Merit and individual aspiration must be the overriding factors in deciding who to appoint to leadership positions in the NHS - and who should be offered leadership development opportunities.

That is not to say that the leaders of the NHS should not be representative of the society they serve: I believe that it would be a better place if they were. But I don’t think positive discrimination - picking leaders and potential leaders because they belong to particular groups - is the right way ahead.

We should be alert to hidden discrimination

There is always a danger that selecting by criteria other than merit and enthusiasm for the task could lead to aptitude coming second when making decisions. Those who are not picked may harbour resentment that the system had unfairly discriminated against them.

And it can be very difficult for individuals who have been picked out other than in a merit based system, as their inherent abilities for the job can come under question. No one likes to feel they are suspected of getting where they are other than on their own merit.

That would be unfair. I believe there are plenty of capable and talented people from under-represented groups in the NHS who can rise to the top on their own merit. And I hope that the NHS is blind enough to gender, race and background to enable them to do so. The NHS cannot afford to let talent go to waste.

We should, of course, be alert to hidden discrimination and do all we can to ensure there is a level playing field that allows all talented individuals to take advantages of the opportunities available. Without thinking, we can sometimes recruit in our own image - and choosing someone who is “just like us” isn’t always recruiting on merit.

The NHS should have a proactive leadership programme, but selection for that scheme should be from those already showing an aptitude and enthusiasm for leadership - although the NHS should be proactive in encouraging people to step forward if they are already displaying those qualities.

It is important that leaders know their business; we have seen the disastrous results of what happens when they don’t in the banking industry.

The NHS needs to avoid this by selecting leaders who understand what its business is all about: improving services and outcomes for patients. Clinicians are often in a good position to lead NHS organisations because their currency is the currency of the business.

It is important that staff from all backgrounds with proven leadership capabilities play their part in the complex business of NHS leadership

A majority of medical students are now women and there is strong black and minority ethnic representation as well. Many medical schools have also worked hard to ensure there are opportunities for talented youngsters from all backgrounds to study medicine.

If this cohort of clinicians prove themselves worthy of taking up leadership development opportunities and move into leadership positions, this may help the NHS leadership look more representative of society.

NHS Leadership Spring Debates: Positive action