Who will be the next NHS England Chief Executive?

In truth, I struggled to get started with this blog. I’m not sure why as it wasn’t for a lack of ideas about leadership or what qualities the new leader of NHS England should hold. Perhaps it felt like a colossal task to try to articulate in a few hundred words what it is that a leader should embody, and the impact this would have on those they lead. Something that is difficult to express in writing but easier to feel and experience.

In any case, I always take note when I experience resistance to a task as a useful source of data for me to work with and reflect on. Why was it difficult for me to engage in thinking and writing about the qualities and characteristics of this new leader? Perhaps it was because I had already made some assumptions – about the likelihood of somebody with a diverse background being appointed, and whether the recruitment process would encourage this. Only time will tell I suppose.

Perhaps I am being pessimistic, but based on track records in the NHS on senior appointments I do have some curiosities about the process. After all, of more than 20 permanent and interim appointments made at chief officer and national director level to the senior team at NHS England and its predecessor organisation, the NHS Commissioning Board, I am not aware that any have been from an ethnic minority background. This is all the more striking when one in five of the NHS workforce come from ethnic minority communities.

'This isn’t only about having a leader with a diverse set of experiences in place, perhaps even somebody who looks different; it’s also about what they bring to the role and also what this demonstrates to the rest of the NHS and its staff.'

What if the process were truly an open one, with candidates from diverse backgrounds genuinely encouraged to apply (and not just as a footnote relating to a commitment to 'equal opportunities'?). Or somebody who has a diverse heritage? Or somebody who comes from a sector outside the NHS? Or somebody who holds all these identities. And more. What more could be achieved if somebody was brought in who was truly ‘different’ and the impacts and benefits of this explored consciously and openly. This isn’t only about having a leader with a diverse set of experiences in place, perhaps even somebody who looks different; it’s also about what they bring to the role and also what this demonstrates to the rest of the NHS and its staff. When people who hold minority identities can see themselves in their leaders and can aspire for such positions; it allows them to tap into their own authority and leadership as a consequence and contribute to the whole more confidently. Not to mention the advantages we know diverse teams and leaders bring when they are supported well, with growing evidence that more diverse boards and senior teams perform better.

We all lose when institutions don’t embrace truly open recruitment practices. We lose out on possibilities, we lose out on alternative leaders stepping into contested spaces and perhaps bringing different insights, perspectives and skills – much needed especially when the role focuses on ‘doing things differently’…

Regardless of who is selected, there will be many issues they will need to be alive to, not least how to nourish and support an exhausted workforce, how to inspire and connect with leaders at all levels in a fragmented system, how to lead the digital agenda in partnership with those who use the NHS and, perhaps most pressingly for now, how to support recovery in every sense of the word from the damage of an enduring and unpredictable pandemic that we have sadly not yet seen the back of.

'Recruiting a leader from a diverse background won’t in of itself confront issues of discrimination in the NHS, but it is part of tackling the issue and developing an alternative narrative around leadership.'

Having said all of that, I would also be careful about what we project onto our leaders especially in times of uncertainty. This new leader, whoever they may be, will not be able to address all the challenges facing the NHS and we should be wary of being seduced by the idea of a ‘heroic’ leader. Especially with the increasing levels of uncertainty we are living in as a result of the pandemic. Similarly, recruiting a leader from a diverse background won’t in of itself confront issues of discrimination in the NHS, but it is part of tackling the issue and developing an alternative narrative around leadership. The identity of our leaders is important, including what we notice about how they take up their role as a result and importantly what that models. The personal is the political.

My hypothesis is that the system will ultimately replicate itself. Having an unknown person, someone who holds a diverse identity perhaps, from outside the traditional NHS system would represent too much of a threat to the status quo. My heart sinks at the thought of this potential missed opportunity. But I also hope I am wrong and the opportunity is taken to do something different, to be different and to invite difference, in order to have a different impact across the system.