Martin Marshall's analysis of the state of NHS leadership is only partially correct. Much more has been achieved than he gives credit for.

A national leadership framework has been in place since last year, underpinned by a model derived from primary research. The competency-based model has been used to appoint seven provider consortia, who are now employed across the health service to develop senior managers. The framework is deliberately light touch and intended to be augmented by regional contextual challenges - what works in Manchester may not in Birmingham and so on.

The first regional programme commenced in January 2007 and has been subject to stringent evaluation. This highlighted good conceptual design and delivery. It was noted that participants, including doctors, had successfully competed for chief executive posts.

For the first time in the recent history of the NHS, a coherent start has been made, which needs to be tweaked in the light of experience. Fortunately, the service has now recognised it should get on with it and stop searching for the holy grail of leadership development - it doesn't exist.

Neil Goodwin, GoodwinHannah, Cheshire

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