The NHS Finally Defined 'Good Leadership.' That Might Not Be Enough.
The NHS Leadership and Management Framework needs practical methods of learning transfer to turn standards into everyday behaviour.
The NHS has reached an important moment in how it develops leaders and managers.
The NHS Leadership and Management Framework gives the health service a common definition of excellent leadership across settings, professions and levels of responsibility. It creates shared expectations for development, career progression and professional practice.
At its core is a code of practice built around six principles: Be accountable, Be collaborative, Be compassionate, Be curious, Be inclusive and Show integrity. The standards are organised around three focus areas: Personal impact, Managing people and resources, and Delivering across health and care.
NHS England has asked all NHS leaders and managers to use the framework during 2026 as a starting point for reflection, development and improvement. By the end of quarter 4, every manager and leader should self-assess against the framework stage relevant to their level, discuss the outcomes with their line manager and agree a focused development plan.
That is an important step forward. It treats leadership and management as capabilities that can be developed deliberately, with common expectations rather than leaving every organisation to define good practice for itself.
The central argument: The new NHS Leadership and Management Framework gives leaders a clearer definition of good practice. The remaining challenge is learning transfer: helping people turn those standards into different behaviour under real clinical pressure. Behavioural experiments provide the bridge.
The gap between knowing the standard and being able to enact it under pressure is where the real challenge begins. To understand why learning transfer matters, we first need to look at what happens to leadership behaviour under clinical pressure.
The NHS Leadership and Management Framework Is Still a framework
A framework can define expectations. It cannot, by itself, make those behaviours available in the moment they are needed.
When emergency departments overflow, rotas are stretched and discharge pressures build, leaders can revert to familiar responses rather than consciously choosing the behaviour the situation requires.
That makes this a self-leadership problem as much as a leadership standards problem. Self-leadership in the NHS means being able to notice your own reactions, assumptions and habits early enough to choose what to do next, especially when pressure is high.
Leadership Capability Should Not Begin With the Job Title
I am a former nurse. In my experience, clinical development rightly places enormous emphasis on technical expertise, diagnostic accuracy and patient safety. Leadership capability often becomes more explicit only once someone is already supervising others, coordinating a service or carrying formal management responsibility.
The new framework creates an opportunity to make leadership development more deliberate earlier in a clinician's career, then keep developing it through practice rather than treating it as knowledge acquired once someone is promoted.
That gap is compounded by the way authority operates in clinical settings. Because clear hierarchy and decisive action are often essential for safety, it can be easy to confuse having the final say with leading well.
Position and Decision-Making Authority Are Not the Same as Leadership
Clinical environments sometimes require clear authority. During acute deterioration, a direct instruction can protect patients and create needed clarity. The difficulty comes when the same command-and-control response becomes the default for routine team leadership.
Having final decision-making responsibility does not mean a leader should make every decision personally. Repeatedly stepping in can teach teams to wait for direction, reduce opportunities for colleagues to build judgement and increase the leader's own workload. Managers who coach know when to give a clear answer and when to create enough space for someone else to think, decide and learn.
'Consent and Evade': Hidden Resistance to Change
Originating in military command culture, “consent and evade” describes apparent agreement followed by little or no change in practice.
In healthcare, the risk is easy to recognise. A team can agree with a new pathway in a governance meeting, complete the required documentation and still return to familiar habits once operational pressure rises. That does not always signal defiance. It may reflect unresolved disagreement, low ownership, practical barriers or simply a stronger pull from established habits.
The important point is that visible agreement is not the same as behavioural adoption. If leaders want change to survive contact with the ward, they need a way to surface friction early and help people practise different responses in context.
The Learning Transfer Ladder: Turning NHS Leadership Standards Into Behaviour
The Learning Transfer Ladder uses small behavioural experiments to help clinical leaders move from automatic reaction to deliberate choice.
It addresses a central challenge in behaviour change in NHS leadership development: the gap between knowing the standard and being able to enact it when the environment is busy, emotionally charged or uncertain. I use five stages as a continuous cycle:
Stage 1: NOTICE - What is happening in me?
Before a leader can change their behaviour, they need to recognise their internal state. This can include emotional reactions, physiological stress signals, implicit assumptions or the automatic urge to step in and take control.
- Clinical reality: A sudden surge in patient admissions creates anxiety and a strong urge to orchestrate every detail personally.
- What supports it:
Diagnostics, emotional intelligence work and mental fitness practices can help strengthen this self-awareness.
Stage 2: CHOOSE - What does this situation actually need from me?
This stage creates a pause between impulse and action. The aim is not to replace one preferred leadership style with another. It is to build enough behavioural range to select what the situation requires.
Clinical reality: Instead of immediately taking over, the leader asks: "Does this situation need me to solve this directly, or do I need to step back and support the team to handle it?"
This is where managers who coach are particularly valuable. They can distinguish between moments that require direction and moments where a well-judged question will build capability.
Stage 3: EXPERIMENT - What could I deliberately do differently this time?
Behavioural experiments for clinical leaders do not need to be dramatic. The leader tests one small, observable behaviour in a live situation, then gathers evidence about what happens.
Clinical reality: If the habitual response is to supply immediate solutions, the experiment might be: "In this bed-allocation meeting, I will ask two open questions to prompt solutions from the team before I offer my own view."
