Marketisation of health care provision in the UK will result in a 'seismic' culture shift for many organizations and their nurse leaders. This short item explores the role nurse leaders will need to play in a world where increasingly, competition is becoming as important as collaboration.

This article argues that developing more sustainable and effective local health and social care systems by taking a place based approach requires a new model for leadership development. Leaders will now be required to share power, contradicting a preceding social policy that emphasised competition-policy now places greater emphasis on collaboration and a 'systems approach'. Leaders in this new environment will need to build mutual respect and trusting relationships in order to address complex issues-rather than thinking they can be managed from one organisation's perspective. This will require conscious development and an understanding of the cultural tensions involved. Place-based leadership development across health and social care systems offers leaders an opportunity to work on themselves, together, and it is this collective journey of discovery that creates the necessary leadership capability development as social capital, enabling place based public value to be achieved.

NHS leaders could be forgiven for better equipping themselves and their organisations for life in a more competitive world. Throughout England, the reality of competition between healthcare providers is increasingly evident.

The coalition government has set out what it is describing as the most radical set of changes for the NHS since its inception. The White Paper,‘Equity & Excellence: Liberating the NHS’( Department of Health (DoH) 2010 ) includes considerable reforms to organizational structures within the NHS, cutting management costs in some areas by 45% and saving £20 billion by 2014. These headline grabbing elements of the white paper are something likely to preoccupy many of those currently involved in the leadership and management of health services in England. This is unfortunate as the distraction of structural change to organizations has previously been seen as a causal factor of non-delivery, in both public and private sector organisations. This new era for the health service will result in many issues for leaders and managers in the NHS to tackle. For instance, one consideration that prompts debate is that of further enhancing the ethos of competition between healthcare providers and indeed, between commissioners too. While the White Paper reassures the reader that competition will be regulated through an OFGEM/OFCOM like Monitor, it is also explicit that the principle of competition will be further promoted. Of course the notion of enhanced competition between providers of NHS services is not new, as the last government also promoted this concept—for example, through greater ‘choice’ as a mechanism for driving up quality. In the many other sectors of the business world where competition is well established, the general research shows us that as competition increases, ‘business ethics’ and ‘moral leadership’ are likely to be matters of greater concern for the likely leaders and managers of our future NHS.