Waking the sleeping giant: reflections on leadership and the National Institute for Mental Health in England (NIMHE) 2002‐2009

English governance has repeatedly had a tendency to veer between national, regional and local centres of power and influence. This has often led to profound disagreements, sometimes even open conflict. National policy guidance is usually helpful, if developed through consultation, to steer a clear, coherent direction for the system. But a narrow, excessively top‐down, mechanistic target‐driven approach can lead to a prevailing culture of ticking boxes at the expense of real patient priorities. Government ministers and civil servants, however, are often caught in a tension between being too dogmatic, or alternatively too flexible and giving responsibility to local agencies, whereupon people may complain about a ‘postcode lottery’ in services. Balancing perspectives and narratives in a coherent way for policy development and implementation and service improvement is a major challenge of leadership. The creation of the National Institute for Mental Health in England (NIMHE) was designed to bring together the local, regional and the national in a form that would see policy and practice mutually developed and nurtured at all levels of governance.