Naylor: The NHS requires fundamental change if it is to survive

It is a great honour and privilege to be invited to follow in the footsteps of Sir Roy Griffiths by chairing HSJ’s important inquiry into the future of NHS leadership.

‘We find ourselves in an era in which the NHS requires fundamental change if it is to survive another 30 years’

I, along with a few other survivors, count myself as a child of the 30-year-old Griffiths report; that’s when I was appointed to my first chief executive job.

All of my colleagues regard his as being the seminal report into health service management since the inception of the NHS. Its main focus was to replace consensus management – which had become a euphemism for procrastination – through the introduction of a single leader at every level of management. Some of us chose to stay close to the action as hospital general managers and certainly don’t regret it.

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Once again we find ourselves in an era in which the NHS requires fundamental change if it is to survive another 30 years. We live in a society with an ageing population, technological innovation, increasing consumer demand and long term financial constraints. If the NHS is to be sustainable (quality care at reduced cost) then leadership will be a key part of that.

The NHS is the most successful social institution in the UK for the past century and, as Nigel Lawson said, “the closest you can get to a national religion”. I couldn’t agree more and hope that this inquiry will make a contribution to keeping it safe for future generations.

Personal accountability

Griffiths had an enormous impact by vesting personal accountability in one person at every level of the NHS – we became known as accountable officers and adopted the concept of “the buck stops here”. Those of us who have had the pleasure of attending the public accounts committee know exactly how that feels.

There are few who would now argue that his changes were not essential or that we should turn the clock back. But today’s NHS is unlike the one which Griffiths knew and the solutions to our current and future problems will be very different – technology is transforming how care is provided and the rate of change is exponential. Patients with multiple chronic diseases have replaced those needing isolated and occasional care. Integration and the dissolution of boundaries between primary, secondary and social care will become the norm. We will all need to learn new skills to deal with the revolutionary changes ahead.

There are many questions to answer about the qualities needed to succeed in future leadership roles. Command and control strategies are no longer appropriate in a fast moving consumer society. Helping people to take much greater responsibility for their own health and social wellbeing through the use on new technologies will become critical skills. I hope I and my fellow inquiry members will be able to suggest what these qualities should be and answer some of the questions raised.

‘The future of our health and that of our children is at stake’

Clinicians will need to take much greater responsibility for the services they provide and become ever more accessible to the patients they serve. This was perhaps the least successful aspect of what Griffiths set out to achieve. The NHS lags behind many other developed healthcare systems in clinical engagement and there is an arguable need for the professions to take centre stage in addressing this, starting at Royal College and university undergraduate level.

Consequently one of the questions we will address is how to create the environment to encourage clinicians to develop as leaders. I am delighted that we will have the help of impressive clinical leaders such as Gill Morgan and Sam Everington, together with Emma Stanton representing the younger generation.

We will be making a public call for comment and evidence in due course to which I hope you will be keen to respond. These discussions will bring us to recommendations on how we should see NHS leadership in the future and the new skills that will need to be developed. The conversations need to be wide, challenging, thought provoking and cause debate. The future of our health and that of our children is at stake.

Sir Robert Naylor is the chief executive of University College London Hospitals Foundation Trust and chair of the HSJ Future of NHS Leadership inquiry