The white paper Equity and Excellence: Liberating the NHS (2010), will bring about large-scale changes to structure, process, and not least, new ways of working-requiring inter-related changes in culture, behaviour and practice. Given the scale of these changes, this represents a considerable challenge for clinical leaders in the NHS. As Giordano points out: 'Courageous decisions are needed to reshape services and help us prepare for the most significant leadership challenge the NHS is ever likely to face' (Giordano, 2009). It may well be the most significant challenge but it is not necessarily new to the NHS. It has happened at each change of government. Flanagan, writing at the beginning of the New Labour government in 1997, wrote: 'Managers are key to implementing change in the NHS. New Labour will require them to drive their set of changes over the next few years. Have they been equipped to cope?' (Flanagan, 1997). The same question can be asked this time round, although, given the nature of the reforms, it can also be asked of clinical leaders. Are they equipped to take on the leadership role/function?