Leading Health Services in the Age of English Devolution
England’s health leadership landscape is being reshaped by two major forces: the 10 Year Health Plan, and the English Devolution and Community Empowerment Bill. Together, they signal a move from traditional NHS governance towards a model where health outcomes are co-owned with Combined Authorities and Elected Mayors.
Why does this matter for recruitment and retention?
The 10 Year Health Plan commits to three big changes: moving care closer to communities, digitising access, and prioritising prevention. Meanwhile, the Devolution Bill introduces mayoral strategic authorities with a statutory duty to improve health and tackle inequalities. For NHS trusts and Integrated Care Boards, this means leadership roles now demand skills that extend beyond healthcare into economic development, housing, and transport.
Trailblazer deals in Greater Manchester and the West Midlands have shown the clear potential of an approach which integrates health with wider determinants to improve outcomes. As these models are adopted more widely, the demand for leaders who can navigate complex, multi-sector environments is likely to increase.
The new leadership profile
Boards will seek leaders who combine clinical credibility with system-level agility and political awareness, and recruitment strategies must respond to this evolving reality. Let’s look at a few of the non-negotiable characteristics that will be essential for delivering the Plan’s vision of a “Neighbourhood NHS” and meeting new accountability standards.
Successful strategic integration means understanding how health plans are aligned with local growth, housing, and transport strategies. Moreover, population health expertise underpins the process of designing prevention programmes that deliver measurable impact.
Financial acumen is always essential, particularly in managing multiple funding streams and complex programmes. Working effectively with elected mayors and responding to public scrutiny needs a high level of political astuteness, and – like all modern civic leaders – they need a high level of digital fluency.
Retention through development
We believe that retention will depend on creating career pathways that prepare leaders for this integrated future, as well as ‘future-proofing’ leadership capacity. Organisations may want to consider investing in cross-sector leadership programmes, which include joint training between local government and combined authorities. Place-based secondments could provide invaluable experience in housing, transport, and economic development to NHS leaders who want to develop. And mentors / coaches will always play an important role in supporting leaders to build confidence in political and partnership working.
The bottom line
The next decade of NHS leadership will be negotiated with mayors, delivered in neighbourhoods, and measured through wider determinants of health. Recruitment and retention strategies must start to evolve now – because the leaders who can integrate health strategy with place economics will set the pace for transformation.
Dawn Faulkner is Partner at Faerfield Limited. Originally published in Healthcare Management, 11 November 2025.
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