This paper explores future leadership requirements for health services in the context of relevant leadership theory and the changing environment for health services in the UK. The output of leadership research is both prolific and confusing and its applicability to health services management uncertain especially in the context of constraints on the strategic managerial behaviour and choices of public service managers. The introduction of general management to the UK NHS in the 1980s, followed by an internal market for health care in 1990 should have provided the opportunity for managers to work differently and to create personal space for leadership. However, it is not known whether sustainable , new ways of leadership working have emerged although it is reasonable to hypothesis from studies elsewhere that a number of contextual and behavioural leadership models are likely to be found in the NHS. Although management researchers have explored networking and referred to the impact of the external environment of leadership, insufficient importance has been attached to-date to the impact of future trends in health services on the leadership of change in the health sector. The paper argues that in future health services leadership will require much more than traditional networking with other organizations and groups and will need to focus on developing and securing external agreement to an agenda for positive change turning the apparent constraints of the external environment, determined primarily by government policies,into opportunities. In other words, the demands of external or contextual leadership will increase forcing a stronger focus on having to achieve change through others.