NHS leadership development spend averages just £106 per manager per year. For a system employing more than 1.5 million people, it is a drop in the ocean.

This underinvestment explains why so many new leaders are under-prepared. With nearly two-thirds of trusts led by first-time CEOs, the pipeline is dangerously thin. Inadequate training leaves boards reactive, not strategic, and leaders reliant on firefighting rather than long-term planning.

The impact cascades down. Managers with little development support struggle to lead teams through deficits, waiting list pressures, and workforce shortages. Poor leadership capability feeds staff frustration, higher turnover, and inconsistent improvement programmes. The system cannot retain talent if it fails to equip people to lead.

Meanwhile, central government rhetoric about “modernisation” jars with the reality: training budgets have been eroded, leadership schemes cut back, and staff expected to deliver transformation on fumes.

Patients don’t care how much is spent on leadership programmes, they care that services are safe, staffed, and well-led. Without real investment in people, NHS leadership churn will continue, frontline morale will suffer, and the cycle of instability will deepen. Training on fumes delivers only one outcome: exhaustion.