Victor Adebowale: Leading change in the health and social care system

This content relates to the following topics:

Article information

  • Posted:Wednesday 09 November 2016

In the closing keynote address at The King’s Fund Annual Conference 2016, Lord Victor Adebowale – Chief Executive of Turning Point and Non-Executive Director at NHS England – reflects on the current context and the challenges of implementing change in the health and social care system.


Do you know, just before there’s any change, there’s that horrible tension and that’s where the health and social care system is. We’ve got all these things running, some are good, some are bad.  What’ll kill the opportunities within the changes is your inability to learn. So we can stand up and spout stuff about leadership: the reality is that if you’re not learning, and if you’re not learning in real time and picking up what works from the point of view of the people who aren’t in this room, i.e. the patients, all this will be for nothing. That’s the first thing.

The second thing is, that moment before we know is the moment of greatest anxiety. And it’s the moment when leadership really counts because out there, people are really scared. They’re really anxious. They’re worried about the realities of getting an appointment with the GP. They’re worried about this miasma of change.

The excitement, the issue around STPs and the plans wasn’t just about the content, it was the notion that, I don’t know what the vision is, but I tell you what if you’re going to close my A&E and it takes me two weeks to get an appointment with a GP, I’m hitting the streets, and I’m middle class, I haven’t don’t this before, but I will. Yeah?

Oh, and by the way, Section 13Q of the Health and Social Care Bill, actually sets a fairly high bar for consultation. You need to have a look at it because its judicial reviews are really expensive.

You have to lead and you have to hold that anxiety, not just on behalf of your staff, but your patients and your patient citizens. I say patient citizens because I never want to be a patient, but I am a citizen. You have to hold that anxiety, that’s what leadership is.

And the third thing I want to say is on, is really about this notion of collaboration. The key to collaboration is understanding that it’s got to start somewhere and you can’t force people to collaborate. You can only invite them and that means it starts with you, the leader. It’s about your behaviours.

McKinsey will tell you 70% of transformation interventions fail. HBR, 80%. You know why? Because the leader fails to change themselves, and if there’s anything that I know about the NHS, is that leadership has a tendency to avoid changing itself. It does it beautifully. It invents lexicons of words, systems, financial structures, anything to avoid changing how you think, how you communicate, with whom you communicate and why.

So, I think we live in a lucky country, still, because we have the NHS. I think that we can transform the way in which health and social care delivers change for millions of people. I think we can do that. In fact, I know we can do it, because my organisation has delivered models that have changed the lives of individuals and communities, I know it can be done.

What I don’t know, and only you know, and only you can answer this question, is whether you’re the change, to coin a phrase, that’s needed? Out there in your services, in your communities, on behalf of your patient citizens.

Thank you very much.


Add your comment