Who leads the NHS?

In a previous life as a training consultant (specialising in areas such as leadership), I used to define a ‘manager’ as someone who successfully maintained the status quo and a 'leader' as someone who moved people and organisations forward to shared goals. The reality is that all organisations need both to be sustainable, but the ratio of one to the other will need to change as the organisation responds to its environment.

My observation is that the NHS is full of managers, who are very good at maintaining the status quo.

So who leads the NHS at the moment – who moves organisations and people forward? The closest to that definition at the top of the NHS would be Professor Sir Bruce Keogh. He’s identified issues, signposted a direction and started to create a picture of how elements of the NHS could be in the future.

This has been done on the basis of safety science and data, but also a strong element of personal belief that for too long healthcare has followed the principle of ‘acceptable harm’. Bruce believes that no harm should be acceptable or tolerated. You can debate the finer points, but clinicians and patients can buy into that.

Who else?

Don Berwick. Because when you ask people at the centre what’s happening they’re all waiting for the ‘Berwick Report’. What direction should we be going in? ‘I’ll let you know when the Berwick Report is out’ is the standard reply. Of course, once that’s out we will still have the response ‘We’re waiting for the government’s response to the Berwick Report’ (which, before you ask, is October).

When the HSJ was looking for nominations for its top 100 leaders of the NHS this year, I tweeted ‘how about Julie Bailey?’ After all, she’s had a massive influence on the NHS and, in my book, that’s leadership. And then there’s James Titcombe, who has all the passion and drive to mark him out as a leader.

Who are these people? You won’t find them on any organisational chart, but if you don’t know them then perhaps you should.

Of course we could then start to talk about Robert Francis. He’s probably had the same impact on the NHS as shining your car headlights at a rabbit.

Over the history of my own charity, the Clinical Human Factors Group, so many of my colleagues who are achieving change in the NHS, either across the system or at a frontline/departmental level, are doing so because they’ve taken a leadership role and shared their own passions, values and beliefs that things can be better.

It’s been a combination of safety science built around human factors and understanding people in the system, data, and common sense that colleagues can ‘get’. Indeed, one of the HSJ’s top 50 most influential women, Professor Jane Reid, is a classic example of that.

You don’t need a formal title to lead.

It’s back to those words – passion, drive. It’s about having a belief – a vision, if you like – that others want to aspire to and who’ve been inspired and excited about what might be possible; and a set of values so clear and strong that it would be rude to compromise. But it’s also about being firmly grounded in understanding how people and systems work, because then it becomes something that people around you can see, often like a light bulb.

If you sit at the centre of the NHS, you can sit and wait for Berwick, and the government response, and then wait for something else.

Maybe you can’t start ‘making policy’ (and actually maybe that’s not what the NHS front line wants). But you can start talking about what you’d like things to be like. You can start sharing your own visions and values - it is okay to be passionate about the NHS. I know that loads of you are. I know so many on the front line are.

In life you’re either a pilot or a passenger, it’s your choice.

Martin is a pilot and the founder and current Chair of the Clinical Human Factors Group, www.twitter.com/MartinBromiley.