Stephen Dorrell supported our argument that politicians should focus on setting the direction for the NHS and accounting for the use of resources – and should avoid becoming involved in operational issues. The proper role for politicians in his view is overseeing the commissioning of services, with providers having responsibility for deciding on the best way of meeting the requirements of commissioners.
Ara Darzi argued that politicians have become technocrats focusing too much on targets and not enough on mobilising commitment within the NHS. Mobilisation, motivation and capability are critical to the further reform and improvement of the NHS but in his words are just ‘not sexy in Whitehall’. He argued that reform needs to refocus on business units within the NHS instead of on the system as a whole.
David Dalton gave his perspective as chief executive of Salford Royal NHS Foundation Trust, one of the case studies in our report, where the aim was to become the safest organisation in the NHS. Key ingredients included setting specific goals for improvement and measuring progress towards them. Transparent reporting of the results helped to stimulate change as did investing in staff through training in quality improvement methods.
Dalton highlighted how his role has shifted to engaging with and supporting staff, and deferring to their expertise, rather than leading from the front. Over time this has produced positive results with Salford Royal performing well on key indicators such as mortality ratios, staff experience and patient experience to the point where it can claim with justification to be a leading example within the NHS.
The snag? The approach used at Salford Royal takes time to work in a context in which politicians and regulators are often impatient to see improvements in care. It also depends on NHS leaders being willing to move away from a pace-setting style to embrace a model of leadership in which they work with and support staff to bring about change.
The leaders of the international case studies described in our report have all shown a deep personal commitment to service improvement, including undertaking training in quality improvement methods themselves. They have also had to change their own leadership styles when they have understood that real and sustainable change relies on motivating and engaging many hundreds of staff in improvement work. The message is clear: unless NHS leaders are prepared to change, reform from within will remain a distant dream.
These insights align well with the approach we are taking within the Fund in our leadership programmes, as described in two new reports launched at our fourth annual leadership summit in May.The Fund will be playing its part by helping to develop the leaders needed to build collective capability and shape change from the bottom up instead of the top down. We will also be using the experience of high-performing organisations in our programmes to support NHS leaders learn from the very best.
- Read our reports: Reforming the NHS from within, Developing collective leadership for health care and Delivering a collective leadership strategy for healthcare
- Listen to the highlights from the event: Reforming the NHS from within
- View our interactive diagram: Visualising reform in the NHS
- Catch up with our Time to Think Differently work