Angela Pedder: Is there a leadership crisis in the NHS?


Angela Pedder

Angela Pedder, Chief Executive of Royal Devon and Exeter NHS Foundation Trust, gives her views on the perceived 'crisis of leadership' in the NHS and the challenges facing NHS leaders.

This presentation was recorded at our breakfast event on 11 May 2016.


I'm slightly nervous about talking to you today, but I’m going to, in my usual characteristic way, tell you from the heart, because that’s what I’ve learnt is the best way to go about things, and I really want to start by thanking Nick for the excellent report that’s been produced – if you haven’t read it, it’s a really good read and I’m not saying that just because I’m in it, it’s a really good read! And what’s really important, and I think I’m going to start with the bit that Nick finished on that these are wonderful jobs.

We have to really be very clear about that, and encourage people – despite some of the challenges and some of the problems – to really embrace the opportunities that it gives you to work with some truly spectacular people who deliver compassionate care, technical skill and kindness each and every day; and there are very few jobs, I think, that give you that mix of ability, skill and kindness where you can actually see what happens from a patient perspective, and the impact you have on people at usually the most vulnerable times of their lives, and that’s a really important part of the cultural conversation

I think we need to have about leadership, that this report talks about, and it’s very easy to take the negative headlines out of a report like this, and we shouldn’t do that. There is lots that needs to improve, but don't let’s lose sight of the good things that exist, because it is a privilege to lead an NHS organisation, it’s a privilege to lead a Trust, and there’s lots of things that can do.

I’ve been around – as Chris said – I’ve been in the NHS for 42 years now, so I’ve been around for quite a long while, and you do see peaks and troughs in behaviours, and you do see peaks and troughs in how people describe the roles, and you do see peaks and troughs in people wanting to come through the pipeline. But I think each year we go on, the pipeline becomes more difficult, and I don't believe it’s because people are cosy in the middle management roles. Having come through middle management roles, they’re some of the toughest roles that you have, and if you survive middle management to get to the more senior roles, then you are good.

So don't be put off by the sort of headlines you might have seen in the press in relation to that, because we all need to build those broad based careers, and that was one of the comments I made in my particular piece with Nick which as the NHS has become increasingly silo’d, I think peoples careers have become increasingly silo’d, and very few of us, and very few of you coming through now, I think would be able to describe the breadth of experience that some of the twelve were able to describe, as they came through system.

And that doesn’t make us better people than you will be, but actually what we gained was that ability to look across the system, to find our way through and understand the perspective of different parts of the system, and the big part of a leader’s role is to translate what’s going on into an action plan with their teams, and to deliver something, and you remain in a single silo, your ability to do that translation I think is incredibly challenged and diminished as a consequence of that.

So my plea is we have to find a way, when we talk about leadership development or we talk about career managements, to encourage people to move between sectors, and that requires leaders of organisations to be prepared to take some risk. So I was appointed to my first unit general manager job, probably a chief exec role in today’s terms, when I was 29. I can’t imagine any board willing to take a chance on me again. If I was 29 now, would you take that risk? Because if that person made a mistake or something went wrong on their watch, you can read what would be in the report about the capability of the chief executive and the risks people took in response to that.

So we need to get that balance in place. These are difficult jobs. What was interesting to me from the report that were people that had been willing to take on some of the most challenging roles ended their careers in circumstances they may not have chosen to end their careers on, but their courage in taking on those roles is the courage we need if the service is going to deliver the transformation that we all say is needed, and that transformation is needed. But transformation isn’t about painting it a different colour. It’s fundamentally looking at our leadership capabilities and our leadership behaviours.

So regulation is important. We spend a huge amount of public money. We need to be held accountable. But that accountability has to be appropriate, and my plea in terms of encouraging leaders for the future is that we get to a place where our regulation and our performance management truly demonstrates the values and the behaviours so many NHS documents say we have, and in the very best organisations, you can see it permeate through those organisations – if you read the CQC reports, if you look in those organisations. So my request is yes, we have a very disparate system, but those values and those aspirations are shared, in fact drawn up by the regulatory bodies that we have. So we need to see some of those behaviours demonstrated in the way that we’re regulated.

So we are rightly pushed, challenged to be open, to be transparent, and the duty of candour applies to provider organisations. But it sometimes feels as a chief exec transparency, openness and duty of candour is not something you’ll get brownie points for if you do those things, and those of us that have been around for a while know how to negotiate the territory, and as a leader, as a chief exec, the first thing I was told by a colleague was be clear about the things you’re prepared to be sacked for.

I'm very clear about the things I’m prepared to be sacked for, and that is about being open, being transparent and having that duty of candour. I’m happy to be sacked for finances. I will not do anything that colludes with poor patient care. But we have to recognise the financial challenge that we’ve got is huge and the open debate about how we’re going to calibrate what we need to do to make the transformations we need to make, and that open public dialogue about you can’t have Scandinavian-style health and social care for US-style funding is a debate we have to get into and for me, that’s openness, that’s transparency, and that’s candour.

So I'm going to stop there.

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