The recent National Health Service (NHS) reforms are having a fundamental impact upon the culture, structure and financing of the NHS, and the way in which patients receive care. The challenges this presents for the future of nursing practice, management and leadership are profound. This paper provides an account of how one NHS region, South West Thames, has sought to identify and develop the competencies required of future NHS trust nursing directors, and other top managers within the region, by participation in a sophisticated diagnostic process known as the Development Centre. The paper firstly explores the background to the Region's Career Development and Planning System (CDPS), then outlines the process of the identification of competencies, before exploring in detail the six stages of the Development Centre diagnostic process.