The NHS needs leadership of the highest calibre if it is to respond successfully to financial and service pressures that are unprecedented in its history. We need to move on from a concept of heroic leaders who turn around organisational performance to seeing leadership as shared and distributed throughout the NHS. Leaders must engage their colleagues in bringing about improvements in patient care, and transforming the way in which care is provided.
Turning these ideas into practice is a challenge in an organisation where many leaders have adopted a pacesetting style in which they have set demanding goals and led from the front in delivering them. The dominance of pacesetting is not surprising when successive governments have used targets and performance management to drive improvements in patient care across the NHS. But it is unlikely to be sufficient to enagage or motivate staff to play their part in making the changes now needed to use constrained budgets as effectively as possible.
Future leaders need to follow the example of successful NHS organisations like Salford Royal foundation trust which is widely recognised for its work in improving patient safety and quality. This has been achieved through high levels of staff engagement as assessed in the annual staff survey and devolution of decision making throughout the organisation. Doctors, nurses, managers and other staff are empowered to improve care without having to seek permission to do so and members of the trust's executive team work as much as coaches and mentors as senior leaders in the organisation.
One of the characteristics of Salford Royal and other high-performing NHS organisations is continuity among senior leaders. Unfortunately, this is often the exception rather than the rule in a system where chief executives and other senior managers turn over much too rapidly to have any chance of making a tangible difference. There is an urgent need to allow leaders the time to improve performance in organisations that frequently have a long history of financial and service challenges.
Greater coninuity of leadership may also help increase the attractions of senior leadership roles in the NHS at a time when too many of these roles are filled on an interim basis. The insecurity associated with chief executive and other senior positions serves as a deterrent to talented managers making their careers within the NHS. A more systematic approach to talent management and career planning is also required to give greater confidence that a future generation of leaders is emerging.
For their part, regulators should pay much more attention to the quality of leadership in the NHS. This means providing support to leaders in organisations that are particularly challenged rather than automatically replacing leadership teams when the going gets tough. The work the CQC has initiated to assess leadership and culture in its inspections is a step in the right direction.
Encouraging clinicians to go into leadership roles should also receive more attention in view of the well-established relationship between high levels of medical engagement and organisational performance. Renewed efforts are required to support doctors to become leaders and ensure that they work in partnership with experienced managers and others to improve patient care.
Last but not least, NHS leaders need to reflect more accurately the diversity of the communities they serve. Put simply, this means actively recruiting more women and people from BME backgrounds into leadership roles. It also means developing patients as leaders able to work alongside those in formal leadership positions to ensure that the voice of users is heard and acted on.
As the general election approaches, leadership and management within the NHS will come under scrutiny with politicians competing to criticise unnecessary bureaucracy. Our research has shown that the NHS may be over administered but there is no evidence it is over-managed.
If politicians want to cut spending on administration, they first need to reduce the reporting and regulatory burden imposed by successive governments on the NHS.
We shall be debating these issues at the fourth annual leadership summit at The King's Fund on 21 May where we will publish two new reports on how the NHS can take the initiative to develop the leadership needed in the future.
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