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The future of leadership and management in the NHS

No more heroes

At a time of enormous change in the NHS, leaders and managers have a crucial role to play. But what sort of leaders does the service need? Does the model, prevalent in public service over recent years, of the 'hero' chief executive still hold sway?

The King's Fund set up a commission on leadership and management in the NHS with a brief to:

  • take a view on the current state of management and leadership in the NHS

  • establish the nature of management and leadership that will be required to meet the quality and financial challenges now facing the health care system

  • recommend what needs to be done to strengthen and develop management and leadership in the NHS.

The commission invited submissions from individuals and organisations with an interest in management and leadership and commissioned papers from experts. The future of leadership and management in the NHS: No more heroes reflects the conclusions of the commission's work.

The conclusions challenge some of the negative attitudes towards managers, and questions current plans for major reductions in management and administration costs. The commission believes that the NHS needs to move beyond the outdated model of heroic leadership to recognise the value of leadership that is shared, distributed and adaptive. In the new model, leaders must focus on systems of care and not just institutions and on engaging staff in delivering results.

There is a clear message that the NHS will be able to rise to the financial and quality challenges it is faced with only if the contribution of managers is recognised and valued. It is also essential that the number of managers in the NHS, and expenditure on management, is based on a thorough assessment of the needs of the health service in the future rather than arbitrary targets and is supported by continuing investment in leadership development at all levels. In taking this approach, the commission emphasises the contribution of both general managers and clinical managers to leadership, the fact that leaders exist at all levels – from the board to the ward – and the increasing importance of leadership across systems of care as well as in individual organisations.

Find out more

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  • Listening to NHS managers

    What do managers in the NHS think of the current situation? Do their roles and responsibilities reflect the leadership needs of the NHS? We spoke to some managers to find out more.

  • Managers and the NHS

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