This book is for anyone who is interested in the leadership and management of the National Health Service at the start of the 21st century. At a time when the NHS, the biggest organisation in the UK, is facing massive change through modernisation, the authors represent the positive and constructive approaches many clinical leaders and senior managers are taking to become better leaders. It is hoped that the book will contribute to a better understanding of the need to work with complexity and change in a radically different way. The separate chapters of this book have been contributed by practitioners who are - or who have recently been - senior managers and professionals in the National Health Service. They have been asked to write for people like themselves - practical, experienced contributors to the NHS, who know there are no instant solutions, no magic cures, and are prepared to spend a little time standing back for a moment from the bustle of immediate demands to understand the patterns and the problems and the possibilities of leadership in the health service. Clinicians and managers in the UK healthcare system have been subjected to a relentless stream of changes imposed by one political initiative or another over the past twenty years. This has made some practitioners passive. Even at senior levels in some organisations we find managers who say: 'I can't influence strategy. I can't lead. I can't innovate. I'm told what to do.' In these challenging times, we believe that healthcare organisations need more than ever people who are prepared to take what opportunities they can find to lead, rather than just to follow, who are pre- pared to develop the new ideas and practices that will shape their organisations. These leaders are needed at every level. Those at the top of the organisation's structures have the added responsibility of creating sufficient space for leaders at lower levels to be able to take action. Effective leadership is not the business of minutely directing the behaviour of others, as many of our contributors make clear. Effective leadership in modern healthcare is more about working well in partnership, influencing others and also being prepared to influence, working cooperatively rather than in competition.