The British National Health Service (NHS) employs over 1.3 million people, and spends about £90 billion a year. Services are delivered through about 300 NHS organisations and 5,200 GP practices. The NHS sees about 1.5 million patients every day. It is a huge enterprise, which dwarfs most other areas of the public sector in scale and complexity, touches the lives of almost every citizen directly or indirectly, and operates under intense public, media and political scrutiny. In any terms, it presents a unique leadership challenge.