Sir Stuart Rose’s delayed report into leadership in the NHS is expected soon. The mirror he holds up to the NHS will feel uncomfortable in places. As we gaze into it, it is human nature that we will be drawn to any blemishes but must not lose sight of the finer points of NHS Leadership – the sheer guts, resilience, inspiration and ingenuity we see from home to hospital and board to ward every single day. It’s these points that will see us through but only if we redefine and embrace a new set of relationships between government, national bodies and local leaders.
Back in May, alongside national organisations representing patients, doctors, local government and NHS leaders, the NHS Confederation published the 2015 Challenge Declaration. The declaration, designed to kickstart a proper debate on the NHS, was an evidence based statement of the seven big challenges we face. At the heart of the seven were a triumvirate of defining a new leadership style; delivering an open and engaged culture; and creating a 21st century workforce.
The NHS is made of people – it’s what we spend most of our money on and is why we exist – so these are definitely pre-eminent challenges to address and leadership is where we must begin. In May, we said the leadership challenge was: creating value-based, system leaders across the NHS and empowering them to improve health and wellbeing for local people.
In September, we led 21 national organisations in the biggest ever coalition of royal colleges, national charities and trade associations assembled across health and care. We set out a 2015 Challenge Manifesto to create a burning ambition for the NHS. Alongside this was a promise to make significant changes to the delivery of health and care in return for 15 asks of national bodies and government. These asks included a new deal between local and national organisations to meet the leadership challenge, underpinned by relationships of trust. They also included a recognition that the post 2012 world is not ideal but is preferable to an imposed top down reorganisation of the health and care system.
Recent coverage suggests Rose will focus on the current “hydra-like” management structure and how we fail to fully exploit the talents of the people we have in our system. These are givens and stated in the 2015 documents. They will feel different coming from him. Whatever sector you work in, external reports always have a different feel to those done within “the family”. The NHS family can act like any other – we can say what we like to each other, including the harshest of truths set out in the 2015 Challenge work. What we mustn’t do is respond to external criticism as many families do, by uniting against it.
My prediction is that Rose’s mirror will reflect much of what we have said already and what I see in practice each day. It will also reveal blind spots – of good and bad – which is the benefit of him doing the review.
We know in today’s NHS that we have great people showing effective leadership in tough circumstances and under intense scrutiny. We also know that this is not the case everywhere. Leaders in struggling organisations are often in systems that need support to work through changes that will take time to have an impact. We need a system focus on the issues we face and this needs reflecting in our regulation and performance management arrangements.
At the heart of all of this is a simple truth. When things are tough then you always go to your values and behave accordingly. In healthcare, we make difficult choices every day and must always be guided by our values which should be consciously stated and shape our recruitment, selection and development processes. Perhaps the consensus set out in the 2015 Challenge documents and the consistency with the Five Year Forward View give us hope.
That hope will also need to be fed by reality. Around 31,000 staff are engaged in the programmes of the Leadership Academy. NHS Employers supports values based recruitment at scale. Here at the NHS Confederation, we have just finished a round of regional meetings with our 520 member organisations. I was surprised by how often senior people described a hierarchical performance management approach, including being put under severe pressure to deliver. When this happens, it risks rubbishing the espoused values of the NHS Constitution and undercuts the respect that we need in the system. It needs to change.
I have a new year’s resolution for the NHS. Let’s deliver a new leadership approach between national organisations and the frontline NHS, built on a culture defined by our values and a focus on system leadership. Let’s celebrate the changes we need to make and inspire a new generation of leaders to deliver a burning ambition for a better future. Because the NHS is made of some of the finest people doing the toughest and most rewarding jobs in the country. They deserve our support and our respect.
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