National Health

Britain’s National Health Service is under pressure. A series of scandals has scarred its reputation for high-quality care just as it is facing the overwhelming challenge imposed by an ageing population and the most prolonged period of constrained expenditure in its 65-year history.

One theme has emerged with depressing consistency from each revelation of poor treatment: the presence of an internal culture in which staff felt unable to highlight poor conduct by colleagues, or to heed the concerns of patients or relatives.

Jan Sobieraj, managing director of the NHS Leadership Academy, is at the forefront of a concerted attempt by UK health ministers to change all that. The institution he heads is still in its infancy, founded only in 2012. But its core mission, to “professionalise leadership in the health service” has, he suggests, never been more timely.

He cites a report by Robert Francis, a leading lawyer, which in February sent shockwaves through the health service by concluding that failures at every level of the NHS had contributed to many potentially avoidable deaths at a Staffordshire hospital. He pointed “to the need for strong leadership that is focused on compassion and care”, says Mr Sobieraj. Later in the year the focus intensified following an investigation by Sir Bruce Keogh, NHS medical director, which found unexpectedly high death rates at 14 hospitals, and a government-commissioned inquiry into patient safety by Don Berwick, former administrator of the Centers for Medicare and Medicaid Services in the US.

With this in mind the NHS Academy decided that, as well as recruiting a strong in-house team, it would tap into the expertise of some of the world’s leading business schools.

In selecting its partners, it looked for providers with both the right set of values – inclusion, diversity and genuine engagement with staff, for example – and strong capabilities in areas such as employee development and facilitation. They needed to offer a practical and applied approach to academic study, says the Academy. International partners were selected to encourage NHS leaders “to look up and out beyond the boundaries of their own experience and to learn from other healthcare systems and non-health industries,” says Mr Sobieraj.

He adds: “We’re trying to place ourselves as a leadership academy at the centre of a triangle of best academic thinking and research, best commercial practice and best healthcare practice wherever that may be found. So from the word go, we pulled together what we call our faculty, who are a mix of academics and leadership development experts, who work across the public and private services

“These people have got incredible experience, wide networks [and] are very good at what they do. They advise us and help shape our thinking, and they also provide our programmes.”

In pursuit of its mission, the academy, which has an annual budget of £40m, offers three main programmes, run by two consortiums.

The first, run by the Hay Group, a global management consulting firm, in conjunction with the Open University Business School, is the Mary Seacole Programme. Named for a pioneering nurse who saved many lives during the Crimean war, it is aimed at people who are taking a step into a leadership role. Mr Sobieraj says: “This could be a ward nurse who is seeking to take on her first role as a ward sister; it could be a consultant who is taking his or her first step in to a leading role in their team. It could be a junior manager just starting off on their career.”

The second consortium is running two programmes, also named after two healthcare giants: Elizabeth Garrett Anderson, the first woman to qualify as a physician and surgeon, and Nye Bevan, the founding father of the NHS.

Mr Sobieraj says these programmes “are aimed at more senior leaders who are already in leadership positions but wanting to pursue their career and build on the skills they’ve already developed”. This consortium is led by KPMG and has a range of partners, including the University of Birmingham and Manchester Business School. Mr Sobieraj adds: “They’re also tapping into the best financial practice, working with Erasmus University in Rotterdam, University of Pretoria and also [the school of public health at] Harvard.” Another programme, Edward Jenner, is delivered entirely online.

In addition, the academy is working on a scheme, announced in September by Jeremy Hunt, health secretary, which is designed to put both clinicians and high-flyers from the corporate world through a rapid but rigorous training programme designed to fit them to be the service’s next cadre of top executives.

Participants will spend two months at a leading UK or US business school, with the chosen providers due to be announced in mid-November. A combination of class work, case studies and scenarios, small group work, project work and experiential learning will help to hone the candidates’ skills, says the academy.

To benchmark the success of its programmes, the academy will look for improvement in the national staff surveys that measure employee engagement.

Another measure of achievement will be the extent to which the prevailing leadership culture is transformed in the years ahead. Within three to five years, says the academy, there should be “a single, recognised, consistent approach to leadership built in to career development”. It aims to train leaders “who have more breadth, are more innovative and more able to lead health services to fit the context and environment”.

To gauge the extent of the transformation, the academy will fund a longitudinal study, conducted by an external research organisation, which will explore what difference the core professional leadership programmes have made to the culture and performance of the NHS. In recent years it has also been collecting data on individual leadership styles among senior managers, the better to measure any change.

The model of doctors as leaders has been around for more than 20 years in the UK, says Mr Sobieraj, ever since NHS trusts were formed – freestanding bodies allowed a strong measure of operational independence. “At that point the concept of clinical directors, which could be a doctor or could be a nurse or another clinician, came into being. So I don’t think it’s necessarily that young a model.”

But the NHS is now facing what he calls a “wicked” set of challenges, which demand strong leadership. Foremost among these is the need for better integration between hospital care and care in the GP’s surgery and the community, particularly for the fast-growing numbers of elderly Britons.

Another key problem he identifies is the need to build a more diverse “leadership cadre” that better reflects the community that it serves. Also vital is to ensure that innovations that can improve patient care are spread around the entire NHS system – a challenge for a service that has not always been good at ensuring best practice is widely disseminated.

Mr Sobieraj acknowledges: “Senior leaders are grappling with some of these transformational second order change issues, rather than the simpler ones they’ve had in the past.”

While some of the leadership challenges in the NHS would be recognisable in other organisations, the responsibility of caring for patients gives the work of health managers a particular weight and significance, he suggests.

“I think the goal and aspiration is far more meaningful and far more important,” adds Mr Sobieraj.

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