There is no sustainable ideology – so leaders find their staff disengaged and that their job is impossible..

The Guardian has an “anonymous” opinion. I guess those close to the decision making action will know who it is. “The NHS sets leaders up to fail – and then recruits more in the same mould” on 27th March 2017.

NHSreality maintains that there is no sustainable ideology – so leaders find their staff disengaged and that their job is impossible. There are no exit interviews of high turnover Trust Directors, and no feedback to Politicians – probably because they know they don’t want to hear it. Anonymous is one of the many disillusioned …. and a 1p hypothecated tax will change nothing. Lincolnshire will get nowhere with it’s request for suggestions because rationing overtly is excluded… Politicians with only one eye on health (the other in Brexit) will continue to be conned ….

It’s my job to support and develop senior NHS managers. And I’m deeply worried that we’re setting them up to fail – then recruiting more in the same mould.

I’m a former primary care trust director

Most of these leaders were hired to lead foundation trusts at a time when NHS providers were being encouraged to compete with other trusts for business; to invest in new services; to develop their own organisations at the expense of other providers. To make use of the freedoms granted to foundation trusts – including the ability to borrow money at commercial rates – they hired leaders with commercial, transactional and financial skills: hard-edged, competitive businesspeople who could expand their market share.

But then the environment changed. Trusts were – quite rightly – put under greater pressure to improve service quality and patient safety. And demand rose much more quickly than budgets, so the tariffs paid for trust services were cut year after year. Soon, many new services were struggling to repay the investments made in them. In a world of shrinking revenues, those skills in business growth suddenly looked out of place.

Meanwhile, health system leaders began pushing a new agenda – one built around collaboration between organisations, professionals and sectors. To protect healthcare nowadays we need people to work together, rather than to compete: the emphasis is on building services around the patients’ needs, rather than the providers’. The Sustainability and Transformation Plans and the Five Year Forward View create a need for leaders who have emotional intelligence; who are approachable and listen to their staff; who put the public’s needs above those of their trust; who can share power and responsibilities with other organisations. And in that context, the skills and approach of many NHS leaders look hopelessly outdated.

Too often, leaders are remote and isolated. Poor links between ward and board mean that board members often remain unaware of emerging problems. To deliver great care, you need your staff behind you – but we’ve spent years recruiting empire-building business leaders who have no feel for the kind of hands-on, visible leadership required.

; I now work as an executive coach, helping NHS executives to improve their skills. Many of my clients lead trusts whose leadership has been deemed “inadequate” or “requires improvement” by the Care Quality Commission – but few of them are genuinely bad leaders. The problem is that they were hired to do one job, and the requirement is now for something quite different. Yet they’re not being helped to change their approach, and when their trusts run into trouble they are being replaced with people likely to encounter exactly the same set of problems.

We end up with chief executives who find themselves receiving a lot of criticism, and being pushed out – creating huge damage to their careers and reputations. But it’s the system that’s let them down, not them letting down the system. Nobody’s given them the right advice or development or challenge, and the characteristics once seen as assets have become liabilities.

Unfortunately, trusts’ recruitment practices haven’t changed to reflect the need for a new kind of leader – so when these more commercial, transactional managers fail, trusts are too often replacing them with new figures cut from the same cloth. Many trust chairs are still stuck in an empire-building mindset; job descriptions focus on financial and operational experience; and recruiters are often cynical about the softer skills required for staff engagement and partnership working. So the trusts select new managers well-suited to facing the challenges of five years ago, and organisations head off towards a fresh set of failures.

What’s to be done? For a start, trusts need to refresh their recruitment practices – taking their cue from NHS Improvement’s new leadership framework, and shifting away from a narrow focus on technical competences towards a values-based approach. The solution is not simply to swap our existing leaders for a new set. The NHS cannot afford to lose a swath of senior managers. Many of these people could develop the skills we need, we just need to help them to do so. After all, we require doctors and nurses to refresh their skills regularly, revalidating their qualifications; and these days, the disciplines of management and leadership are changing just as fast as medical practice.

It’s hard for senior leaders and managers to reflect, train and change their approach. Most already work 60 hours a week, and seeking new skills is too often seen as a confession of weakness or incompetence. But this is a nettle we must grasp. For many of our senior leaders are ill-suited to the task in hand. If we are to serve the interests of NHS organisations, staff, leaders themselves and, above all, patients, we must reshape our leadership cadre – equipping it to understand and address the vast new financial and organisational challenges facing the NHS.

NHS faces ‘mission impossible’ to meet performance targets and budget savings, new analysis from health think-tank NHS Providers finds

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This entry was posted in A Personal View, Stories in the Media, Trust Board Directors on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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