No other nation has what we have in the NHS. No other healthcare system is as comprehensive or as big, but that doesn’t mean that we should be complacent, that we can’t learn from others and particularly when it comes to leadership.
The only organisations that come close to the NHS in size are the US Department of Defence, McDonalds, Walmart and the Chinese People’s Liberation Army.
Look at what McDonalds does. What they do is spectacularly less complex, yet they drive leadership training through every level of their company. Restaurant managers learn how to develop a culture of continuous improvement, general managers learn how to create and execute business plans and then there’s the apprenticeships, the university degrees, the leadership institute. Surely, the lifesaving business requires at least as much emphasis on good leadership as the fast food business.
The best led trusts have the best clinical performance, financial performance, staff and patient satisfaction. So we need to have an open and honest conversation about how we get the right leadership in the NHS.
So I want to focus on three areas. First, training. We need to train more people to be leaders in the NHS. We need more clinicians becoming chief executives, so we need a pipeline of talent from the frontline to the boardroom, and we also need new people and new ideas from outside the system and how we do this is by making sure that they get the right tailored training and external recruits at all levels learn how the NHS works. If there’s a golden thread running through all of this, it’s that we need to create leaders who are comfortable with challenge and change. Leaders who create a learning not a blame culture. A culture that’s less hierarchical with greater autonomy at all levels.
There has been a mindset where there are certain errors that should never happen and therefore that it is wrong to make them. Mistakes will happen, despite everyone’s best efforts. What matters, is that we admit mistakes, we learn the right lessons and that we improve. It’s vital to creating system leadership that I want to see embedded across every level of the NHS, and when I say every level, I really mean it. If you are the senior nurse running a ward, then you are involved in the leadership of that system just as much as somebody running a CCG is involved in the system leadership of their local area.
So let me turn from training to the second point, which is about technology. Another area where leadership has a crucial role to play, but improving technology is only a small part about the technology itself. It’s mostly about cultured. Leaders must ensure that their staff have the right skills to constantly innovate and continuously realise the benefits that technology can bring from basis decent IT to the huge opportunities of genomics and AI and digital medicines that are going to change the NHS fundamentally over the decades ahead, and this means that we must have the right skills and capability in management and leadership and technology is no longer just another department, but it’s at the core of how every good organisation works.
So if you’re a chief executive, I don’t expect you to know everything about technology, but I do expect you to have a CIO or a CCIO on the board who does.
And third, I want to talk about diversity. And here I want to borrow a phrase from Idris Elba. What we seek is diversity of thought. Now one of the most obvious forms of diversity is what people look like and if we look at racial equality, how leadership within the NHS looks spectacularly un-diverse. 40% of hospital doctors and 20% of nurses in the NHS are from a black or ethnic minority background, yet BME representation on NHS trust boards is just 7%. Diversity of thought also comes from gender too. Over 75% of the NHS workforce are women, yet at board level that figure is just 40%, but it’s not just a question of fairness and justice. Diversity of thought, diversity of leadership is about diversity of experience and diversity of perspectives. Diversity of thought is essential to the future of the NHS, leadership is listening to people, empathising, being open to challenge and change. Empowering people and being humble enough to admit you don’t know everything and you make mistakes.
That’s the culture I want to see across the NHS. It’s a culture that we must work together to create across the NHS, because only then can the NHS truly be the best which is what our citizens deserve.