Is lack of leadership talent a long-term condition for the NHS?

With the growing body of evidence that links good leadership to positive compassionate cultures, added to our recent research into the worryingly high levels of senior leadership vacancies, I have begun to ponder if the lack of leadership talent is another long-term condition for the NHS?

Developing leadership that is ‘fit for purpose’ is often cited as the most common workforce challenge facing all sectors – and the health service needs to take this challenge seriously. One way to do this would be to take a strategic approach to talent management, a concept that first emerged in 1998 in response to a paper entitled ‘The war for talent’ (McKinsey 2001) and that we explore in a paper published today.

Talent management is a set of integrated organisational workforce processes designed to attract, develop, motivate and retain productive, engaged employees. In short, talent management is a strategic human resource issue, but it is much more than a function of the human resources team; it is a distinctive capability that needs to be embedded throughout the organisation. And the board’s job is to own and manage that broader capability by developing a collective approach to leadership.

There are a number of different approaches to developing a talent management strategy: an inclusive approach where everyone in the company is considered part of the talent management programme; the executive talent pool approach where the focus is at senior management level;  future leaders approach focusing on staff at all levels who are identified as having leadership potential; a succession planning approach that identifies key roles that will need staff with the skills and abilities ready to take the position when someone leaves or retires; and a blended approach, where two or more of the first four approaches are used in combination.

In my opinion, the health service should adopt the blended approach. As health care becomes more complex and the NHS five year forward view moves us towards new delivery models, we need to cultivate an agile leadership workforce. There are particular issues that the health service needs to be aware of – diversity is an Achilles heel, with a chronic absence of members of black and minority ethnic groups and women in senior and board leadership roles and also a lack of diversity of thinking – recruiting ‘mavericks’ who think and possibly behave differently from others and who will change the system. There is also a difficulty in encouraging clinicians to consider managerial roles.

If you’re lucky enough to have a decent succession programme, you know the reality. Unless you heavily invest in the concept of talent rotations and offer stretch opportunities, it’s hard to keep people with high potential talent interested and motivated to stay. I will leave you with an idea – shadowing. Amazon have just announced the appointment of a new ‘shadow’ for their CEO, Jeff Bezos. This long-established post is given to an up-and-coming executive, who gets the chance to go with Bezos to daily meetings, talk over problems, and learn from him on the job. Shadows usually last about two years in the role and go on to lead big projects within the organisation.

Now most of you will come with an automatic objection – that the NHS isn't Amazon, followed by another – ‘our CEO isn’t Bezos.’ Fair enough. You might also say that the roles you really need successors for aren’t at the CEO level, they are three to four levels below that. All that is true, so why not think about this as a way of developing a collective leadership approach where all leaders and managers at every level of the organisation model leadership behaviours that tomorrow's talent can learn.

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#544016 Ian Richardson
Programme Governance & Benefit Champion

Leadership is very important. We need to take a lesson from Gary Hamel - 'make our organisations fit for humans' . Successive leaders have made our organisations too complicated by reacting to the environment, without adapting their approach. Make work easier and there will be no shortage of leaders and satisifed patients.
A solution lies within the principles of OpenStrategies (@OpenStrategies #prub)

Drop me line if you have any questions.


#544017 Ed Macalister-Smith
NED and coach

Shadowing has always been a part of the personal development armoury that is easy, quick and effective - not necessarily for 2 years but even a couple of well-picked days can shed huge light on how senior people and their teams work. And it doesn't cost anything... And there's no need to confine shadowing to people inside the NHS, many senior leaders from other worlds (maybe even a coachee's personal role model) are likely to be only too willing to help.

#544018 David Dundas
Managing Director
Lion Industries UK Ltd

I was a Governor of Burton Hospital NHS Trust for 7 years until I had to resign to put more time into my company, so I had a good outsider's view of a DGH in action and the limitations of their executives, who were pretty good at the daily running, but in my view many lacked strategic vision, largely because of their limited experience outside the NHS. So please add strategic vision to your list of skill sets, for it is not enough for a rising star to just learn how to emulate the present Leader.

#544024 Trixie McAree
Head of Midwifery
Birmingham Women's NHS Foundation Trust

I agree with the sentiments in the above article but it seems that as leaders we spend most of our time surviving and fighting fires which prevent space for strategic thinking.

#544029 Candy Morris
managing director

Hi, I've been struck by my recent coaching work about how much current talent is abused and misused. I don't see any lack of ability, rather a reluctance to keep on going with the risks of perceived failure.

#544030 George Coxon
Various inc 2x care home owner
Various some NHS &social care

Got to recommend Derek Sivers again as ever. How to start a movement. My personal view on leadership always includes words like reflection, culture shaping, direction, empowerment, style&substance but most critically credibility. I said in reply to Nick Timmins's recent KF piece on system leadership. - in Derek Sivers 3 mins YouTube TED talk. The dancing guy is still dancing when the crowd join in. That's credible leadership so often lacking sadly

#544036 Umesh Prabhu
Medical Director
Wrightington Wigan and Leigh FT

Sad reality is that NHS appoints wrong leaders. Many NEDs are appointed for their professional skills and not for leadership skills. Many do not know how to hold EDs to account. Many do not understand how NHS works. If this sounds like sweeping generalisation my sincere apology. Since we adopted new method of selection now we got brilliant NEDs.

Also when it comes to Executive Directors NHS appoints many without any proper leadership training. Many Medical Directors have not had any training in leadership. Many do not get any feedback for their leadership behaviours and that too those who are affected by their leadership.

As MD of Bury I had the same passion and enthusiasm but I was a poor leader. I had anger, I used to get frustrated, meetings were firefighting and I spent 80% of my time on 10% so called difficult doctors and I hated the job.

Then as NCAS adviser I saw too many tragedies for patients and for doctors and most of them were preventable. I defined my values, once I knew my purpose and values I learnt the art of leadership.

I joined Wrightington, Wigan and Leigh FT in 2010 and 5 years on we got 26 awards and we got 22 value based leaders and 450 less patients die and today I sleep well, I am proud of our success and all we did was inspired 80% of our staff who want to do a good job and challenged 20% and removed few poor leaders from the top of the organisation. Today 450 less patients die, staff feedback from bottom 20% to top 4th and we have 280 patient safety champions and excellent leadership training. Patients are happy and staff are happy. Happy staff - Happy patients But we are not perfect.

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