NHS Leadership Spring Debates: Positive action

Readers' comments (42)

What do you think?

• Anonymous | 8-Feb-2010 1:22 pm

  Im undecided on the 'nature vs nurture' debate but what i am clear about is that the apology for a selection process employed to identify the so called NHS's Top Leaders, will get you anything but that and at the same time ought to have the equal opportunity lawyers dancing in the aisles.Utterly shambollic and totally demoralising it lacks two fundamental components required to instill any degree of confidence in any process;- Fairness and transparency.

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• Anonymous | 9-Feb-2010 9:46 am

  Our first question in developing leadership should be "does this person show potential?" not "is this group under represented?" Under representation should be addressed, of course, by identifying ways to grow all people at all levels.
  Anne Axford, from Linkedin

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• Anonymous | 9-Feb-2010 11:09 am

  The idea that specific groups should be boosted would suggest that the culture relies on positive discrimination as a means of putting right the wrong of a failed inclusive culture.
  There seems to be something inherently wrong about the NHS approach to leadership. Most people have the capacity to take a lead; the question for individuals is whether they want to take a lead formally within the organisation. If an individual has this desire, he/she needs to be assessed as to their suitability for development as a routine within his or her job. This will require the add on experiences, because the framework for developing managers and leaders requires the acquisition of skills, knowledge and experience at three levels - level 1 the behaviours that promote trust and commitment; level 2 the skills to apply policies, procedures and techniques that are described by protocols, and level 3 the eclectic skills, knowledge and experience needed to draw on all theories and principles of management and leadership and apply them to the issue that confronts the leader at the time. As level 2 skills are those in greatest demand, the acquisition of level 1 and 3 skills is quite difficult - the failure of which can be witnessed around the NHS today. So, there is a need for someone to specifically ensure that all leaders acquire all the skills at all the levels, but as part of their routine development, not as a separate activity.
  Derek Mowbray, from Linkedin

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• Anonymous | 9-Feb-2010 9:50 pm

  I don't know about specific groups but where there is potential people should be nurtured. Unfortunately leadership programmes are simply not available to all bands of staff. I am acutely aware that people are targeted for promotion simply because of who they know, the networks they form and because of the meetings they attend simply because they want to be seen. In the spirit of equality and diversity everyone should be provided with the opportunity to grow their potential and all bias should be stamped out. I continue to be amazed at the number of people, (and in my organisation there are man)y that are fast tracked because of favouritism or friends in higher places. Conversely the people with real potential are held back either because their face doesn't fit or because the organisation may be seeking to employ external candidates rather than to promote from within. Systems for appraisal and performance management seem to be abused within the NHS and this is because there are 'managers' in post that are not qualified to be managers, who have simply been lucky to move up the ladder because of their contacts.

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• Anonymous | 10-Feb-2010 1:25 pm

  There are two important words in the question: representative and talent. We do need to make sure that the leadership of our health service is representative of the people we serve - and who pay us via their taxes - so that our services meet the needs of all our users. However, we also need to ensure that we encourage genuine talent - and this requires an open and honest dialogue between staff and their bosses about whether they have the skills and attitudes needed to develop their leadership aspirations.

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• Anonymous | 10-Feb-2010 1:27 pm

  We will never improve leadership in the NHS if there is positive discrimination of under represented gropus. Individuals chosen for leadershoip training should show the most potential - whichever group they come from.

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• Anonymous | 10-Feb-2010 6:18 pm

  Selection criteria based on knowledge, skill and passion not ambition... we hope the process will be based on fairness and transparency not "Club Culture" oriented.
  Via email

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• Anonymous | 12-Feb-2010 2:46 pm

  I am approaching this as someone with several non-executive roles in the public and third sectors. I also run talent management events for top public servants from Commonwealth countries, mainly Nigeria, India and Kenya.
  
  I agree with parts of Anne and Derek's comments. There are several points that flow from their conclusions.
  
  1. I start from the position that leadership is a distributed function in all organisations and not something that is or ought to be confined to a small elite group in managerial roles. One has only to consider the somewhat under developed practice of integrating fully clinical leadership into most NHS organisations. Separately in some situations there are people who do not hold high "office" but nevertheless exercise strong intellectual (aka thought) leadership.
  
  2. Equally it seems to me that the question ought not to be does this person have potential but rather what is the potential that this individual human being has - and flowing from this is the conversation about whether there is a value for the individual's potential in the NHS. I find it hard to see many forms of talent that cannot find a role in an organisations with well over 1m employees.
  
  3. If the potential of a significant number of people in an organisation is not apparent then there is almost certainly a more fundamental systematic problem in that organisation's culture.
  
