the day, including a medical director being cautioned by the police for kerb-crawling, accusations of elder abuse and financial crises.

The teams were judged on their partnership working, ideas and outcomes, but the most intimidating task for many was facing up to the baying local press - played by two of HSJ's most hammy reporters.

The challenge was written by Neil Goodwin, a former strategic health authority chief executive and now a director of GoodwinHannah, a leadership development consultancy for chief executives, their boards and organisations. 'It's a question of organisations deciding when they need to collaborate and when they should compete,' he says.

Each cluster was further divided into teams of five representing the top management organisations in Rivergate: Barset General Hospitals trust; Casterbridge University Hospital foundation trust; Rivergate Mental Health and Social Care foundation trust; Rivergate Primary Care trust; and Rivergate Hospital, an independent treatment centre owned and managed by Eurohealth UK.

The challenge was built on a simulation of the English health service as it is likely to develop during the next few years.

Enormous effort

In the scenario, the financial management and operational challenges of 2006-07 have largely been resolved in the short term. But although financial balance and the creation of a surplus were achieved across the NHS by March 2007, this was the result of enormous managerial effort that included job losses and increasingly fractious relations with trade unions and professional bodies over financial, workforce and other operational management issues.

There was an emphasis on the new players created in the past few years such as PCTs, practice-based commissioners, the private sector, foundation trusts and the development of the market-based system with commissioning, competition, consumerism and potentially failing organisations.

Oxfordshire PCT finance director Matthew Tait was one judge. He says: 'This helps people to understand the relationships between NHS bodies and some of the behaviours necessary to come up with new solutions. People are quickly put out of their comfort zones. It's a very good learning tool, but very difficult to do.'

The competition and the heated discussion that went on as the clusters tried to thrash out the best possible health system for patients must surely have been a microcosm of the real-life process.

The overall team winners were chosen for their vision, leadership, and altruistic outlook in considering the greater good. But as the old saying goes, it is the taking part that counts, and Mr Goodwin was impressed at the skills demonstrated by many of the participants.

Talent tapping

He says: 'The teams were fantastic. There's clearly no shortage of managerial talent and innovation in the NHS. It's just a case of senior managers tapping into that.'

This is the intention of SHA director of workforce and organisational development Jim O'Connell, who says it was a useful talent-spotting exercise.

'These people are the directors of the future,' he says. 'This helps us to spot and track talent, so if we're looking for someone to lead a piece of work we know who we can turn to. By identifying that group, we can take them through the system and use them as a resource for us.'

Milton Keynes PCT deputy director Richard White, who was on a district general hospital team, says: 'The collaborative work built on our understanding of management. We were not working in our own organisation, which was not always comfortable, but we found it interesting and challenging.'

Assistant director for children and young people at Berkshire East PCT Fiona Slevin-Brown says: 'Everyone got a big kick from the challenges and the opportunity to be stretched.'

Working together

Isle of Wight PCT estates manager for engineering John A'Court was part of the team that won the partnership working award. He says: 'Our organisation is all about partnership working. We are so pleased we won this award as it's so relevant to us.

'We could not have won a better award and it has given us great confidence.'

Alison Jennings, NHS South Central facility development and leadership networks coaching manager, says the day was a success: 'I was so impressed by the engagement and the commitment of the teams, and I would recommend that other SHAs take the challenge.'

Awards were given for: the best media performance, won by Hampshire Partnership trust; best partnership working, won by Isle of Wight PCT; and best overall team, won by Milton Keynes PCT.

The ultimate prize was for the five teams who worked as a cluster to transform their local health community and create a compelling vision for the future for each of the component organisations.

The winner comprised Winchester and Eastleigh Healthcare trust, Berkshire East PCT, Hampshire Partnership trust, Royal Berkshire Foundation trust and Hampshire PCT.