This document outlines Stephen Welfare's vision for putting clinical leadership at the heart of quality improvement. It discusses establishing a "Change Leaders" program to support tangible quality improvements and develop leadership skills among clinical and managerial leaders. The program would involve fellows working on quality improvement projects within their organizations over 20 months, receiving coaching, training and a postgraduate certificate. It also discusses the need to maximize synergies across networks to support quality improvement and leadership development across the NHS.