Editorial by Dr Simon Moralee | EHMA newsletter
31 October 2025
An editorial by Dr Simon Moralee, Head of the Health Management Group at The University of Manchester, written for the October 2025 edition of the health management newsletter.
Raising the bar? Why England’s new NHS Management and Leadership Framework might matter beyond the NHS.
I have had the privilege of being directly involved in the development of the forthcoming NHS Management and Leadership Framework, working with the UK Chartered Management Institute (CMI) on behalf of NHS England. Over the past year, I have been part of a national conversation that has spanned clinicians, operational managers, partner professional bodies, academics and – crucially – patients. What is about to emerge is aimed at being not just ‘another’ competency framework, but the latest shift in how managers are expected to act with professionalism, accountability and public value in a publicly-funded health system.
Why now? Why this framework and these standards?
Calls for clearer expectations of NHS managers have been growing for years, not least following the 2019 Kark Review and 2022 Messenger (and Pollard) Review, both of which highlighted inconsistent standards, variable capability, weak accountability and limited recognition of management as a profession in its own right. Healthcare management – unlike medicine, nursing or allied health professions – has long been without a clearly-defined code of conduct, a national development pathway and an agreed benchmark for “what good looks like” across every level of leadership, despite the work of organisations such as the Institute of Health and Social Care Management dating back over a hundred years to support those leading health and care organisations.
These new standards aim to respond directly to close that gap. They are being framed deliberately not as a technocratic checklist, but as a values-led, behaviour-based professional anchor for anyone who holds responsibility for people, resources or systems in health and care, at whatever clinical or non-clinical band or grade.
The framework’s code is underpinned by six principles: Accountability, Collaboration, Compassion, Curiosity, Inclusion and Integrity. These are explicitly tied to appraisal, career progression and potentially – in future – to licensing and regulation.
Structure with Purpose
Rather than pitching management learning as “accidental”, the standards map a structured progression across five stages – from new or first-line leaders through to Executives. Each level contains descriptors of behaviours, competencies and responsibilities across core domains, such as:
- Self-Effectiveness: balancing safety, productivity and wellbeing; communicating and listening effectively; and delivering with accountability and integrity.
- Managing People and Resources: creating high performance work environments, improving delivery and maximising resources and value.
- Delivering Across Health and Care: improving outcomes and experiences, leading innovatively and working collaboratively.
As with all attempts at codes of conduct, standards, frameworks (and the curricula that will follow), the devil will be in the detail, balancing what gets done (efficiency) with how that is done (effectively but also compassionately). The framework attempts to hold both of these simultaneously. For example, leaders are expected to ‘manage with civility and compassion’ while also take accountability for operational delivery and improvement; to optimise resources, efficiency and productivity, but in service of health equity and long-term value.
This duality, of care with competence, kindness with commercial sense, is not a new focus for the NHS; nonetheless, it reflects the ever-emerging reality of health systems delivery in 2025 with modern approaches to (healthcare) management and leadership: to be emotionally intelligent, data-literate, ethically grounded and improvement-driven.
Implications for Other Government-Run and Regulated Systems
Although designed for the NHS in England, this framework has significant potential implications for other publicly-funded health systems internationally.
Almost every one of those systems faces similar challenges to the NHS: blurred lines of accountability, varied cultural norms between professions, inconsistent leadership pipelines and leadership cultures that reward crisis firefighting rather than long-term stewardship. What the NHS is attempting here is not just managerial standardisation – it is, to quote Andrew Abbott and Pierre Bourdieu – a professionalisation project, anchored in public trust, towards greater professionalism.
Three specific features are likely to resonate internationally:
- The marrying of behavioural expectation with competency assessment – this is not simply asking “what can you do?” but also “how do you behave when you do it?” What is significant is the challenge to manage in a way that sustains improvement and cultural buy-in (and with managers supported to learn how to do this better).
- Digital-first appraisal and development – the intention from next year is for all managers to be able to self-assess against the standards via a national platform linked to 360 multi-source feedback and aligned curriculum pathways. This is conducted sporadically already in health systems such as Canada, the US, the Netherlands and Australia, but to what extent might the NHS’ foray into this – as one of the longest-running, largest and most well-recognised national systems – give rise to more universal adoption across other government-run systems?
