Leading in the NHS

In difficult times, people need leadership as well as management. This is true in the NHS today, and in the foreseeable future. It is true, too, in many other organizations in Britain and elsewhere. Yet ‘leadership’ is a word that many in the NHS are still chary of using. Even ‘management’ may still be viewed with scepticism and the traditional term, ‘administration’ used instead, especially by doctors referring to non-medical managers. Each word has a different, though often ambiguous, meaning and each is necessary in the NHS today. Before we can focus on leadership, we must first understand how these terms differ.

In most jobs leading staff is a key aspect of your leadership. You can help to set the standards and values for their work. You can enable them to give of their best. You can grow future leaders.

The ideal to be aimed at in the leadership of, and by, nurses, midwives and health visitors must take account of the ways in which nursing (for convenience ‘nursing’ is used from now on to include midwives and health visitors) differs from other occupations in the NHS or in private health care. It must also take account of what should be supported and maintained and what it is desirable to try to change. Above all it must take account of the major changes that are affecting nursing and nurses

The quotation is still true today and will remain so because it highlights a key leadership task. This is to enlist doctors’ cooperation in the provision of effective and efficient health care. It is a task that must not be avoided by those who should be seeking to influence doctors.

The chair is the official leader of the board, but this leadership may, and usually will, be shared with the chief executive as discussed in Chapter 5. Chairs are constrained in their leadership of the board by: the time that they give to the job, their understanding of the issues, the attitudes of the members to their leadership, and the role played by the chief executive. All of these they can seek to change, but it remains a difficult role to play.

Regions in some form are likely to continue to exist in the NHS whatever further reorganizations may take place. The tasks of monitoring what is happening and of taking remedial, or, even better, preventive, action cannot be done efficiently at the head office of a very large organization. This is especially true where the aim is to have common policies applied throughout the organization The centre of the NHS is also too far away to know what is happening in the field, which is often essential information for making realistic implementable policies. So the question of regional leadership will always arise, though some may argue that with maximum devolution to the field there is no need for it.

Many staff in the NHS have to work with people outside the NHS, other than patients. This requires two different forms of leadership. The first is to take the lead with NHS staff in setting and observing appropriate attitudes to the local community. The second is to lead in these external relationships. The latter can often be more difficult than leading staff because you will have less power to influence what is done.

I had a very atypical career. I did not do any of the ‘right things’ that people traditionally do to get on in the NHS. I joined from school when I was 17 and started training as a laboratory technician because that would enable me to study further. I worked for three years but then hurt my back and was off for 14 months. It was suggested that I should leave the service, but I was determined that nobody would write me off. My parents were not in a position to give me financial help and did not know anybody who could give me advice

These are two linked case studies of Heather-Jane Sears. The first is when she was Hospital Manager at Didcot Hospital. She was 29 at the time of that interview, July 1988. The second is of her views in a job six years later, where she is Executive Director — Nursing at King’s Healthcare NHS Trust, a major teaching hospital in London.

The aims of this case study are to illustrate two key aspects of leadership and many of the subjects discussed earlier. It is retained in a shortened form in this new edition because, despite the changes in the NHS, it still illustrates many aspects of leadership, and the research on which it is based enabled a much fuller picture to be given of how the individual leads, than is possible in the single interviews on which the other case studies are based.

Two essential aspects of being an effective leader are first, understanding and managing yourself and second, understanding and managing your job. This chapter draws on what others have learnt to help you to do both better.

Nowadays leaders need to develop themselves, both as leaders and as managers, if they are to cope successfully with the changes affecting them. The aim of this chapter is to help you to think what this means, and how you can best develop yourself — it is not about professional updating.

The NHS needs leaders who can enthuse others with high goals for what they can achieve.