As the National Leadership Academy programmes get under way, I was asked to write something for our developing managers and leaders to use as a basis for discussion. Here are a few thoughts…



At a time when the NHS feels unsettled, what are three key messages for those managers starting their Leadership Academy programmes?


The recent reforms created new roles and responsibilities, and uncertainty, while the difficulties of last winter, the profound implications of the Francis report, and the ramifications of the Keogh reviews have created a sense of, well, failure

All this just three years after public satisfaction with the NHS was at a record high, following a decade of extra resource and falling waiting times. What can we, as leaders and managers, learn from this dramatic change in fortunes?


British Social Attitudes Survey, via Kings Fund



I often advise managers to be sure they understand the wider context in which they work. What are the hot topics and trends, and what lies behind them? What are people saying and what are their priorities? What are the common underlying themes behind the headline news items? With this knowledge one has a better sense of place, purpose and direction

As a whole system we arguably failed to do this in recent years, and as a consequence we missed a shift in priorities that was occurring. A decade ago, these were elective waiting times, A&E queues, and cleanliness. We set out, successfully, to improve these by setting targets, instituting performance management, and adopting a pacesetting style of leadership

But we can now see that unintended consequences started to accrue. Front line staff did not feel targets were aligned with patient best interest, and the managerial pressure to achieve them created both disengagement, and a view that only these priorities were important. ‘What gets measured gets done’ so, by default, what is not measured might be overlooked

Now, almost overnight, the NHS world has changed and care quality, compassion, and clinical safety have (not before time) come into sharp focus. Along side this, the way we, the leadership community, operate is also under scrutiny. Are we open, do we listen properly to patients, relatives and staff, how do we treat those who raise concerns, and are we genuinely putting safety and quality of care at the top of our agenda?


Elizabeth Garrett Anderson


Drucker said that leadership is ‘doing the right things’ and management is ‘doing things right’. This is powerful because it tells us what the job of an NHS manager is. We are all, whatever our level, a combination of manager and leader. Knowing the right thing to do is crucial, but it only benefits patients if it is put into practice, which is the management part of our role


The message for us is that ‘doing things right’ must now include adopting a style and approach that is open and authentic, listens to patients, and welcomes staff who raise legitimate concerns about care standards. And ‘doing the right things’ means prioritising safety, improved clinical outcomes, and care that is compassionate, professional and patient-centred


Two key messages, one about leadership approach, and one about priorities. If we do these things, I believe we will engage our staff better, and share the same priorities as the public we serve. My third message is about the very significant service changes we must make


For years we have talked about ‘shifting care from hospital to community’, but it has yet to happen at scale. Achieving this will require huge change – to move from a 65 year old ‘acute’ model of service to one based on the needs of those who have lifelong chronic health conditions, including frailty. The need is urgent – the experience of last winter suggests that under the current model we will soon fail to cope with demand

Implementing change of this magnitude will severely test all leaders and managers, but it is essential if we are to meet our demographic and financial challenges. It will require considerable change management skills, and we will need to up our collaborative game considerably to create over-arching goals that put narrow sectional interests aside and bind us together as leaders of systems rather than individual organisations


We face a new era as leaders. Unprecedented scrutiny, a new set of priorities, a very different culture and way of operating, and the need for whole system transformation are the key headlines on our agenda. No pressure then!