Marcus Powell: Is there a leadership crisis in the NHS?

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  • Posted:Wednesday 11 May 2016

Speaking at our breakfast event on 11 May 2016, Marcus Powell discusses the state of leadership in the NHS and offers his views on what needs to change.


So just a bit of background in terms of me – I’m an outsider, I’m going to sort of like wear that badge quite proudly for the next few months anyway. I started my career at Marks & Spencer’s as a buyer, did that for nearly twelve years, moved into learning and development for the whole of the organisation. I then joined Ashford Business School as a consultant and spent seven years’ sort of going around the world the world working with almost exclusively private sector organisations who were going through periods of huge transformation, working with their boards, working with their leaders, working with their management teams around how do you navigate your way through very complex situations?

I then joined Nuffield Health, on the board of Nuffield Health, and did that for nearly eight years and I was group OD/HR director, and sort of grappled with some of the issues that some of the chief executives are talking about in this report, and in terms of how do you actually make a safe system and a high quality system work?

And then I joined The King's Fund, and one of the things that I just wanted to sort of reflect on – and I think it comes through the report – is that when you look at organisations who are going through change, and I don't think anyone would doubt that what is happening at a system level for the health service is there’s a huge amount of change happening now, but also a huge amount of change that’s about to probably come – it’s that you have to have very, very confident and competent and leaders who have the energy to do the job. If you don't have that right through the system, then your ability to actually navigate your way through the change is impossible.

Now in my experience working with all sorts of private sector organisations would say that that is the single common denominator – you have to have leaders who are really, really confident because when you’re in periods of huge uncertainty, the big issue that people face is are we dealing with the right problem? And the angst that that provokes is one that you have to be able to contain. For me, the job of a leader – first and foremost – is whilst all of this stuff is going on around us, are you able to contain your own personal anxiety to be able to create the atmosphere for your team – as positive organisational culture within your team – so that they can play the part that they need to play.

This is my observation but I think it comes through in the report is that actually there is a huge amount of angst out there at a system level, but also at a leader level, and that is something that the system I think needs to deal with. When you start to look at, “Okay, so where does that angst get amplified?” it certainly gets amplified at a leader level in terms of, “Have you got the right person for the job?” But the system also amplifies.

One of the features of regulated systems is that in a period of very extreme change, what regulators and regulation does, it’s not just the same in health, it’s the same in all sorts of regulated industry, is that in response to the change, the regulators start to button down. They want to take more control, because that gives them the sense that they are in control and the system can be managed, and you can see it going on here. In a perfectly reasonable response to their own anxiety, they start to batten down and overregulate and then start to move into spaces that they shouldn’t be regulating.

So you have these sorts of paradox going on in organisational change, which is at the time when you need leaders to be the most innovative they possibly can, and the most confident they possibly can. The forces at work drag them in the opposite direction, and when you’ve got leaders who are very experienced leaving the service – the ones that could bat away this sort of – interference is the wrong word, but you know what I mean – then you really have got a situation where actually at the time where you need to be innovative, the system is retreating into what it already knows because that is the simplest response to it.

So at a system level, you have to get to a place whereby you are encouraging confident leaders to do what they need to do which is to innovate, and sometimes that means getting it wrong, but actually the response to that is, “Okay, well we have got it wrong, so what can we do to try and move onto the next thing?”

And this positive organisational culture, one of the things I talk about is bullying, you know, bullying is very, very corrosive to any organisation and it should be stamped out if that’s not a bullying term, but you need to move away from it because people will not have the confidence I’ve talked about if they feel bullied. And the system is bullied itself, and I talk about this in the report is you have to reflect and think, “Okay, so how is the system that tis bullied, it’s not surprising that then that that is received as being bullied and the bullied become the bullies,” and on you go. So that all has to change.

The other thing that I think is really interesting, and again I’m saying this as a commentator, well actually one of the things I always said to myself is, “Don't become a commentator,” but I’m going to become a commentator! Is this view that there are experts out there that know better than we do. Now again, one of the huge observations I’ve made working with all sorts of different sectors is that in a complex environment, you have to believe that the person you’ve given the job to is the best person to navigate their way through that complexity, and that all the experts in the world will never be able to really understand the complex mix of issues that you’ve got or that you’re facing.

So again, observationally, this sector seems to be completely dominated by the need to find a silver bullet and to find experts out there as opposed to actually you are the expert to do the job that we have appointed you to do, and we will get out of your way to enable you to do it to the best of your ability, and I don't think that’s – observationally, I don't think that happens enough.

And the final point I make is people have got a choice. This sector – like any other sector – is a goldfish bowl. People know what it’s like to join this sector before they’ve joined. What’s interesting to be is that having been an outsider to the NHS, some of the negative stuffs in the report was not a surprise to me. That is, to be honest with you, really worrying because as people have got a choice, good people have got a choice, what they will say is, “I will go to a sector that actually can provide me with a career which is rewarding, stimulating and allows me to do the job. Why would I go into a sector whereby the consequences of… well just the environment is one which is very, very difficult and I’m not able to do the job that I came here to do?”

So there’s something at a system level we really have to get our arms around which is all of us – and everybody in this room probably has a part to play in it – has to move away from this very pernicious culture to one which actually you create an environment where people can do the career they came to do and live the really positive things in the report which we should hold on to.


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