Congratulations to Amanda Pritchard on her appointment as Chief Executive of NHS England. While her predecessor has successfully led the health service through some of the greatest challenges in its history, she takes over with the NHS in a perilous state – still battling with a global pandemic and delivering its largest ever vaccination programme, with an exhausted workforce, rising waiting lists and increasing health inequalities. Faced with that to-do list, you may wonder why anyone would want to do the job.
Given the mammoth task ahead, how could Amanda approach her new role? What follows is my advice, offered with humility and respect to the size of the leadership task facing Amanda, and informed by our work across The King’s Fund, based on what we hear people in the system saying is wanted and needed right now.
Amanda brings continuity in the sense of her deep knowledge and management experience of the NHS, as well as understanding the current delivery and reform challenges. And indeed, that continuity is welcome as it will mean the system continues to deliver on the important agendas of integration, population health and inequalities set out by her predecessor, which together could really shift how the NHS delivers better health and better care for all. But alongside that continuity, I hope she will bring radical change to how to undertake her role.
So here are my six dos for the new Chief Executive:
Do have a credible workforce plan. Without it, you don’t have a delivery plan for anything. Yes, it’s about the training pipeline, but just as critically it’s about the role of the NHS as an employer; making it both the best place to work and the place where people can bring their best selves to their jobs. Unfortunately, staff survey after staff survey tells us the NHS has a long way to go to tackle workplace bullying and harassment, and improve levels of stress and burnout.
Do realise that letting go rather than holding on at the centre is the way to deliver transformation and improvement. It’s tempting to believe that tight central control is the way to ensure delivery – it’s what the NHS in recent history is used to. But it doesn’t work. Much better to create a clear sense of purpose and clarity on the desired outcomes, then unleash and support local teams to deliver to that purpose, learning from and supporting others across the country.
Do recognise that although you are now the leader of the biggest cog in the health and care system, even the biggest cog relies on smaller – and the smallest – cogs to work. So, ensure you and your colleagues partner well with other players in the system – be that local government, the voluntary sector, public health teams, social care providers, patients and communities, and commercial partners. As the past 18 months has shown, these partnerships are crucial to the work of the NHS.
Do be realistic about the pace of recovery and transformation. There will be enormous pressure on you to perform a miracle with waiting lists. The staff in the NHS are amazing, but they are now exhausted, and the miracle cupboard is looking bare. Recovery will take time, perseverance and patience. It will take honesty with government and the public about what they can expect to see and how quickly. Welcoming, listening and acting on what you hear from the system, will help you speak truth to those in power around and above you.
Do recognise that the culture in some parts of NHS England currently does not align well with the future vision for collaboration and locally led change– and act to change it. An organisational restructure in the system requires a cultural change in the national body too. And let us be frank, parts of NHS England are seen to have a toxic culture, both by the people who work there and by those who work with it. Unless significant focus is giving to helping those in NHS England to be confident in the new behaviours the system will need to model, the vision for the new NHS will fail.
Do listen to the people and communities you are serving, work with them, and act on what you hear. This is essential to ensuring the NHS does its job well. This especially means reaching into communities the NHS has not always traditionally listened to. Without a change in the relationship between the institution of the NHS and the communities it is here to support, heath inequalities will continue in our society.
And finally, the key to achieving these priorities will be collective and compassionate leadership, utilising the skills, commitment and energy from all staff as a whole rather than relying on heroic leadership. The new Chief Executive can help transform the culture of the service through her own practice of collective leadership – with a system full of people who stand ready to help, support and lead in the months and years ahead.
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