Education and training are key components of Lord Darzi's plans to increase clinical leadership in the NHS. Ingrid Torjesen explains how the clinical landscape will change

"Greater freedom, enhanced accountability and empowering staff are necessary but not sufficient in the pursuit of high-quality care. Making change actually happen takes leadership," Lord Darzi argues in his review of the NHS.

His report, High Quality Care for All, identifies three core elements of leadership that everyone leading change in the NHS will be expected to understand:

vision - which quality improvements they are trying to achieve and how they will benefit patients and local communities;

method - the management methods they will use for implementation, continuous improvement and measuring success;

expectations - what the difference will mean for people, the behavioural changes that will be necessary and the values that underpin it.

Clinical leadership has been neglected in the NHS reforms of recent years, but Lord Darzi's report insists this must now change. Training in leadership skills will be made integral to the education and further development of all clinical staff.

New skills

At undergraduate level, curricula for all medical and nursing students will be reviewed to ensure they provide the leadership skills needed for working in the NHS. Leadership development will also be made an integral part of modernising careers programmes for other healthcare professions.

Leadership skills will also be incorporated into postgraduate curricula and appraisal processes. Meanwhile, strategic health authorities and new health innovation and education clusters (partnerships between the NHS, academia and industry) will establish clinical leadership fellowships to enable clinicians with a particular interest in leadership to spend dedicated time on enhancing their skills.

Many local NHS organisations have their own leadership development programmes, and a new leadership for quality certificate will be created to ensure these programmes cover the relevant subject matter and meet appropriate standards.

The certificate will have three levels :

• level 1 will be for members of clinical and non-clinical teams with an interest in becoming future leaders;

• level 2 will be for leaders of team and service lines;

• level 3 will be for senior directors, such as medical, nursing and operations directors.

High fliers

Finally, the top 250 leaders in the NHS, both clinical and non-clinical, will be identified and have their personal development supported through mentoring and active career management.

A new system-wide body chaired by the NHS chief executive will be created to oversee all clinical leadership matters across healthcare. This NHS leadership council will have a particular emphasis on standards, including overseeing the leadership for quality certificate, changes to the various curricula and assurance processes. It will have a dedicated budget and be able to commission leadership development programmes.

The NHS medical director and national clinical directors will also work with senior clinicians to ensure clinical leadership becomes a stronger force within the NHS.

Financial awards to senior consultants under the Clinical Excellence Awards scheme will also become more conditional on clinical activity and quality indicators. The scheme will have to encourage and support clinical leadership, with the independent Advisory Committee on Clinical Excellence Awards, which runs the scheme, having to take account of advice from the new NHS leadership council and national quality board.

The NHS chief executive and the leadership council will also commission a new development programme for trust boards. Masters-level programmes in leadership relevant to the health sector will be encouraged, with the Department of Health matching funding to SHA-commissioned programmes for board members.