The management challenge of the government's health policy is becoming clearer. It is a formidable one. Recent policy statements and guidance have begun to map out the changing management agenda in greater detail, covering partnership working, health improvement programmes, integrated national priorities for health and social care, and moving from annual contracts to long-term service agreements.
And there is more to come, including the public health review aimed at strengthening the capacity and capability of public health to implement the new strategy.
These announcements all have two features in common. First, an unswerving passion for implementation and action backed up by a system of carrots and sticks. Second, and crucially, all the initiatives demand a new and different managerial response. There are no precise precedents for what is intended.
Take the guidance on long-term service agreements. This seems innocuous enough as it fulfils the government's pledge to end the annual contracting round with all its perversities and high transaction costs. It was also already happening to some degree. But over time these agreements are expected to be built around care pathways for patients, with funding flows organised accordingly, rather than to suit the needs and preferences of institutions.
While the focus on a care pathway approach is entirely consistent with the government's concept of integrated care and its determination to break down professional and organisational barriers, it nevertheless requires a quite different mindset on the part of managers.
With some exceptions, they have been trained for a quite different world in which health and healthcare are synonymous if not with hospitals then with facilities and bricks and mortar of some description. But such vertical silos are not the way of the future, in which the patient, client or care group will occupy centre-stage with support and services organised around them.
We've heard much of this stuff before, but the NHS has displayed impressive resilience in remaining more or less unchanged. The climate may be different this time. The government's resolve to disturb the way services operate should not be underestimated. The multiple initiatives promise radically to transform the face of health policy and of the NHS. But this will demand a style of management and type of manager that is in short supply.
The government talks in glowing terms of recruiting social entrepreneurs who will unlock energies and harness creative impulses. This has echoes of the heroic-leader syndrome - with all the defects that accompany attributing success to a single individual, who may move on after a short time.
What is needed, surely, is the development of a new managerial mindset and the skills to go with it. Otherwise the risk is an absence of sufficient management strength to make significant or sustainable progress.
By investing heavily in grooming social entrepreneurs, we risk ignoring the vast majority of managers who are followers rather than leaders. Their needs demand attention, too, as they will have a major role in realising the new agenda.
In developing the right managers for the job, there is a need to pay critical attention to how they are prepared for it. It may be that much of what is on offer by way of management training and development is in need of a radical overhaul.
It is at least arguable how much of the new agenda can be grasped through classroom learning without significant direct experience of real problems. And how appropriate are management models based on industry and the private sector in the context of the public service ethos that the government wishes to revive?
More important, how far is management training directed towards equipping the individual with the means to increase their personal power and status rather than preparing potential senior managers for a management task that is complex, messy and contingent on working collaboratively in situations where influence rather than direct control will become the norm? Doesn't management development have to create a new moral and philosophical framework to meet the needs of the new health policy?
Much management training, especially that in business schools, breeds conformity. But if we need creativity and innovation, then a new managerial imagination is needed - and fast. The policy agenda is already outstripping the ability to implement the desired changes. There is a danger that a crude form of performance management will fill the vacuum.
There are those who believe that the answer lies in evidence-based management. It appeals to a government wedded to a technocratic style of policy making. But if evidence-based management is perceived as a straitjacket on the assumption that there are universal laws just waiting to be discovered or applied, it would be a disastrous development. It is a fiction.
Management success depends on multiple and complex interactions occurring in diverse settings populated by different personalities. This will be even more true in future.
What is required above all is the sense of judgement that often comes from experiential learning. This approach to management resonates with the 'soft systems' thinking of Peter Checkland and Geoffrey Vickers. It may hold the key to reshaping a management function that can engage confidently and successfully with the new agenda. 'Soft systems' thinking was in vogue in the 1960s and early 1970s although it failed to penetrate mainstream management education. Perhaps its time has come again. After all, if health policy is being overhauled and modernised, shouldn't its management be?