The NHS Leadership Conundrum

As a sector we have been awash with leadership development initiatives, programmes, reports, articles and books and speakers and yet we constantly go on about needing better leadership. Why?

The recent publications from the Kings Fund on leadership in the NHS felt like déjà vu and I admit to laughing at the irreverence of Julian Patterson’s blog on the subject.

Don’t get me wrong, I think it’s great that there are so many opportunities for people to engage in leadership development. I have set up such schemes myself and have had the privilege of taking part in some over the years. Personally, the most satisfying and enjoyable one was when I enrolled on an INSEAD course (the international Business School based in Paris). I was the only public sector person in a room of telecoms, bank, oil, insurance, technology peers. I’m pleased to report that I held my own and even surprised myself at how much I enjoyed role playing a chief executive of an alcoholic drinks distribution company in a joint venture that was going wrong (INSEAD is linked to Harvard and uses their case studies and learning techniques). What I lacked in business language and know how, I made up for in strategic thinking and, well, leadership.

As well as my work in health and social care I am now working with people in justice services, youth employment, community safety and development. It may be that I don’t know these sectors as well but they do not seem as obsessed with leadership.

So here’s a proposal. Before we launch the next leadership programme how about asking ourselves why we need them. Wouldn’t we be better creating an environment where good leaders blossom and evolve anyway? What is it about our sector that seems to inhibit good leadership so that we constantly have to say we need it? If you put good people into a bad situation is it not the case that all but the very strongest of them can be overwhelmed or develop destructive coping strategies? Which comes first, the culture or the leadership? Is it the environment rather than the people that causes the leadership capability gap?

Health creates anxiety. Our daily work is someone’s life, death, disability, illness, injury. This creates an emotional level around all we do. I was struck by a conversation with someone from one of the large consultancies. He was just off to go overseas for a year to work on risk rating for investments in energy sector. He said he had found working in health really tough as his advice (he was one of a team who were helping a health economy with service redesign) could affect people’s lives. Until then, I had not realised how much we have become immune to that enormous responsibility. Here was someone about five layers back from the frontline who found it all too difficult.

Added to this inherent anxiety is the constant scrutiny from media and politicians – be they local or national. The easy headline is the blame one. If you then add the system issues where there are so many competing and conflicting imperatives, then you have a context and environment that too easily defeats even the best.

Just as there is truth in the saying that every design gets the results it deserves, it may also be true that our health system gets the leaders it deserves. Trouble is, changing the system requires great leadership. And therein lies a problem.

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