At a time when NHS leaders are under a great deal of pressure, the health secretary’s announcement of a review into leadership detracts from the job at hand
"In the NHS, leaders must meet targets set by politicians – and the expectation is that this will include reducing waiting list times, even though they are dealing with a growing and chronic problem of staff shortages in the immediate aftermath of a pandemic." Greg Allen, FCC CEO
Sajid Javid has recently announced a review into NHS leadership. This is the latest in a long line of leadership reviews of the NHS, the biggest being the Griffiths review of 1983.
What is the real point of this review and the timing of it? Will it actually lead to a more fit for purpose health and care system that results in improved experience for those in receipt of care?
Leaders in the NHS face a particular set of challenges – many of which were highlighted during the pandemic. These include often having to navigate complex layers of command and control whilst delivering under difficult circumstances and with very real resourcing pressures and issues. Generally, we would expect leaders to knowingly take on the responsibilities and accountabilities of their roles. In the NHS, leaders must meet targets set by politicians – and the expectation is that this will include reducing waiting list times, even though they are dealing with a growing and chronic problem of staff shortages in the immediate aftermath of a pandemic.
Whilst the NHS budget is significant, the current challenges facing the system have placed additional pressure on money and resources – and this has a direct impact on whether leaders are set up to succeed or fail in the first place. Added to that, regular historic reorganisations driven by government, an ageing population which is increasing pressure on the service and the ongoing debate about the degree to which health and social care should be integrated, have created exceptional circumstances for leaders.
What do patients think of all this talk? Will yet another leadership review make any difference to them, in terms of the care they will receive?
There are many fabulous leaders within and across the NHS. Not all of these are developed “organically”. For example, it can be of value to bring in external leaders to the NHS, with fresh ideas and experience of other sectors. I was fortunate to have had the opportunity to join the NHS from the private sector in the early 2000s (via such a programme called “Gateway to Leadership’) and I have seen how peers from that programme have achieved and delivered things that have made a real and positive difference to the care that people receive.
One of the flagship internal NHS leadership programmes is the NHS Graduate Management Training Scheme (MTS), which has had a successful history of developing leaders within the NHS. I know that some leaders who join from outside don’t always find it straightforward to embed themselves successfully in their roles, without having had that early “part of the NHS family” experience that might be what participants get from the MTS. So, to what extent will this leadership review conclude that new perspectives from outside the NHS will continue to be valuable? Equally, how will this review help to change the reality for some established and very capable “organically developed” NHS leaders who might be moved to manage a failing NHS trust, and then find themselves set up to fail? This sometimes leads to brilliant long serving achievers then leaving the NHS or having their NHS careers derailed only to find someone else being brought in to lead in the same impossible context, with the pattern repeating itself.
While it’s important to make sure that the people running the NHS have excellent leadership skills and the right values, it’s just as important to make sure that they are properly supported with resources. They need to be able to recruit enough of the right skills, retain staff, invest in equipment and implement up-to-date IT systems.
Alongside the leadership reviews over the years, in the past decade we have seen multiple NHS reorganisations, all of which have consumed time and energy as staff and managers adapt to new ways of working. This has led to some real benefits as well as some extremely unnecessary distractions from the important job at hand – improving care and its experience for patients.
The NHS has just emerged from a pandemic and this is not the time to be implying that there is something fundamentally wrong with NHS leadership through a major review. The focus now should be on supporting NHS leaders to do their job to the best of their ability during these incredibly challenging times.