This chapter provides a two-part overview; first, of changes to healthcare policy in England and how these changes have affected managers; and second, of changes to arrangements for management and leadership development in the National Health Service (NHS). It focuses specifically on the nature of management in healthcare and examines the structure of healthcare organizations and the place of managers within them. The chapter examines the various leadership and management training and development initiatives across the sector. Managers, and middle managers in particular, play a vital role in large organizations, co-ordinating activity between the upper and lower organizational reaches and across various departments, translating broader policy/strategy into operational outcomes and frequently serving as a key repository of organizational memory. The chapter also provides an overview of government policy as it affects NHS management and presents the changes as a series of stages or phases to illustrate how the direction of travel has been towards a more entrepreneurial service.