  4. Then comes the difficult question of whether at a particular point in time an organisation should give priority to developing some forms of potential over others. This raises hard ethical, moral and equity questions. In any resource limited organisation such choices have to be made - and it is generally better that such choices are transparent rather than covert.
  
  5. I am not opposed in principle to taking account of equality and diversity policies when deciding which individuals should have priority access to funds for developing their talents. This seems appropriate in any public sector body given the duties given to us by various pieces of equality legislation over the past decade.
  
  6. Derek's analysis of leadership development is a touch too formulaic for my taste. Though steeped in competence based approaches over the years I am increasingly of the view that competences are necessary but not sufficient for successful leaders - especially where innovation and change is required. In any talent development process I would want to provide the time, space and variety of experiences to nurture individual intuition, creativity and innovation.
  
  Eric Galvin, from Linkedin

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• Anonymous | 12-Feb-2010 3:39 pm

  The ‘inclusion’ agenda never fails to spark emotive and sometimes polarised views. But one thing that is consistent when it is raised is the surprising lack of understanding by most commentators, of the rationale and distinction between positive discrimination and positive action. This is why the NHS needs to continue to focus and strive to embed, a long term strategic approach, towards a more inclusive leadership. Why, I hear you ask? Should it not be based on the most talented rising? , and why do we need these ‘programmes’? Well, the facts are clear. Positive action – not discrimination - has significantly contributed to the increased representation of women across most clinical fields and management to a more respectable level not just across the NHS, but across the UK’s private and wider public sectors too. But stubbornly, across the other ‘strands’ for example, ethnicity, disability and sexual orientation the progress has been woeful.
  
  The National Leadership Council has rightly identified the need to develop and implement inclusive leadership strategies for the current and next generation of NHS leaders. And about time too!
  How can we seriously expect to lead and deliver on the financially challenging, ambitious and intricate healthcare needs of an increasingly diverse UK population, without aiming to try and reflect the communities that we serve? We simply have no choice but to select the best talent from the widest possible ‘pool’ available, for arguably the most complex and sensitive service a nation can provide to its citizens (if you doubt this, just note the scale of reaction to President Obama’s healthcare proposals in the US!).
  
  In short, I believe this means our recognising the benefits of having sustainable inclusion programmes that support the identification and development of our best talent, addresses under representation head on and, continue to think creatively, proactively and most importantly, strategically, about this in the future.
  
  Roy Ebanks
  Regional Inclusion Coordinator
  
  Breaking Through Programme
  
  Via email

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• Anonymous | 12-Feb-2010 4:49 pm

  What really makes me laugh, is the opeing line:-
  "Should the NHS identify potential leaders"
  Errr answer NO!
  Get some people who actually know what they are doing to do it!

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• Anonymous | 12-Feb-2010 5:52 pm

  It would be wise for the NHS to recognise that different personality types bring different skills to leadership.Many of those who aspire to lead are less suited to the job than some who take a step back by natural inclination but are nevertheless gifted and respected.These latter are often more sensitive to the needs of others and as a consequence able to encourage much more in the way of esprit de corps and real inclusive, across the board progress -avoiding some of the pitfalls from insensitive management.

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• Anonymous | 13-Feb-2010 1:01 am

  Isn't it interesting that none of the good/great leaders that we all recognise and none of the ones we recognise in our local NHS contexts are products of so-called 'talent management'!
  By asking this and other questions, it is clear that there is a real lack of understanding in the NLC about what good leadership is or what it should be in the NHS.
  Leadership happens in ALL contexts and at ALL levels in the NHS. Therefore, talent management and leadership development should be happening for ALL people in the NHS, and not just for the FEW
  selected on flawed bases/assumptions/leadership knowledge.
  Come on NLC... earn your corn and show us the leadership innovations we ALL need. Does the 'NLC Emperor' have clothes or is it just a new series of leadership illusions wound in threads of gold (that we ALL pay for)?

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• 

  Derek Mowbray | 13-Feb-2010 8:10 am

  I am responding to Eric's reasonable interpretation that my levels of leadership are too formulaic. I don't see it that way. These are not competency interpretations but skills, knowledge and experience interpretations which lead to levels of competency, just as innovation attributes and skills in articulation of the innovation leads to a competency. Level 1 skills are the behaviours that are so far not taught and graringly missing focused on building trust and commitment; level 3 skills are those to which Eric refers as enhancing the innovative, entreprenaurial and other imaginative attributes of leadership so vital for future growth - I call this level eclectic as it draws on all the experience, theories, principles that individuals accrue. I didn't describe the attributes of a successful leader in my last contribution, but will add these later although they can be found in the Code of Conduct paper from IHM.

