Final Report > Chapter 25: Competent Healthcare Professionals > Broadening the notion of competence > Leadership

Leadership

23 We heard in our Seminars about the characteristics of leadership best suited to the NHS. Arguments were put to us that the NHS needs a more `transformational' style of leadership, a style which emphasises setting a direction, motivating people and managing significant change. This was contrasted with a more conventional style, referred to as `transactional', which focuses on planning, organising and problem- solving. While it is not for us to adjudicate on the value of one style over another (indeed skills of both types are probably essential for senior managers and for the chief executive of a trust), what matters is that there should be a place within the NHS to consider such questions and to offer advice. The Centre for Leadership, announced in `The NHS Plan', must be that place. A priority for the Centre should be to offer guidelines as to the leadership styles and practices which are acceptable and are to be encouraged, and those which are not.

24 We have referred earlier to the need for better education in communication and listening, interpersonal skills, and trust and respect for others. These skills are the essence of good leadership. The task of developing them, as we have seen, starts at the very beginning of a healthcare professional's education. Furthermore, we have pointed to the value of different professional groups developing the necessary skills together. Indeed, in the specific area of leadership training, in developing and funding programmes in leadership skills, the NHS should focus its investment in supporting joint education and multi-professional training open to nurses, doctors, managers and other healthcare professionals. As the NHS Executive told us in one of its papers for Phase Two: `It ... makes sense for doctors, nurses and managers to learn together about what makes for effective leadership and to do this earlier in their careers'. [12]

25 We emphasise that leaders of the calibre needed by the NHS at all levels do not just emerge. It is also a mistake to expect that those who are skilled in one aspect of healthcare, or those who have risen to a certain level of seniority in their profession, will by that fact alone automatically make good leaders. Leaders must, to a large degree, be made. The skills of leadership can be taught, acquired and developed, although of course individuals will vary in the extent to which they are able to deploy these skills effectively. Thus, given the continuing and pressing need in the NHS for people with leadership skills, we believe that active steps must now be taken to identify and train people within the NHS who have the potential to take on leadership roles. This must not be confused with old-style succession planning: making sure that there is always someone to replace a person in a given post. What we are referring to is a more comprehensive investment in developing the skills and talents of leadership, so that professionals can exercise those skills at whatever level they work within the NHS, be it leading a small clinical team, a larger directorate, or a major trust.

26 Given the need for programmes to develop skills in leadership at all levels of the NHS, an early task for the NHS Leadership Centre must be to take a firm grip on the myriad of existing programmes. It should develop a framework which would better reflect the values and purpose of the NHS. We heard that the many existing leadership schemes include: the NHS Leadership programme; the NHS Nurse Leadership programme; the British Association of Medical Managers (BAMM) Leadership programme for medical managers; the Royal College of Nursing (RCN) Leadership programme; and the NHS Development programme for finance managers. Further, much money is spent by the NHS on leadership programmes provided by non-NHS bodies, such as the King's Fund and various business schools. We are not advocating a single leadership programme, or that the NHS should no longer use providers of such programmes who are outside the NHS. Instead, what is needed is some proper assessment of the relative value of the many programmes offered, with a view to deciding which and what to support. Moreover, there clearly must be a greater emphasis on multi-professional programmes. In an NHS which puts the patient first, and seeks to integrate all aspects of care around this goal, the rationale for separate leadership programmes for nurses, for doctors, and for managers, looks increasingly anachronistic.

27 It should be clear that we believe that the NHS Leadership Centre should not be regarded as a luxury. It must receive a proper and sustained level of funding. The Centre should be involved in all stages of the education, training and continuing development of all healthcare professionals. The Centre should invest in developing leadership skills from within the NHS and support those who are already in positions of leadership. This makes sense for the patient. We note the recent publication of a Cabinet Office report on leadership in the public sector. We believe that all our observations on leadership in the NHS are consistent with the key findings of that report. [13]

28 By way of conclusion to this part of the chapter, we also believe that competence in all of the non-clinical, non-technical areas which we have identified must be formally assessed, with results counting towards professional qualifications, whether as a doctor, nurse or other healthcare professional. Only in this way will the signal be sent that these are important matters, going to the heart of concern for patients.

Footnotes

[12] Seminar 4. The NHS Executive. Position Paper

[13] The Performance and Innovation Unit of the Cabinet Office. `Strengthening Leadership in the Public Sector' (March 2001). www.cabinet-office.gov.uk