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

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Part of Commission on leadership and management in the NHS

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 The commission believes that the NHS needs to move beyond the outdated model of heroic leadership to recognise the value of leadership that is shared, distributed and adaptive.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.


paul kelly

Comment date
18 May 2011
"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.

A Trueman

Comment date
20 May 2011
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 ?


NHS Manager,
Comment date
20 May 2011
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.

Vlatka Hlupic

Professor of Business and Management,
University of Westminster
Comment date
31 May 2011
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

Jeff Gold

Prof of Org Learning,
Leeds Business School
Comment date
06 June 2011
A special edition of the International Journal of Management Reviews, with a focus on Distributed Leadership, is about to be published.

Maudie McHardy

Lead Nurse Sp in Occupational Health,
Comment date
01 July 2011
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!

Mark Rickenbach

Hon Professor Healthcare and Education Quality,
Winchester University and Park Surgery General Practice
Comment date
04 July 2011
"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

Sharon Hurrell

Practice Development Midwife,
Hampshire Hospitals NHS Trust
Comment date
11 April 2012
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.

Ella Checkley

Comment date
17 July 2012
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.

Barbara Lond

Comment date
09 July 2013
Hi Vlatka, yes please!!

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