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Leaders must now give the NHS a sense of endeavour and purpose

Barring an act of god, the Health Bill will receive royal assent in the next few weeks. Its passage has been a bruising experience for all involved and the fierce, polarised battle it inspired will leave a legacy of bitterness in many.

Speaking at the Nuffield Trust policy summit last month, health secretary Andrew Lansley said that as the reforms took effect, NHS staff would realise the worst predictions made about the changes were bogus.

This claim is another example of the health secretary’s ability to let wishful thinking trump reality. NHS staff have heard little but bad things about the reforms from professional organisations and the media. They may not hold either in high regard, especially the latter, but all evidence suggests they have even less time for government reassurances.

This point was effectively admitted by Mr Lansley when he told the summit: “I’m not here to restore faith in politicians.” This is a statement you cannot imagine any other cabinet minister making, including the health secretary when he first swept into Richmond House promising to end top-down control of the service, tearing up targets to show he was serious.

At the worst, staff are suspicious of the reforms and uncooperative in their implementation. Even at the best, many will be disengaged.

Lack of engagement is death to healthcare reform. It has put paid, eventually, to every NHS reform for decades. Orders from the centre and an army of enthusiasts will only take you so far. Even the New Labour reforms of the last decade, turbocharged by billions of pounds of extra funding, eventually ran out of steam because too few staff understood and/or bought into the thrust of many of the changes.

To achieve deep, long lasting change in the NHS, you need a sense of shared endeavour and purpose.

This is where HSJ readers, as the clinical and managerial leaders of the system at national and local level, have a crucial role to play.

It is the role of leaders to find the good in these reforms – and there is enough to work with – and interpret them for the specific challenges facing their teams. Equally, they must learn how to manage any negative consequences in a way which mitigates their impact and soothes the bad feeling. Many have been doing just that for well over a year.

Our feature on the seven habits of successful medical leaders places “bravery and resilience” at number one. It is an appropriate ranking – for healthcare leaders of all types – especially at this time.

It will be all too easy to blame difficult decisions on politicians and mandarins, to say to cynical staff, “I agree with you, but what can I do?” It will be just as easy to barricade the boardroom or office and make plans away from the concerns of those outside.

The temptation to do either may often be overwhelming when one considers the storms ahead. Some, like the tensions created by pension reform, are out of the control of the great majority, but still have to be handled locally.

Pay seems set to become an issue which will be returned to the local in-tray and the scale of the problem is revealed in HSJ’s exclusive analysis of trust pay levels. Then there is the role of the private sector – from which an increasing number of leaders will come. Determining and striking deals which will benefit NHS patients will test the skills and courage of many. 

It is little wonder that it is the third habit of leadership which may yet prove the most important. Few will succeed in such a testing environment without a healthy dose of optimism.

Readers' comments (5)

  • Of course all employees of the NHS should do their jobs well but it is not necessary to make a religion of it. Nor is it right that all vestiges of critical thinking must be suspended in a desire to be positive. What is important is that when staff see things going wrong but have no confidence in internal procedures they should become anonymous and smart whistle blowers. This is particularly important in measures masquerading as part of the £20bn reductions but are in truth service and staff cuts.

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  • Mr Lansley's claim that "NHS staff would realise the worst predictions made about the changes were bogus" is laudable rhetoric but is exactly why the NHS will worryingly try and hide issues which might expose the Bill as being unworkable. Hiding things is exactly the behaviour we do not want to happen within the service as it is often patients who suffers.

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  • I'm going to try bravery and resistance.

    I certainly won't be hiding any emergent issues and the only thing that has been bogus in all of the is Mr. Lansley.

    We are already beginning to see the seismic changes wrought by the Bill - staff aren't stupid not are they ill informed in the majority of cases.

    As for the storms ahead, I forsee a summer of dicontent.

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  • The biggest risk is the number of people who would revel in the reforms failing - even at the expense of the NHS unravelling in to complete, bankrupt mess.

    The idea that the Coalition should be rewarded for the arrogant and deceitful way the reforms were foist upon the NHS by trying to be constructive and make the system work is anathema to many.

    Lots of ill-will out there to compete with the optimists....

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  • I will rejoice at every negative headline I see during the months ahead. I will do my job to the best of my ability as I always have even through this utter nonsense of a process but I hope with all my heart that these "reforms", introduced by a government which has lied again and again to staff and the public since before it was even elected as to its true intentions, prove to be a complete disaster, and that as a consequence the Tories get routed at the next election.

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