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The future of NHS leadership

Alex Heritage, deputy chief executive at the NHS Transformation Unit, argues we must face up to some essential self-reflection if we are to foster a culture that encourages newcomers into the healthcare sector.

I do not recall the NHS manager visiting careers week at my school, and if that happened, I was so set on joining the British Army or becoming a professional rugby player that I probably would not have listened anyway. As I enter my 10^th year as an NHS manager, perhaps I should have listened more! 

After a career-ending knee injury, I was thankful that I had enrolled at university and had the opportunity to focus on a different career path. I was fortunate to start a graduate role in a local authority following a successful work placement and started a truly energising and varied career in the public sector. 

I spent the first few years as a community health practitioner focused mainly on young people and young offenders, seeking to engage them in positive lifestyles and routes to education, training or employment. This taught me firsthand the positive impact good public services can play on individuals and communities, and many of these experiences still shape how I lead today. 

Moving from local government to the NHS was a natural transition because I wanted to support greater joined-up working between different parts of the public sector. It was here that I then encountered a strongly-held view that there were too many NHS managers, and “if only we could reduce them, all our problems would be solved”. This seemed to be turbo-charged as Andrew Lansley toured broadcasting studios selling his self-styled and highly controversial reforms in 2012. 

Paying equal attention to roles 

As one of the world’s largest employers and responsible annually for more than £100bn of taxpayers’ money, it would seem necessary for the NHS to be well managed and led. Around 4% of NHS spend equates to management, compared with industry averages of 10%. While I am not advocating for more money to be spent on NHS managers, my experience is that clinical and management partnerships can significantly enhance the care provided for our patients. Therefore, we should pay equal attention to attracting and retaining excellent individuals for both clinical and management roles. 

When pressed, I often point out that I went to management school while my colleagues went to medical school. We have different skills and experiences and when nurtured and supported, these are complimentary and play to each other’s strengths. Put simply, why would I want a highly trained and skilled nurse or doctor spending their time on necessary management activities? There are excellent clinicians that manage and lead wards, practices and systems and the recent focus on developing more clinical leaders should be celebrated. 

© sturti

Attracting newcomers 

However, the very real situation that the NHS and wider public services are facing now and in the future should demand the very best individuals from a variety of backgrounds are attracted to work in our sector. Once recruited, greater time and energy should be focused on creating a vision and culture that focuses on developing their abilities and skills. At the moment, the reality is that we will probably not attract those with the highest potential and indeed struggle to retain ‘Rising Stars’ within the service over the long term.  

Therefore, it is imperative that our current leaders start to focus more on this part of our future workforce. In order to respond to this situation, I have recently challenged myself to answer the following questions: 

• Is our vision clear and inspiring? Do all of our people relate and catch on to our vision for the future? Does it excite them to come and work and stay with us?
• Does our culture support our vision? Have we created a culture that is built upon our shared values and supports all people to work towards the vision?
• How are people being supported and developing? What is the evidence that every person is being care for and supported beyond a simple appraisal that builds upon their strengths to ensure they develop? 

Whilst not exhaustive, an honest assessment of these questions provided a good barometer of where we are as an organisation in attracting and retaining these people. If we are serious, we should seek to understand how these individuals are attracted, motivated and encouraged to enter a career in the NHS that will challenge them and which they will find rewarding. I am personally committed to this approach, as I have seen for myself how we can change the perception of NHS managers and attract and retain great people for the long-term future of the NHS. 

If we are unable to share this vision and create the culture to capture the imagination of our school and university leavers, we may actually experience the reality of how confusing and poor care actually feels when we ourselves need it most.

Top Image: © Jirsak