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The NHS National Leadership Council Website1 (NLC) following the NHSNext Stage Review: High Quality Care for All (Darzi, 2008) suggested theimportance of effective leadership in the system emphasising the need forgreater involvement of clinicians in leadership. Consequently the ClinicalLeadership Competency Framework (CLCF) has been developed building onthe Medical Leadership Competency Framework (MLCF) to incorporateleadership competencies into education and training for all clinicalprofessions. This is a major step towards establishing and developing highlevelleadership across the health service.The NHS Institute for Innovation and Improvement (2005) NHS LeadershipQualities Framework2 emphasised the situational nature of leadership andindicated the circumstances under which different leadership qualities willtake precedence.Formal studies of leadership date back (at least) to the beginning of the 20thcentury to seek the characteristics that make certain individuals influenceothers’ behaviour (Alimo-Metcalfe, Alban-Metcalfe et al. (2007). Questionsremain though about the significance of context for understanding howcertain characteristics might be more or less relevant or effective inparticular organisations (Fairhurst, 2009; Liden & Antonakis, 2009; Uhl-Bien, 2006). One important set of findings suggest that leadership doeshave an effect on organisational performance – for good and for ill (Currie,Lockett, & Suhomlinova, 2009; Schilling, 2009). Further, the context,culture, climate and/or structure of an organisation all have an impact onthe performance of the people who lead in it (Carroll, Levy, & Richmond,2008; Goodwin, 2000; Michie & West, 2004).The NHS itself is complex and comprises different organisations includingPrimary Care Trusts, different types of Hospital Trusts, Foundation Trusts,teaching hospitals and other specialist institutions, all with their uniquecharacters based upon their developmental histories, the histories of thecommunities they serve, and most crucially for this study, the people whowork in them.Our study aimed overall to seek out the meanings and perceptions ofrelationships between ‘leadership’ and ‘patient care’ and how leadership istransmitted across organisations to impact upon service delivery.Two models of leadership are examined in this study:First is inspirational and transformational (or engaging) leadership (Alimo-Metcalfe, Alban-Metcalfe et al., 2007).Second is distributed leadership (Elmore, 2004; Gronn, 2002). service delivery (Campbell, Coldicott, & Kinsella, 1994; Collier & Esteban,2000; Simpson & French, 2005).

This article is concerned with the introduction of the agenda of New Public Management (NPM) within the board of a UK Hospital Trust: West London Hospital (WLH). We discuss the literature on New Public Management, including its limitations for analysing the organizational reality of implementing NPM. But we will also be drawing on discourse theory and the literature on rhetoric. The main argument in this article is that in order to understand the reality of the NPM paradigm, we need to study the rhetorical strategies of protagonists involved in the negotiation of the NPM agenda. Rhetorical strategies are means of making general viewpoints more convincing, for example, by comparing ‘our’ organization with similar organizations. Rhetorical strategies show patterns, which reappear in conversations and arguments made by protagonists. Specifically, we identified three rhetorical strategies justifying why and what kind of a more ‘rounded picture’ was required: widening the argument to include national productivity comparisons with other hospitals; widening the argument away from a narrow focus on finance toward a strategic and political perspective; and, lastly, widening the argument to look at innovation in the whole clinical process.