- Preparation for future regulation – while not yet a licensed profession, the language and structure align increasingly with models seen in other health professions. This creates a clear pathway toward eventual statutory accredited status.
Beyond Compliance: The Cultural Bet
Ultimately, the test of the effectiveness of these standards is not just about compliance and regulation. It is a message about cultural transformation: being a leader in a public service is not accidental or personality-based – it is a skilled, accountable, evidenced-based, ethical profession in its own right.
If we expect NHS – and indeed European – health leaders to carry that identity with purpose, then these standards mark a considered attempt to invest in managers’ technically, academically and professionally, with parity of esteem, underpinned by a national curriculum, consistent development routes and clear career pathways.
The framework is expected to launch anytime now, with implementation rolling out through 2026. For it to be impactful, it will depend on more than ‘tick-box’ uptake. For years, the NHS has talked about doing this – and now it is – with other health systems likely to watch this closely.
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What our Members say
I have been active in EHMA since the first years of the '90s and I have seen its evolution from a small association of members interested in sharing knowledge on health management practices to the current status of reference and advisory key player for EU, health systems and organisations, stakeholders associations, industry and universities. EHMA is now a unique knowledge hub, policy advisor, community of practice and network of best in class organisations involved in health policy and management. A place where health managers can build their competences, policy-makers and stakeholder associations envision how to implement and sustain change through health management, industry leaders understand how to engage more effectively with health organisations and systems. The right place to nurture and grow health management capabilities and capacity for every stakeholder of health systems.
Prof. Federico Lega, University of Milan, Italy
Health management has a crucial function in shaping public health and health system challenges. The Medical University of Varna, Bulgaria had success in collaborating with EHMA on EU-funded projects that has resourced us to create new health management competencies for the future workforce. In addition to all classical definitions, health management is a science dealing with individuals, groups, and society at large. It is an art contributing to the beauty of our lives and an interactive communication process at all levels of institutions and human energy. I have also had the pleasure to chair the South Eastern European Special Interest Group which gives members a space to discuss and tools to address how health systems are managed in our regions.
Prof. Todorka Kostadinova, Medical University of Varna, Bulgaria
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Prof. Sandra C. Buttigieg, University of Malta, Malta
EHMA is a pre-eminent organisation for everyone working in planning, managing and delivering health services across Europe. As a long standing member of EHMA I have always been impressed by the vibrant community of managers, researchers and academics it has created and by the many opportunities for sharing knowledge and funding opportunities it has brought to its members. Its international scope is impressive and its impact is often felt in management and research across European and national health systems.
Prof. Axel Kaehne, Edge Hill University, UK
Health workforce has become more essential in operating, managing and maintaining health systems lately, particularly in crisis and emergency situations. European healthcare professions and the workforce need to be high on the agenda of managers and decision makers. The Health Services Management Training Centre, Semmelweis University in Hungary is a longstanding EHMA member, because it connects us with collaborators and experts, with whom we can have complex debates, from whom we can learn and at the end find solutions in various challenging fields of healthcare management.
Dr Eszter Kovács, Health Services Management Training Centre, Semmelweis University, Hungary
As a hospital administrator and health management professor, I see on a daily basis that the healthcare challenges require talented and skilled managers to transform it. the EHMA membership has been beneficial to bring healthcare management research and education to the demanding healthcare services world, promoting healthcare management competencies and knowledge creation.
Dr Alexandre Lourenco, APAH - Association of Portuguese Hospital Managers, Portugal
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Prof. Ann Mahon, University of Manchester, UK
Society evolution, pandemics and ageing modify health needs. So, health policies and services are to change dramatically. EHMA, through webinars, workshops and annual conference provides an excellent insight to a professional changing world, favouring closeness to management innovation and the protagonists of these changes. As a primary care services’ manager, participating in EHMA activities is really worth it and allows to involve oneself in the innovation processes.
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