NHS leaders of the future: more Thatcher or Nyborg?

Aficionados of Danish political drama Borgen, like me, will have to contain their excitement as they wait for the third and final series to be broadcast on British TV. In the meantime, I have been reflecting on the lessons the series holds for NHS leaders.

‘The financial and service pressures facing the NHS cry out for much greater collaboration and partnership’

The central character, Birgitte Nyborg, is prime minister of a coalition government faced with the challenge of negotiating with her partners at every turn. She makes things happen less through ideology than idealism and by being willing to compromise when necessary. Her skill lies in building alliances with others and finding a common cause, even when this seems unlikely.

From a British perspective, the temptation to contrast Birgitte Nyborg with Margaret Thatcher is hard to resist. The Iron Lady was a conviction politician who brooked little dissent.

In the now famous phrase, the lady was not for turning, and she was willing to pursue her convictions even in the face of opposition and outright conflict. These strengths ultimately became weaknesses, as when her cabinet turned against her and she was forced out of office in 1990.

Culture from the top

What relevance does this comparison have to the NHS? For a decade or more, top leaders in the NHS have been closer in style to Lady Thatcher than to Nyborg, making things happen as agents of the government of the day by overseeing the implementation of targets designed to improve patient care.

In the process they have adopted a “pace setting” style consistent with the performance management culture that has characterised the fact that the NHS has been led from the top.

‘Rising to the challenge will mean influencing peers and partners in the whole system of care’

The shortcomings of pace setting and performance management have come back into focus in the wake of the Francis report. This has happened at a time when the financial and service pressures facing the NHS and local government cry out for much greater collaboration and partnership working to address the challenges that lie ahead.

As I argued in a previous article on whole-system working, now more than ever public sector agencies must rise above their own concerns and reach out to others to meet the needs of the populations they serve.

More than pace setting

It follows that in future NHS leaders need to be much more like Birgitte Nyborg than Margaret Thatcher. Their challenge will be to bring about improvements to care in an environment in which working with other organisations will be increasingly important.

‘We may well open with highlights from the first two series, portraying Nyborg as a role model for NHS leaders’

Rising to this challenge will mean influencing peers and partners in the whole system of care. Pace setting alone is likely to be counterproductive in this context and a premium will be placed on pragmatic leaders who can create alliances to make a difference.

The King’s Fund will be playing its part in supporting leaders through this transition in a new programme on collaborative leadership aimed at chief executives and their senior colleagues.

The programme forms a core part of our work on integrated care in which we are moving beyond making the case for integration to offering support in making it happen at scale and pace.

For those of us suffering Borgen withdrawal, the programme may well open with highlights from the first two series, portraying Nyborg as one of the role models NHS leaders may be able to learn from.