Compassionate and inclusive leadership: creating supportive leadership cultures to deliver on the NHS long-term plan

This is something we have been looking at for some time. Our 2016 report The chief executive’s tale highlighted the loss of talented NHS leaders linked   to the creation of a negative environment. From this the idea of more compassion within NHS leadership arose, as discussed in Compassion – not bullying – is the path to improving NHS care.

These problems were leading to issues filling leadership vacancies, and in 2018 we published Leadership in today's NHS: delivering the impossible, looking at how these problems might be overcome. Around this time Matt Hancock MP announced a series of measures to improve leadership in the NHS, which coincided with publication of the Sir Ron Kerr review into the key challenges faced by executive leaders across the NHS. However, despite this realisation, a lot still needs to be done: The NHS crisis of caring for staff: what do we need to do?

The NHS has committed to a target of achieving 50:50 gender representation on boards by 2020. To achieve this NHS boards in England will need to recruit approximately 500 more women. In 2017, NHS Employers and NHS Improvement identified some early actions to correct this gender imbalance at executive level. 

While gender representation of very senior managers in the NHS is representative of the working-age population as a whole, it isn’t so representative of the NHS workforce, which skews towards being female-dominated. Factoring in the underrepresentation of black, Asian and minority ethnic (BAME) leaders at very senior management levels also   means that there are even more barriers for BAME women.

To this end, NHS Employers has set up a network to support current and future leaders within health and care.

NHS Clinical Commissioners’ report also outlines practical guidance to support the development of future women clinical leaders.

Our 2011 Commission on leadership and management in the NHS argued that the NHS needs to move beyond the outdated model of heroic leadership to recognise the value of leadership that is shared, distributed and adaptive. The risks of not switching towards this shared model of leadership is that the challenges facing the health and care system won’t be adequately and efficiently met. However, moving towards a collective approach is not easy; it requires commitment, strong relationships and sacrifice. 

Read more about collective leadership in our 2014 work:

• Developing collective leadership for health care
• Delivering a collective leadership strategy for health care

The most recent WRES results mentioned were published in May 2019 and can be read in full on NHS England’s website. The NHS long-term plan, published earlier this year, made explicit that: 'respect, equality and diversity will be central to changing the culture and will be at the heart of the workforce implementation plan'.

However, both documents reflect that not enough progress has been made. 

The King's Fund's recent podcast on race equality in the NHS workforce featured Yvonne Coghill, Director at NHS England Workforce Race Equality Standard (WRES), and asked what more can be done to tackle race inequality in the NHS workforce.

The King's Fund is currently working on a project that seeks to support the NHS to develop cultures of diversity and inclusion. And all our work around creating cultures of equality and diversity to date can be found on our website.