Based on public hearings about the NHII vision, NCVHS has determined that the most important missing ingredient, which could accelerate and coordinate progress on the NHII, is leadership, specifically, Federal leadership. Public- and private-sector representatives testified that the lack of a strong Federal presence to guide the development of the NHII is a major gap. They urged immediate Federal leadership to bring about collaboration between stakeholders in the private and public sectors and among all levels of government. NCVHS has heard the message and responded with a set of recommendations that outlines the leadership needs and responsibilities to bring the NHII into being. Consequently, the Committee recommends that a new senior position and office at the.