Are you a clinical leader? I hope so, because the future of the NHS depends on you. Indeed clinical leadership has become so important to the NHS that I’ve been asked to judge a competition to choose the top 100 clinical leaders. There is Professor Sir Bruce Keogh, obviously, the former heart surgeon and Medical Director of NHS England, and probably the most powerful doctor in the country. And then there’s Dame Barbara Hakin, the former GP now in charge of commissioning for NHS England (whom I’ve referred to the General Medical Council over the Gary Walker affair). And let’s not forget Professor Sir Mike Richards who has the glorious title of ‘Director for Domain One, providing overall leadership for reducing avoidable death.’ 1 Then I’m a bit stuck. Only 97 to go!
In a sense, this is quite reassuring. The point about clinical leadership is that it has to happen locally. If you think about who motivates and inspires you in your work, I bet it isn’t someone in a Royal College, the BMA, the GMC, or NHS England. And it certainly won’t be the Secretary of State for Health, past or present. But if you’re lucky, you’ll have somebody in your practice or area you would follow anywhere. For the NHS to survive and succeed, we need inspirational people on the front line. You may not be able to name anyone outside your area, but I hope for all our sakes the NHS is littered with local leaders.
When I’m given that list of short-listed candidates for the top 100, I’m not expecting to have heard of most of them. But I’m really looking forward to reading their stories and understanding why they have been nominated. General practitioners are especially used to dealing with complexity under high pressure. We are also very good at getting value for money. I guess that’s why we were lumbered with the role of commissioning. Many leaders may relish this new opportunity, but the best will understand that a reluctant workforce needs to be brought along with these changes. Brave leaders will be unafraid to stand up and tell it like it is. There have been far too many managers in the past who have towed the line, and tried to please their political masters rather than serving the best interests of patients. There are also plenty of excellent non-clinical managers, without whom the NHS simply wouldn’t and can’t survive. A good clinical leader will have constructive relationships with the best non-clinical managers he or she can find, and never lose sight of the patient while doing so.
What makes leadership so tough in the NHS is for all the talk of depoliticising it, we know that will never really happen. The recent furore over whether or not child heart surgery in Leeds should have been suspended makes the point beautifully. It happened in the same week as NHS England went live and promised a truly independent NHS. Yet as soon as Bruce Keogh felt there was enough evidence to call for suspension of surgery in Leeds, local politicians were calling for his head. We all know how complex patient safety is, but in a mature system it should be perfectly okay to suspend the services in a no‑blame way while an investigation is carried out. Investigations into safety need to gather information from a number of sources (e.g. historical information, data submitted centrally, and real-time concerns from patients, relatives, or staff). Provided contingency plans are made to divert patients elsewhere without harming them, we should welcome such investigations in the future.
So the role of an NHS clinical leader is going to be a tough and challenging one, but if we don’t control our destiny, someone will do it for us. If we don’t step up to the plate, there may be no plate to step up to in future. The idea that we can hide away in our local practices and moan about the system, without trying to improve it for the better, is long gone. We are all in the NHS together, some of us up to our necks, and we can only protect it together. Good luck, and I hope you make it into my top 100, whoever and wherever you are.
- NHS England website. NHS Commissioning Board Authority recruits Very Senior Managers (VSM). www.england.nhs.uk/2012/07/06/vsm-recruited (accessed 8 April 2013).G