NHS chief executive David Nicholson has defended a controversial scheme to identify the top 250 jobs in the health service as “unashamedly elitist”.

Mr Nicholson’s robust backing of the programme was given in an interview with HSJ

after the national leadership council, which is looking at how the scheme will work in practice, met for the first time last week.

The Top 250 programme, also called Top Leaders, has been criticised for placing too much emphasis on an elite group of senior managers.

But Mr Nicholson said: “It’s unashamedly elitist, because the whole thing about leadership and nurturing talent is you have to say ‘this person has a much better chance of delivering in the future than that person’.

“It’s a matter of skill and judgement, and that’s what chief execs are paid for – differentiation. I simply don’t believe that everybody is capable of doing everything”

“It’s a matter of skill and judgement, and that’s what chief execs are paid for – differentiation. I simply don’t believe that everybody is capable of doing everything.”

He said around 50 organisations made the biggest impact on the NHS due to their complexity or scale, for example Leeds Teaching Hospitals trust.

At these organisations there would be five executive roles, each requiring at least four applicants whenever a post became vacant.

This meant that 1,000 people needed to be given extra support to equip them with the necessary skills.

Nurturing talent

Mr Nicholson said: “It’s not saying that people outside that 1,000 won’t come to the front and apply for jobs and get them, but we need to start nurturing that talent.”

The leadership council is in the process of identifying the 50 organisations and working up the details of the scheme.

It will also carry out detailed research into why chief executive vacancies attract so few candidates.

This will look at barriers stopping clinicians putting themselves forward, including attitudes towards managerial roles and contractual arrangements.

Responding to complaints that only two of 25 core leadership council members represent primary care organisations, Mr Nicholson said: “People didn’t come forward - which is an issue in itself.”

The council will be looking at the issue of primary care leadership in more detail.

Mr Nicholson admitted there had been a “string of initiatives” around leadership but said the market had failed to provide the NHS with the right quality and quantity of leaders.

The council will create a “kitemarking” system to assess the quality of board development programmes being used in the NHS and could commission new programmes if it finds there are gaps to be filled.