Wisdom, vision and courage are needed to develop people and improve care

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The new national framework for improvement and leadership development in NHS-funded services is a ray of light onto the landscape of the beleaguered NHS. It is inspiring, optimistic and practical in describing the actions that local, regional and national NHS bodies can take to improve local health and care systems in order to meet the needs of their communities.

It also offers potential for strengthening the pride and joy of NHS staff in their experience of work. I should declare an interest, having been privileged to be a member of the team that developed the framework, but I cannot claim credit for it because – like the style of leadership it espouses – it was a collective endeavour.

The framework proposes means by which system leadership can be developed across the country based on a shared vision and goals, trusting relationships and effective collaboration. Reflecting the Fund’s call earlier this year for a national quality improvement strategy, it proposes developing quality improvement skills for all staff so that they have control over improving services, processes and patient experience, thereby enabling a more powerful sense of involvement and vocation.

There is both sense and inspiration in the framework. It proposes that all leaders practise compassionate and inclusive leadership – paying attention to those they lead, understanding the challenges they face, empathising with them and taking effective action to help. The aim is to nurture cultures of compassion rather than cultures of blame and fear. Inclusive leadership means ensuring all voices are heard and that the current discrimination and power imbalances that affect, among others, black and minority ethnic groups are decisively addressed and righted. This is based on a recognition that we have to stop identifying these problems and then merely talking about them year after year. We have to solve them now. And finally, it aims to ensure that within the NHS leadership is sturdy and stable by developing the talent of leaders in a consistent and effective way, and ensuring a ‘pipeline’ of the right numbers of diverse and appropriately developing leaders.

To implement these changes, all leadership teams in NHS bodies will be encouraged to review and refine their people development strategies to ensure alignment with the spirit of the framework. There will be extensive support at local, regional and national level to enable organisations to do so effectively and speedily, given the current challenges facing the service.

Just another initiative? Well, what’s different this time is that the eight main national NHS bodies are all sponsoring the framework’s proposal for action. And commissioners, regulators and inspection bodies are backing the framework too, not just in principle but in relation to their cultures and behaviours. They are pledging to model compassionate and inclusive leadership in all their dealings with the service, and to support local decision-makers by reshaping the way they do their work – by giving organisations and systems the time and space needed to establish continuous improvement cultures. And they are also pledging to use the framework as a guide for any actions related to leadership, improvement and talent management so there is a consistent approach across the service. There is wisdom in this commitment to ensuring a supportive context for achieving the framework’s vision. But it will also require courage.

What is there to be afraid of? There will be inconsistencies between the commitments in the strategic framework and the actions of national bodies. It will require courage to persist with the vision of the framework, and recognition that culture change will take time. Keeping the vision of change bright will be vital when the inevitable inconsistences occur. The national NHS bodies must have the courage to sustain their commitment to the changes embedded in the framework.

The fact that there are no new funds to support this work will require local, regional and national organisations to commit existing spending to development, and to find the means to ensure that the vision is pursued as the only way to ensure the NHS delivers for its communities in the future. Joining up, adapting and utilising the various activities that can support this work will be vital; exemplified in NHS Improvement’s culture and leadership work (supported by The King’s Fund), the work of the Leadership Academy, The Health Foundation’s Q initiative, and the myriad inspirational approaches to compassion, inclusion, talent management and quality improvement adopted by NHS staff and organisations across the country.

And there has to be persistence from all national, regional and local organisations to implement the proposals over the coming years. This will require urgency in the short term to start the process, but also a commitment to sustaining the changes over the next 15 to 20 years. That will require the courage to persist. And it requires the courage of senior leaders to stand firm in the face of inevitable pressure from policy-makers and politicians impatient for action to be seen to be ‘doing something’. The prize is for the whole system – top to bottom and end to end – to embody the same core values in relation to compassion, inclusiveness and quality improvement.

The proposals in the framework are based on extensive consultation with patients and staff across the system, and the document truly reflects their wisdom, vision and compassion. What is needed now is the courage and optimism to sustain all our collective efforts and ensure the framework shapes people development, compassionate care and quality improvement for years to come.


phil strong

M.D Product Human Factors Designer,
Ergo Ike Ltd
Comment date
01 December 2016
Firstly. 15-20 years? How many political footballs is that then?
From my previous experience working in the NHS (30 years+) and supplying the NHS since, this new National Framework will fail miserably IMO.Why ? Because it designed on the same limited thinking and relying heavily on the same staff/employees that allowed us into this present mess.
A 15-20 years introduction period by an ever sliding scale reduction of incompetent staff(who will have a great deal of influence over the incoming new staff by the simple mechanism of seniority.To simply state new model of compassionate leadership is naievity in extremis and to think" just because the eight main national NHS bodies are all sponsoring the framework’s proposal for action. And commissioners, regulators and inspection bodies are backing the framework too, not just in principle but in relation to their cultures and behaviours"is just as equally so.
The eight main national NHS bodies and commissioners, regulators and inspection bodies have all been complicit in and major contributors to the present mess.Papering over cracks comes to mind and the British public are not going to accept this smoke screen anymore.
The NHS (or is that the NIS National Illness Service) has run its course and is not fit for purpose. Rapid prototyping is required and designed to meet the present and rapidly developing population expectations and new requirements. Not same as same as with sticking plaster on.


john kapp

Comment date
02 December 2016
Well done, Michael, this is bang on. This is a manifesto for culture change for a compassionate NHS, which has to happen from bottom up to top. What else is the NHS for? A good place to start is with the 1.4 million NHS staff, whose sickness absence is still over 5% (more than double the private sector) Steve Boorman's report of 2009 having been forgotten. If they can't keep themselves well, God helop us patients. Physician heal thyself.

Jude Ryan

Comment date
07 December 2016
Your blog really resonated with me, I think the time is right to focus on the 'soft skills' and to build on the innate courage, talent and particular the wisdom that people have (including the users of the services) I think we have the knowledge of what to do, it’s now about 'being' and 'doing' that we should focus on. One of the many challenges will be to keep the courage, motivation, commitment and resilience of all involved high enough over the 15 - 20 year time frame, as there will inevitably be political, economic and social turbulence. Understanding what compassionate care and leadership is, is not enough, we need to support and foster new behaviours, we need to learn how to behave, build and sustain compassionate leadership and care, taking it from a state to a trait- Individually and collectively. I believe compassion and leadership starts with self and without this commitment to foster and nurture these qualities I think it's hard to build compassionate organisations, deliver compassionate care and be compassionate leaders.

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