Leading the future NHS

There has been a great deal of discussion in recent months about changes within and the future of the NHS. During these debates, high levels of patient care have been lauded as the ultimate aim. However, in order to achieve this during these turbulent times it is imperative that the NHS is led by strong managers who are able to raise their game to unprecedented levels. They are being asked to take on a wider variety of tasks and to achieve more stretching targets with less and less support and resources. In many cases, even their own jobs are under threat. This has big implications for the way that managers approach their role and for the skills they will need going forward. Ensuring they are supported with training delivered at a consistently high level will be imperative if the reforms are to succeed.

Why management is important
The Chartered Management Institute (CMI) has done work with a wide range of employers and individuals in the NHS on the link between good management and leadership and patient outcomes. The results, which are supported by the findings of government sponsored research (Assuring the Quality of NHS Senior Managers research report by PriceWaterhouseCoopers, February 2010) show that improving leadership and management skills, including good employee engagement, leads to better staff performance, which in turn leads to more satisfied patients and better communication.

What’s more, improving leadership and management skills ultimately saves the NHS money as problems and mistakes are avoided and efficiencies gained. For example, the NHS Institute for Innovation and Improvement estimates that its work has potentially saved the NHS £6bn over the last few years. For this reason alone, all NHS managers, whether clinical or non-clinical, should have the opportunity to develop and professionalise their leadership and management skills. By doing so, they will be better equipped to deliver the ambitious reforms and ensure that patients’ needs are met.

A major new report into the state of leadership and management in the NHS, published in May by The King’s Fund’s Commission on NHS Leadership and Management looked at the effect of ‘arbitrary’ cuts to NHS management and supported this view. The report concluded that plans to cut managers and leaders in the health sector will lead to financial failure instead of improved patient care.

What can be done?
Managers and leaders are much more than bureaucrats there to tick boxes; they are essential to drive change, identify opportunities and set a vision of where the NHS is going.

The government says it wants to make ‘the NHS work for patients, not bureaucrats.’ They’re right to have this as an aim, but the fact is that managers and leaders have a vital role to play in nursing the NHS back to health. However, what matters is the quality of managers in post. Only by having managers who meet a professional and consistent set of skills standards up and down the country, will we have leaders who can make a difference.

Encouraging take-up of professional management qualifications in the health service is an important step in this process. Yet research by CMI, which represents 3,000 health sector managers across the UK, shows that just 37 per cent of healthcare managers believe they have had sufficient training. It’s a worry when there are a variety of qualifications already in existence which can be easily applied to the healthcare environment to equip managers with the skills they need and help to justify their position within the health service. Ultimately, every manager and leader ought to have access to the best available learning materials so that the right skills are developed and patient-centred care becomes a reality.

If the planned refocusing of NHS resources is to be successful, it is vital that we have a health service where leadership and management standards are consistent, no matter what part of the country a patient is in or whether the people they come across are clinical or general managers. CMI’s research found that some three-quarters of healthcare managers think they should be judged by an agreed set of professional standards. So there is clearly a thirst for standardisation within the NHS and with King’s Fund report rightly making it clear that the priority for the future NHS is to deliver the best possible patient care, staff will be better engaged in an NHS where all managers are trained and developed to national professional standards. Under plans for a more devolved health service, managers and leaders will enjoy greater autonomy, but with this comes a responsibility to exercise autonomy properly and effectively.

National Leadership Academy

A key step that was announced in June by Andrew Lansley was to establish a new National Leadership Academy for NHS staff.  Under his proposals, the academy will provide the uniform high standard of leadership and management that the NHS needs to survive and succeed at this time of radical change in the health sector.

CMI has already been supporting the development of leadership skills across the NHS through its work with the NHS National Leadership Council – a forerunner of the new Academy. Activities have included running a pilot scheme through which clinical leaders gained accreditation for their newly developed leadership skills.

CMI has long argued that standards of management and leadership in the NHS directly impact on patient outcomes and that these standards need to be improved. Tragedies such as at NHS Mid-Staffordshire, where poor management standards and senior management failings led to hundreds of unnecessary patient deaths, have highlighted that bad management really does cost lives and that urgent action needs to be taken to ensure those working in management positions in the health service have the skills and knowledge to do the job.

The launch of the National Leadership Academy is great news for the future of the NHS as it is an opportunity to address the confusion that comes from too many organisations having responsibility for developing skills.

The creation of the new academy is also a signal that the role managers and leaders play in the NHS is beginning to be valued. 

The future
In the longer term we look forward to seeing the plans for the National Leadership Academy come to fruition and all the benefits it will bring. A more consistent approach to leadership and management development will lead to better organisational and staff performance. Challenges such as managing costs, improving patient feedback, improving the collaborative delivery of patient services across several different organisations and managing complex commissioning teams, all depend on strong management skills.

We also have to ensure that non-medical managers and medical managers work together and respect each other’s profession.

Further reading:

Chartered Management Institute


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