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Interview: David Nicholson talks leadership

In an exclusive interview following the first meeting of the national leadership council last week, NHS chief executive David Nicholson tells HSJ what was discussed, why the council won’t become a “dustbin” for difficult issues and why all chief executives must take responsibility for leadership.

NHS chief executive David Nicholson on…

Untapped talent:

“I would argue that the market has failed. Whatever the system is that we’ve been using, it simply hasn’t delivered the quality or quantity of leaders that we’ve needed.

“We’ve made some progress with the diversity of leadership in the NHS and there are undoubtedly more women, more people from black and minority ethnic communities and more clinicians involved than there were five to 10 years ago but we still need more.

“There’s a huge pool of untapped talent there that’s available to us to do that.”

Previous leadership initiatives:

“There have been a string of initiatives in this area. Almost every two years we have a big string of initiatives.

“What’s happened in the past is very short-term initiatives, they’ve been too focused on relatively small groups of people when it’s a general issue across the NHS as a whole.

“What’s happened in my experience is these processes get taken over by experts in the field, people from HR backgrounds – who are very important - but it’s a line management responsibility.”

What makes the council stand out from previous initiatives:

“I think we’re in a much better position now. The emphasis on quality makes it much more attractive for clinicians to be involved in leadership. We’re better placed.

“In terms of whether it will work, people will quibble about bits of it but there’s a groundswell of opinion…there’s huge support across the system to make something happen.”

Council membership:

“It’s not a group of old grey beards sitting together reflecting about how it used to be in my day. We’ve been careful about the people we’ve picked.”

Primary care representation:

“We tried to get some kind of balance but to be honest we can only appoint people if they apply. I understand the issue about primary care but it’s not meant to be representative, it’s meant to be the best people. People didn’t come forward – which is an issue in itself.

“But the point is that leadership is everyone’s business. Individual PCTs have a responsibility to develop leadership within their patches.

“We need to be careful that the leadership council doesn’t become a dustbin so everyone chucks in all the stuff they can’t deal with themselves.”


“Some have identified they’re particularly interested in certain areas. If we come up with ideas we’ll test them out with the patrons to see whether we’re broadly in the right area. We can also hold video conferences.”

Coping amid tightened budgets

“It’s a personal responsibility of all chief execs to spend time spotting and nurturing talent. That’s a fundamental part of the job, just as much as having a discussion with the finance director about the money.

“We simply won’t deliver the sort of service we need in the environment we’re going to unless we’ve got top quality leadership.

“One of the real dangers of the situation we find ourselves in at the moment is that managers go over here, dealing with the money, and clinicians go over here, dealing with the quality.

“It’s absolutely essential we keep both these groups together in all of this. And that’s why the leadership council is so important, to combine quality and productivity together.

“You don’t need to spend a lot of money on chief execs sitting down with clinicians talking to them about leadership and the way in which they’re organising themselves, mentoring them, supporting them.

“It’s massive in terms of time, but that’s what chief execs do. But I feel at this particular stage we should be investing more in our leaders.”

The council’s programme of work

“We’re commissioning the national graduate training scheme, the IT scheme, all the big national schemes and we’ve got to decide whether they’re shaped right, whether we’re putting the right people in, there’s quite a bit of work around all of that.

“With board development, there’s a huge amount going on. It’s about making sure it’s all being done effectively and coherently.

“Going forward, there’s only one game in town really - how do you improve quality and improve productivity at the same time? My connection between the two is innovation, that’s how you do it, and that needs to be central to board development.

“So we’ll be looking at all the good things going on to make sure we’re building that into the centre of it.

“We might commission new things – if we see there are gaps that we need to fill, but we haven’t quite got to that stage yet. We need to make sure that what is being done is in the right direction and of a quality we think is right and suitable for the future.


“As a leadership council we want to identify a kitemarking system where we’d mark existing board development programmes to make sure they’re consistent.

“Because what’s the point of the NHS investing huge amounts of money in programmes that don’t support the values or the direction the organisation is going in?

“By leaving everything out to the market to respond to, it hasn’t delivered us what we need for the future so we need to intervene.”

Readers' comments (2)

  • Because what’s the point of the NHS investing huge amounts of money in programmes that don’t support the values or the direction the organisation is going in?
    Indeed! Please do not fool yourself that the NHS has any direction, it hasn't, and any values it had have been eroded over the last 10 years.
    The new purpose of the NHS has to become a vehicle for satisfying patient demand, open all hours, staffed by people who do not have the clinical skills or resources to meet the public's expectations. This has been achieved by fragmentation of the service and dumbing down of front line staff, who are almost universally unsupported by so called managers who do not seem to understand that their prime purpose is to ensure efficient effective delivery of clinical services.
    The splitting of the services into purchaser/provider arms has increased bureaucracy, depriving the NHS of resources to invest in clinical staff. This is of great benefit to senior managers who grow their empires while staying below the radar.
    Primary care, and especialy primary clinicians, has been systematically disengaged from the decision making process, so, yes, it is extremely worrying that primary care is not represented in the top 250 initiative. Without a well organised and well resourced primary care, down stream costs will mount and mount, as we have already observed. David Nicholsons ramblings give me no confidence that he understands the NHS.

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  • NHS senior management like to be seen as senior executives of large businesses even though the majority would go bankrupt in a year if they were. Top NHS management pursue these schemes because it is an easy answer to opposition government ministers and the media when they ask what the NHS is doing to improve the quality of its executives. They could have used Agenda for Change to do it, but the DoH had too many plates spinning at the same time to notice. The only way a scheme like this can work is by completely changing the way management employment contracts are executed in the NHS. Not an attractive prospect for Nicholson or anyone else.

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