The future of leadership and management in the NHS

No more heroes
Comments: 18
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 The commission believes that the NHS needs to move beyond the outdated model of heroic leadership to recognise the value of leadership that is shared, distributed and adaptive.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.

The future of leadership and management in the NHS: No more heroes report cover

Print copy: £8.50 | Buy

No. of pages: 38

ISBN: 978 1 85717 620 9

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#720 paul kelly

"Shared" and "distributed" leadership could become oxymorons if taken too far. Ability to adapt (responsiveness to change) important but depends on factors other than leadership.

#721 A Trueman

Managers concentrate on figures, and not people, i work within the NHS and we are extremley short staffed , i work far over my hours for no pay or unable to get time owing, as a team we expressed our concerns to managers, we were told not to be so "negative" and our "opinions did not count" if your managers wont support us who will ?

#722 L
NHS Manager

I don't think anyone should ever say 'your opinions don't count' whether a manager or not, but I do think that the issue of financial management is key to clinical service delivery, e.g. being short staffed can't be rectified without consideration of funding. We've somehow got to work together and not against eachother if we are to keep services alive and effective with a challenge of this magnitude facing us in the NHS, that means valuing and utilising the range of skills/professions in our organisation to best effect.

#723 Vlatka Hlupic
Professor of Business and Management
University of Westminster

Very timely and interesting report. The idea of distributed leadership is not new, but only recently more efforts have been made by various organisations to implement this in practice with various benefits. My research is focused on practical implementation of these ideas and I would be happy to share this work with anyone interested.

Professor Vlatka Hlupic, University of Westminster

#724 Jeff Gold
Prof of Org Learning
Leeds Business School

A special edition of the International Journal of Management Reviews, with a focus on Distributed Leadership, is about to be published.

#725 Maudie McHardy
Lead Nurse Sp in Occupational Health

Many of the staff we are referred have issues with not liking change which affects their health and ultimately if become unfit for work, then affects Trust finances.
However, the view of mine and colleagues in the same field is that many dedicated staff are being pushed to breaking point and that includes managers. Good leadership I feel is crucial when managing any change and managing staff and we are going through major changes but they are required to sort out the mess the NHS is in in my opinion!

#726 Mark Rickenbach
Hon Professor Healthcare and Education Quality
Winchester University and Park Surgery General Practice

"Targets and terror" have produced change but have lead to perverse incentives and demotivation. A focus on leadership that is "shared distributive and adaptive" across all parts of the care pathway, has a close duality between clinical leads and management leads, and has professional freedom to focus on local outcomes, is the way forward

#1041 Sharon Hurrell
Practice Development Midwife
Hampshire Hospitals NHS Trust

It has long been my personal belief that leadership begins at the point of qualification, and agree this is demonstrated not only within the boardroom but also ward environments by staff at all levels. Staff are required to delegate, lead by example, provide mentorship to trainees/students, maintain a high level of patient care regardless of staff numbers and resources (equipment); and demonstrate professionalism at all times. Aside from the provision of patient care, for some there are also meetings to attend, ordering of stock, budgets, problem solving, daily checklists, deadlines for reports, appraisals, provision of support to colleagues, and somehow fitting in time to eat during the working day. The key to effective leadership is not only by ensuring staff are fit for purpose, enabled to be flexible, motivated and dedicated, but by demonstrating these same abilities themselves. I would be interested in hearing more on the practical implementation of ideas as mentioned above, and the upcoming publication of Distributed Leadership.

#1042 Ella Checkley

Isn't distributive leadership a bit of a cop out? How do anxious staff in anxious times deal with their fears without a heirarchy or at least someone they can blame? Isn't there a risk they can blame each other and those they care for?
Denial of these dark times is only another form of defence after all.

#40627 Barbara Lond

Hi Vlatka, yes please!!

#40766 Paquita de Zulueta
GP, CBT therapist, coach, clinical ethics teacher,
Imperial College, Human Values in Healthcare Forum, London Shared Services

Dear Professor Hlupic - I would be interested in your work.
Professor Rickenbach - absolutely agree.
Can we please take account of the science of compassion and motivation in all this (see work by

Dear Professor Hlupic - I would be interested in seeing your work
Dear Professor Rickenbach - absolutely agree and with other comments on this site re stressed, under-resourced staff. Can we please be mindful of the extensive research on science of compassion and motivation?
(e.g. work by Paul Gilbert and Edward Deci) ? You simply cannot expect motivated, compassionate and effective local leaders and staff if the environment militates against this. Command & control management, overload, excessive bureaucratisation and industrialisation of healthcare, low trust, high levels of fear, excess focus on the biomedical vs whole person, the transactional vs relational etc All of these are very much alive and well in many NHS institutions and combine to form "toxic" cultures.

#41203 emily
physiotherapy student

Dear Professor Hlupic,

I would be very much interested in viewing your work



#41792 Helen Jervis

I agree that the key to effective leadership is by ensuring staff are well trained and able to do the job, they need be motivated and dedicated to the job they have taken and leaders must show this as well. Leaders must lead by example. It is hard to stay motivated when there are staff shortages and no signs of improvement. If we cope short staffed then it is seen that we cope and then there is no need for more staff!
In my experience those that govern patient to staff ratio only look at the numbers, not the type of nursing required on a particular ward/unit. As much as you have an opinion, it doesn't seem to count until problems arise... to late was the cry. Look at The Francis Report. On a more positive note, there are some great leaders and managers out there who I am sure have the same frustrations.
Leaders must to be on the 'same team' as the rest of the staff, sharing the same goals for patient outcomes not just meeting targets. I have seen this in action and it was a pleasure to work with such a team.

#41828 Nic Slater
community nurse

Dear professor Hlupic, i would be interested also in viewing your work

#42015 Laura Green
Student Nurse

I am only speaking from personal experience which is limited as i am a student, but my first impression of leadership and management was confusing as the role of a manager seemed more focussed on funding and staffing levels than on patient care. However on another placement area the manager seemed focused on improving staffing levels as the current ones were always low, this resulted in staff being highly stressed, tired and feeling incapable of achieveing good patient care. The difference that seemed evident to me between the placements ad the anagement type was that the second manager seemed more involved within the ward and witnessed the struggles of the ward when the staffing levels were low. The involvement of mangement I witnessed seemed to motivate the manager to advocate for patients and also for a tired, stressed staff team. The managers actions to try and improve patient care and staff moral seemed to be effective as the manager seemed to listen and act on the concerns of the staff.

#56512 Cristal

I have the same experience as A Trueman. If staff say anything they are fobbed off. Whenever they change a procedure, things get worse. I worked in the private sector for a long time and in comparrison the NHS management is extremely incompetent. Business was govered by profits in the private sector but in the NHS it's manager's ego that governs business. The private sector made sure their staff were happy because that meant more profits for them but managers in the NHS still get paid the same whether patients and staff are happy or not.

#280704 diane wilson
St.helens and Knowsley NHS Trust

leadership I believe is affected by the relationship between non clinical and frontline clinical workers as health professionals are all subjust to accountability whilst non clinical leaders are still not accountable, the survey results confirm this from staff views on culture.

#549108 Barbara

Would welcome valka research paper

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