The White Paper: the challenge for NHS leaders

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The scale of the challenge facing NHS leaders in pushing through the major reforms outlined in the recent health White Paper, Equity and Excellence: liberating the NHS, against the backdrop of current financial constraints, is unprecedented.

Trust boards have their work cut out – and have never been in more need of advice and insights from leaders to help them assess and prepare for the direction and speed of the reforms.

In the past few weeks, we've welcomed several leading speakers to the Fund to share their insights with London chairs and non-executive directors as part of our Board Leadership Programme.

David Nicholson, NHS Chief Executive, and Stephen Dorrell MP, former Secretary of State for Health and the new Chair of the Health Select Committee, have been among those who have shared their views with us.

Despite all of our speakers' very different histories in the NHS, there has been a lot of common ground. All agreed on the importance of quality and a system that puts the patient at the centre of its work. There was also a consensus that the pace of change is like nothing ever seen before, and that successful change needs effective leadership.

So what are the main challenges for NHS leaders? Holding on to those staff who will be part of the future and keeping them motivated to stay was a key concern. Leaders also need to nurture opportunities and relationships outside of their current business while managing the 'business as usual'. And they need to be open to input from a wide range of sources, such as support for commissioning from the private sector and looking at solutions that have worked internationally.

There was a clear message that change can only be achieved if the leadership challenges are honestly acknowledged and the change process is properly resourced and managed. It is particularly important to train, develop, educate and support GP consortia if the system is to work.

The rate of change is always contentious in system or organisational reforms. If change is too slow the reforms start to feel like a phony war and good people are more likely to leave. On the other hand, pushing the system too fast risks primary care trusts falling over, commissioning standards declining and threatens the £1billion surplus that the system has built up.

But it can also be argued that there are also risks associated with not changing. The real leadership challenge is to anticipate the risks of change to individual organisations and to create contingency for these.

The reforms will only be achieved if leaders keep the need to manage change at the heart of their agenda. This means attention to detailed planning, stakeholder mapping and management, and a focus on internal as well as external relationships. But above all, as all our speakers were at pains to say, we need to balance the discipline of the shorter-term quality, innovation, productivity and prevention agenda (QIPP) with the creativity of the longer-term system reform.

Find out more about leadership programmes at the Fund


Nigel Roper

GP Trainer / Trustee Colchester MIND,
The Surgery!
Comment date
15 October 2010
Dear All,

We have the opportunity to de-institutionalise the NHS - to go back to using technology to support educational webs and to let policy emerge through participative caring and action learning. I am reminded of Ivan Illich and his ideas for de-schooling teaching.

For example, the care of children can become the central ideal for the delivery of care services. In looking to set up services that support and advocate for children, their level of need will emerge. If it is possible to meet this need with the resource of team then the child is supported at a primary care giving level - if the need exceeds resources then this informs assessment (and the team generate a CAF form) and the child is sign posted to more specialist services.

This is common sense, but it is also the start of a service that is led by need within communities. For too long, I have had the honour to serve my community (an "zone" of high deprivation) - only to find that there is no relationship between the level of need and the availability of resources.

My only request to the King's fund is not to reinvent the need for Public Health in authority or a strategic health in authority - they will only continue to direct services to communities with the loudest and most empowered voices. Please let us commission services on the basis of local need - and please let communities participate in finding ways to identify their needs and to participate in planning to meeting these needs.

as Terry would say if we do this we will have earned our spots.


jon abrams

Comment date
05 August 2010
Gaius Petronius Arbiter (ca. 27–66 AD) was a Roman courtier during the reign of Nero. His comments are as apt today as ever:

"We trained very hard, but it seemed that every time we were beginning to form up into teams we would be reorganised. I was to learn later in life that we tend to meet any new situation by reorganising and a wonderful method it can be for creating the illusion of progress, while producing confusion, inefficiency and demoralisation"

Dr Ian Williams

Williams & Associates
Comment date
05 August 2010
Hopelessly bureaucratic PCTs with unworkable political constraints, lack of clear direction and leadership, a failure to achieve consultant and patient buy in, complacent GPs and far too many amateur and incompetent managers have all contributed to poor patient service and budget overuns. Under the new NHS Plan GPs anxious to limit their new responsibilities will take the easy way out and merely employ a rebranded PCT to meet the provider function. I fail to see where the improvement is going to come from.

Dr Joe Lamb

retired medical professor,
Comment date
05 August 2010
The NHS reforms & the other 'slash & burn' ones are typical of politicians who have never run an organisation, so have no understanding of problems on the ground. These politicians are like children let loose in a toyshop who randomly rearrange everything. Hopefully they might be stopped before total chaos ensues.

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