Stage 4: REFLECT - What actually happened?
Reflection turns experience into usable learning. The leader looks at what happened within themselves, what happened in the team and what effect the different behaviour had on the situation.
Clinical reality: "When I asked those questions, the team hesitated at first, then the Charge Nurse proposed a sensible triage adjustment I had not considered. I felt anxious giving up control, but the ward ran more smoothly."
Stage 5: ADAPT - What will I do next time?
The leader decides what to retain, refine or replace. Effective leadership development builds contextual judgement, not rigid adherence to a checklist.
Clinical reality: The leader decides to keep using open questions during routine bed meetings while reserving direct commands for acute clinical emergencies.
I used this approach when co-designing and delivering Tillotts Pharma UK’s award-winning LOGIC LEAD in IBD programme for experienced IBD nurses. Using immersive learning, real-world practice and structured follow-up, the programme increased participants’ leadership confidence from 5.8 to 8.8 out of 10. The 52% improvement was highly statistically significant (p<0.001) and sustained after the programme through coaching.
An unmet need that was really well identified… brave and insightful… an extraordinary piece of work.
Judge, Communique Awards 2025
The Learning Transfer Ladder gives individual leaders a practical way to move from reflection to behaviour change. But its impact will depend on how well trusts, Integrated Care Systems and line managers embed that learning into everyday development. The following six steps can help.
1. Use self-assessment as a developmental conversation, not a compliance exercise
NHS England expects leaders and managers to use self-assessment as part of reflection and development. The value will depend on the quality of the conversation around it. Instead of stopping at, "Do you meet this competency?", ask: "Which of these principles is hardest for you to demonstrate when the department is under pressure?"
2. Build leadership capability earlier
The framework should not become something people encounter only after promotion. Trusts and Integrated Care Systems can use preceptorship, early-career development and existing clinical education as opportunities to introduce self-awareness, team leadership, coaching behaviours and reflection earlier.
3. Practise behavioural experiments in the flow of work
Leadership development is more likely to transfer when people practise inside the environment where the behaviour is needed. Ask a leader to choose one small experiment for the next handover, one-to-one or multidisciplinary meeting. Managers who coach can then help them review the evidence rather than simply tell them what they should have done.
4. Make 'consent and evade' discussable
If a team appears to agree too quickly with a new process, create space for the practical objections before implementation. Ask: "What will make this difficult to deliver on the ward?" and "What might tempt us to revert to the old way when pressure rises?" Surfacing friction does not undermine change. It gives leaders information they can use to make the change workable.
5. Build reflection into existing operational rhythms
Reflection does not need a two-hour workshop. A two-minute debrief after a handover, escalation or difficult conversation can be enough to ask: "What did I notice in myself? What did I choose? What happened? What will I try next time?"
6. Measure learning transfer, not just participation
Attendance, completion and self-assessment data can show that development activity happened.
Measure what changes after the development, not simply whether someone attended.
The above-mentioned LOGIC LEAD in IBD combined experiential learning with structured follow-up and measured a 52% increase in leadership confidence. The stronger evaluation question is: “What can this leader now recognise, decide or do in a real clinical situation that they could not do before, and can they repeat it when circumstances change?”
Moving Beyond Compliance: Behaviour Change in NHS Leadership Development
The NHS Leadership and Management Framework provides a much-needed national standard. It gives the service a shared language, clearer expectations and a more deliberate basis for leadership development.
But a framework can set direction without determining behaviour. If implementation becomes mainly about completing a self-assessment, there is a real risk that organisations measure compliance more easily than development.
The bigger opportunity is to use the framework as a starting point for self-leadership, reflection, coaching and behavioural experimentation. Culture change is more likely when clinical leaders can notice their automatic stress responses, choose deliberately, test a different behaviour, review the evidence and adapt. Managers who coach can reinforce that cycle by helping people think, not simply by supplying answers.
The national framework defines what good leadership looks like. Learning transfer determines whether it shows up where it matters most: on the ward, under pressure, with the team.
Where do you see the biggest gap between leadership standards and everyday behaviour in your organisation?
Sources
- NHS Leadership & Management Framework: NHS Leadership Academy - Framework Microsite
- Royal College of Nursing Analysis: What the new NHS Leadership and Management Framework means for nursing
- Official Announcement & Standards: NHS England - Leadership and Management
- NHS England: Launch of the NHS Leadership and Management Framework and new NHS staff standards
- College Launch Details: NHS College of Leadership and Management
- British Army Leadership Doctrine: Appendix 1, The Ten Diseases of Leadership
- Civil Service World: Build your organisation, on the use of "consent and evade" in organisational change
Developing leadership capacity across healthcare and pharma
Purposefully Blended partners with organisations to design and deliver diagnostic-led leadership development that builds the inner capability leaders need to navigate complexity, lead with conviction and create measurable organisational impact.
About the Author
Lucy Philip, Purposefully Blended, Founder
Lucy Philip is the multi-award-winning founder of Purposefully Blended, a boutique Learning and Development Consultancy that blends learning design expertise with high-impact leadership practices to drive sustained behaviour change.
Purposefully Blended has established a strong reputation among pharma and healthcare organisations for developing leaders at all levels through tailored programmes that demonstrate highly significant, measurable impact.
