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No more heroes: Leading the NHS through change

What type of leadership do you think the NHS needs?

Most of the recent debate around changes in the NHS has been about structures, rather than people.

These structural changes are a complex mystery to almost all outsiders and even many of those who work in the NHS. There has also been a lot of comment on the scale and nature of the financial challenge facing the service, but in fact the much more critical question is: do NHS leaders have the capacity to implement these changes while also meeting the challenges facing the service? It has been described as the greatest leadership challenge to face the NHS since its inception.

The type of leadership the NHS needs is a key question and many commentators have a view on what is needed.

The King's Fund review of leadership in the NHS brought together academics, practitioners and clinicians to consider what needs to change in the way the NHS is led. The report, Leadership and engagement for improvement in the NHS, released in May, focused on the need for the NHS to move away from a model of leadership based on the skills and style known as "demand and deliver" toward a more engaging leadership approach based on building teamwork, working with partners and fostering staff support.

Dedicated and competent leaders would still play a key role but, as the report put it, there would be "no more heroes". Individual senior leaders would increasingly need to inspire and influence rather than "command and control". They will need to build engagement with the public, patients and especially staff.

This would not be a return to consensus management as tough times required tough decisions, but recognition that reliance on talented individuals at the top was no longer enough. It is also clear that "parachuting in" experienced leaders to turn around challenged organisations is not a viable response to service failures.

It is increasingly understood that leadership is needed at all levels, from the 'board to the ward'. Almost all staff already have some form of leadership role and this needs to be recognised. Leadership is no longer the preserve of those with 'manager' in their job title and the leadership roles of, and for, clinicians need to be enhanced.

Many NHS organisations are already working to improve the skills of people with team leadership or line manager roles and there are some great programmes out there. Training for clinicians is also being reviewed in many places to ensure that it includes leadership skills.

The NHS is already reshaping its models for leadership training in light of the wider changes, with a new Leadership Academy aiming to support NHS organisations to develop their own leaders rather than harvesting their talent for central deployment. The new Faculty of Medical Management and Leadership aims to build on existing good practice and enhance clinical management to provide the most effective care. Similarly, the new nursing strategy aims to enhance nurse leadership.

The recently released CIPD report on the role of HR in supporting leadership development is therefore extremely timely. The CIPD's Perspectives on leadership in 2012: implications for HR examines the critical role of HR in developing leadership capability by discussing:


  • What good leadership is
  • Development of leadership skills
  • Creating systems, processes and policies that support good leadership
  • Creating conditions in which the value of leadership is recognised
  • Ensuring that leadership development frameworks are aligned with organisations' core purpose and values.


Leadership training programmes have in the past been criticised for an overly academic content and lack of connection to organisational priorities. Organisations have often had a "sheep dip" approach to leadership, concentrating on the selection of "talented" individuals who are then left to sink or swim. A fresh approach needs to combine the application of theoretical insight and research evidence, of which there is a growing body in the NHS, with effective practice. It needs to extend leadership skills development to "front line" leaders and recognise that leadership takes place on the ward as well as in the board. The CIPD report emphasises that leaders need to act in line with their organisations' espoused values.

It is anticipated that the Francis report into patient safety failings at the Mid Staffordshire Hospital will be critical of aspects of leadership in the NHS. There has never been a more important time for NHS Employers to be working with the range of organisations that are operating in this field, including the NHS Leadership Academy, to help the NHS support and develop its leaders at all levels.

Dean Royles (pictured) is director of the NHS Employers organisation