The NHS needs a new generation of leaders

As another turbulent summer passes, and we prepare for the inevitable pressures the winter will bring, it is hard to avoid the conclusion that our national health system is fast reaching breaking point.

According to the regulator Monitor, NHS trusts are in their worst financial position “in a generation”, after racking up a deficit approaching £1bn in the first three months of the financial year. In this light, the extra £8bn that the health secretary has pledged to give the NHS by 2020 is likely to be nowhere near sufficient.

In fact, one could legitimately argue that the entire health system is no longer fit for purpose. Last month the Care Quality Commission found that three-quarters of NHS hospitals in England are not safe enough for patients. Doctors and medical staff are routinely overstretched and underpaid, and the entire workforce finds itself navigating continual uncertainty, financial constraints and organisational restructuring.

Moreover, with an increasing focus on devolution from the centre towards local communities and leadership, one can reasonably anticipate that the increased transparency and accountability will inevitably bring further change in the short term.

In light of these challenges, one thing is clear. “Heroic” or “charismatic” leadership models are unlikely to work, and we should not look for individuals to rescue us. Instead, a sustained effort to strengthen leadership across the entire sector is required. We should seek to build cadres of clinical and managerial staff and board members who can focus on the entire system rather than simply their organisation.

It won’t be easy of course, and the barriers - be they institutional, financial or cultural - are numerous. Yet we cannot ignore the fact that what is needed is a new generation of leaders, one in which roles interchange rapidly and managers are able to work within a team that emphasises shared and collective leadership responsibility.

‘“Heroic” or “charismatic” leadership models are unlikely to work’

This is a model that Clare Gerada, former chair of the Royal College of GPs, termed “peloton leadership”. Just as a cyclist can only win with the full cooperation of their teammates, so too must the NHS encourage leaders to pool their talents and energy and collectively drive their teams forward.

It’s not a panacea, and it certainly won’t plug the budget deficit. And it is also true that this new style of integrated leadership will undoubtedly require considerable support from within existing resources, as well as external expertise. Yet if we are to fix the many problems facing the NHS today, we need to start building a much more collaborative, sustainable and patient centred leadership model than we currently have.

Professor Mike Bewick is managing director and senior clinical adviser of FTI Consulting Healthcare’s Performance Improvement and Transformation team. He was, until August, national deputy medical director at NHS England