Compassionate leadership is not optional

Sir Ron Kerr’s assessment of NHS leadership is hard hitting. In his review of the challenges faced by executive leaders, published on Wednesday, he concludes that NHS bosses operate in a culture where “bullying and discrimination are prevalent and accepted.”

The impact of that culture is clear. Research by The King’s Fund and NHS Providers found that more than a third of trusts have at least one vacant executive director role, with director of operations, finance and strategy roles having particularly high turnover.

It also found that the highest vacancy rates and shortest leadership tenures are found in trusts with the biggest performance challenges.

On the same day as The Kerr Review was published, Matt Hancock was on hand with a set of measures to create “the right leadership culture” in the NHS.

Speaking at The King’s Fund Annual Conference, he focused on training, tech leadership and diversity and emphasised the need to train more managers and to recruit talent from outside the NHS. He namechecked several initiatives including a clinical fast track programme and an expansion of the graduate management training scheme.

Ambition to reality

The secretary of state is right to emphasise the importance of leadership and culture, but the challenge is to translate this ambition into reality. Many of the actions he announced have been tried before.

Expanding the graduate management training scheme was recommended by Sir Stuart Rose in his 2015 leadership review, which also recommended the NHS Leadership Academy move from NHS England into Health Education England. As long ago as 2004, the Gateway to Leadership programme aimed to attract talent from outside the NHS.

When will we equate “strong leadership” – a term I hear so often – with compassionate leadership?

A greater focus on training leaders is welcome but training alone isn’t the answer. The health and care system is made up of thousands of formal and informal leaders, especially clinicians, who are influencing culture through their daily practice. They need support to develop throughout their careers, and not only as individuals but importantly as part of a team.

Recruiting talent from outside the NHS will enhance diversity and bring a wider range of experience into the service, but again, recruitment is only part of the answer. If we really want greater diversity of thought in the NHS, leaders need to practice inclusive leadership, every day, at every level of the system.

The secretary of state spoke of “getting rid of command and control”. This style of leadership continues to be rewarded and applauded, resulting in the negative behaviours and top down bullying culture highlighted in the Kerr report. When will we equate “strong leadership” – a term I hear so often – with compassionate leadership? This involves distributing leadership power to wherever expertise, capability and motivation sit within organisations.

In 2013, Don Berwick called for ”a culture of continual learning that helps everyone to grow”. This approach underpinned the development of the first national strategic framework for developing improvement and leadership capability in England.

Developing People, Improving Care which was published only two years ago. Thirteen national organisations, including NHS England, NHS Improvement, and the Department of Health, made commitments to demonstrate the compassionate leadership called for by the framework.

Yet, the people I speak to in the service say little has changed. NHS England’s 2017 staff survey found that more than fifth of staff had been bullied, harassed or abused over the previous 12 months, more often than not by managers. This underlines that change needs to start from the top with the national bodies, and that now is the time for action.

The closer alignment between NHS England and NHS Improvement provides an opportunity to start afresh. The appointments made to senior national and regional roles will send an important signal to the rest of the system, while the new chief people officer can be a positive force for change. But the national bodies can do most to demonstrate their commitment by delivering on the pledges they have already made to model compassionate leadership.

Despite the near toxic mix of pressures they face, our report found that NHS leaders enjoy what they do, viewing their jobs as a vocation and privilege and “the best job I’ve ever done”. To keep hold of that passion and to improve care for patients, culture and leadership needs to be taken seriously. Compassionate leadership is not soft and it is not optional. So what’s stopping us?