The scale of the Challange facing NHS leaders

The scale of the challenge facing NHS leaders in pushing through the major reforms outlined in the recent White Paper, against the backdrop of current financial constraints, is unprecedented.

Trust boards have their work cut out – and have never been in more need of advice and insights from leaders to help them assess and prepare for the direction and speed of the reforms.

In the past few weeks, we’ve welcomed several leading speakers to the Fund to share their insights with London chairs and non-executive directors as part of our Board Leadership Programme.

David Nicholson, NHS Chief Executive, and Stephen Dorrell MP, former Secretary of State for Health and the new Chair of the Health Select Committee, have been among those who have shared their views with us.

Despite all of our speakers’ very different histories in the NHS, there has been a lot of common ground. All agreed on the importance of quality and a system that puts the patient at the centre of its work. There was also a consensus that the pace of change is like nothing ever seen before, and that successful change needs effective leadership.

So what are the main challenges for NHS leaders? Holding on to those staff who will be part of the future and keeping them motivated to stay was a key concern. Leaders also need to nurture opportunities and relationships outside of their current business while managing the ‘business as usual’. And they need to be open to input from a wide range of sources, such as support for commissioning from the private sector and looking at solutions that have worked internationally.

There was a clear message that change can only be achieved if the leadership challenges are honestly acknowledged and the change process is properly resourced and managed. It is particularly important to train, develop, educate and support GP consortia if the system is to work.

The rate of change is always contentious in system or organisational reforms. If change is too slow the reforms start to feel like a phony war and good people are more likely to leave. On the other hand, pushing the system too fast risks primary care trusts falling over, commissioning standards declining and threatens the £1billion surplus that the system has built up.

But it can also be argued that there are also risks associated with not changing. The real leadership challenge is to anticipate the risks of change to individual organisations and to create contingency for these.

The reforms will only be achieved if leaders keep the need to manage change at the heart of their agenda. This means attention to detailed planning, stakeholder mapping and management, and a focus on internal as well as external relationships. But above all, as all our speakers were at pains to say, we need to balance the discipline of the shorter-term quality, innovation, productivity and prevention agenda (QIPP) with the creativity of the longer-term system reform.

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