We need to see a new era of leadership for the NHS

At this year’s NHS Confederation conference we heard from many eminent speakers, including politicians, NHS leaders, staff and patients, about the variable quality of care provided across NHS organisations, a lack of patient-centred care, and the importance of showing compassion to frontline teams. Recent reports by Francis, Keogh and Berwick suggest significant failures at all levels of the NHS. So is a different type of leadership the answer?

Our recent publication on collective leadership talks about the need for leadership at every level and the need to be strategic with it – with proper succession plans to enable leaders to deliver services both today and in the future. This leadership strategy must be guided by a vision from the top, and it must be led by those who commission, deliver and use the service, those close enough to the needs of patients, carers and families in a collective endeavor to drive up the quality of care

This all sounds sensible and obvious, but at the conference I was saddened to hear many stories of failures in the leadership and compassion shown to staff. I heard from women leaders who still find it hard to be taken seriously or treated as an equal, and there was a mood of fear among many leaders to do the right thing in case they faced top-down sanctions. A junior female manager told us how, when asked to sit on an interview panel, she was tasked by the HR lead to ascertain which of the female applicants were likely to have children in the near future. Showing her sense of outrage she said, ‘I suddenly realised that my career could be affected in a similar way, what can I do about this?’

At both the NHS Confederation conference and our Leadership Summit in May there was evidence that we still have a long way to go, including Kate Granger’s powerful story about her experience as a patient and the results of numerous staff surveys that show high levels of bullying, stress in the workplace, and that some staff feel that boards are more interested in targets, financial balance and regulatory frameworks than in improving the quality of care and investing in supporting the teams providing their service.

On a positive note, the conversations seemed far more focused and forward-looking than at the same conferences last year, and there was widespread recognition of the need to support and enable staff to deliver and lead high-quality care. I was left with the sense that the new regime at the top, led by new NHS England Chief Executive Simon Stevens, shares this view, with a less top-down approach from the centre, a more flexible workforce strategy and a welcome commitment to diversity in leadership positions, as set out in Simon’s recent speech at The King’s Fund

So are the days of the heroic pace-setting leadership of the NHS really behind us? Are we seeing the emergence of a culture that will support and enable staff to innovate, improve and lead change from within the system? Our recent paper, Reforming the NHS from within, shows that a shared culture, a patient-centred vision, and investment in leadership and quality improvement are more important than structural reforms in driving up quality of care.

I was struck by Simon Steven’s quote ‘Think like a patient, act like a tax payer’ and his commitment to stop the diagnosis of what is wrong, stop structural re-organisations and just get on with it. Do we need to see a new era of leadership for the NHS?

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Comments

#42234 Jeremy Marchant
Specialist in business transformation
emotional intelligence at work

I've read this article and the executive summary of the report, "Delivering a collective leadership strategy for healthcare". And I've read a very great deal of other material on this subject over the years.

At the risk of being very irritating, it seems to me that there is not one single, agreed definition of what a leader in the NHS is, or of what distinguishes a leader from someone who isn't a leader.

Usually, leaders appear to be defined as managers who are, in some way, Special (eg, they're "inspirational"). But the ways in which they are Special are not clearly defined, though they are clearly at odds with each other. As a result, it's actually quite hard to keep going reading this stuff—it all becomes rather vague and hazy.

And, worse, where I feel I have understood what the author means by “leader”, I’m afraid I don’t always agree that theirs is the most useful definition of the term.

It would be inconceivable that, in a clinical environment, say, staff were routinely using words, each person with their own definitions (which they didn’t share with their colleagues).

I’m not sure why, just because we are talking about management terms, a significant degree of imprecision is allowed to creep in.

Just because it is harder to define “leader” than it is to define “stethoscope” does not absolve people from the task of doing so. In fact, it is precisely _because_ it is harder, that it needs to be done!

And, of course, it _isn’t_ hard to define the term. What’s hard is to agree it!

But, that said, I can think of at least one organisation where I suspect you would get a pretty consistent definition of “leader” from whoever in the organisation you spoke to, and that is the British Army: certainly amongst the graduates of the Royal Military Academy, Sandhurst—whose motto, incidentally, is “Serve to lead”.

#42254 Isabel Jackson
Occupational Therapist OT
NHS

I have been working as an OT for 14 years from Acute to an Intermediate care setting. I studied Fine Art prior to studying OT. I have had an innovative idea of how to improve the quality of care and experience of elderly people living in care homes. I have been developing these ideas for the last 20 years but 2 weeks ago an epiphany occurred. My ideas are quite far reaching and I have the determination and motivation to begin this work. I believe if shared properly these ideas could contribute to improving the quality of life for all older people living in care settings. I need to know whom best to approach and I ask for interested parties to help me on my way.

#42264 adams
Office Assistant
Parivartan

It is true that all successful business is based on the performance of its workers. A leader rides the workers in a team which is more effective. A leader’s ability is totally responsible to enhance the working environment of the group. Learn from the current working environment, any past experience and focus on opportunities are very essential for a leader to prove their leadership qualities and face any problems or challenges.

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