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• Yvonne Coghill | 13-Feb-2010 8:56 pm

  The question as to whether the NHS should have a positive action programme rears its head periodically and people debate what it means and whether we should do it.
  I believe very few people know the difference between positive action and positive discrimination and the very sound reasons why positive action exists and is in fact embedded within the law. At the risk of teaching my grandmothers to suck eggs, I feel it is important to explain why today in 2010 the NHS still needs a positive action programme.
  Section 37 of the 2000 Race Relations Amendment Act states that the term 'positive action' refers to measures that may lawfully be taken to meet special needs or to train or encourage people from a racial group that is under-represented in particular work.
  There can be no doubt that people from black and minority ethnic backgrounds are under represented at the most senior levels of the NHS.
  Section 37 allows training or encouragement to be provided for a particular racial group that is under-represented in particular areas of work. Again, we can justify the existence of any programme as a vehicle to train, develop and encourage people from under representative groups. At this point I need to remind the reader that section 37 falls within the RACE RELATIONS ACT, positive action is about under representative groups from different racial backgrounds, this I fear is where the complication begins. There are many people that believe that singling out a group of people for what they perceive to be special treatment is wrong, divisive and unfair. What they do not acknowledge or understand is the history behind the development of the law in the first place. Quite simply racism and discrimination were and unfortunately still are prevalent in society and something needed to be done to support people from different ethnic groups to fulfill their potential. The situation is further complicated by unclear descriptions of what constitutes an ethnic group. This is a red herring. It is irrelevant what racial group an individual is from from providing they are in a group that is under representative in a particular job or profession.
  The law goes on to state that where there is national under-representation - that is, where, during the previous 12 months, no one from a particular racial group has done the work in question in Great Britain, or where the proportion of people from that group doing that work was small compared to its proportion of the population of Great Britain. In this case, training or encouragement can be provided exclusively for the racial group (or groups) in question.
  England is made up of a population of approximately 60 million people, 10% of whom are from ethnic minorities, this figure is expected to grow and by 2020 we expect there will be over 20% of the population from black and minority ethnic backgrounds.
  Over 1.3 million people work in the NHS and around 17% of them are from ethnic backgrounds, that is a substantial number of people. There are approximately 1810 executive director level positions in the NHS and having recently completed a piece of work across all SHAs we know that there are currently around 60 executive directors form BME backgrounds (including the 6 CEOs we currently have in post). 3.3%. By anyone’s standards statistically this is under representation.
  It is this under representation at the highest levels of the NHS that makes the clearest case for positive action in order that true to its founding principles the NHS is a service where the needs of all members of Britain’s population are met.
  I believe the legal explanation as to what positive action is and why it is necessary is as clear as it could be and the answer to the NLC question about positive action is that the NHS should have a positive action programme.
  I believe the question that should perhaps be asked is not does the NHS need a positive action programme but does it really want one?

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• Anonymous | 15-Feb-2010 12:11 pm

  The NHS already has a number of outstanding leaders accross its various organisations. The main problem that I have witnessed is that the skills of these leaders are not always well matched to the needs of the organisation. Often a leader that would excel in a particular organisation can have a negative influence on another.
  
  I do not think that specific staff groups should be targeted for leadership development. Organisations that produce the outstanding leaders should be. There are particular NHS organisations that have historically produced well rounded, capable leaders. Perhaps it would be sensible to focus on these organisations and ask what they do differently to others.
  
  Simon Marcer, from Linkedin

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• Anonymous | 15-Feb-2010 12:51 pm

  3.3% BME in executive positions compared to 17% of the workforce from BME background.
  
  The numbers and percentages Yvonne Coghill listed are simple and strong. These figures speak for themselves, yet I suppose, hopefully I am wrong, that some people never heard these numbers and still are in a denial stage.
  
  The questions posted on the NHS Leadership Spring Debates are totally MISLEADING! To start with, in such a national debate, people would expect to see facts and evidence being presented first to minimise assumptions. Additionally, OPEN questions should be asked to stimulate debate not CLOSED questions to create defensiveness.

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• Anonymous | 15-Feb-2010 2:55 pm

  While it is possible that leaders vary in their ability to be successful in different contexts, my experience is that really good leaders do reasonably well in a range of circumstances. That said I believe that nurturing the ability to exercise leadership in different contexts should be a feature of leadership programmes. This is probably urgent in the NHS context as many leaders have spent most of their lives as leaders in a growing health economy.
  
  Eric Galvin, from Linkedin

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• Anonymous | 16-Feb-2010 9:46 am

  Ultimately someone (the public?) needs to decide what form of leadership is required for what kind of healthcare system we can afford. The hugely ambiguous current NHS contains (at the least) two principal types of organisation within it - the foreground organisation, that essentially is based on chaotic principles, and the equally large background organisation that seems to be based on transaction principles. The background organisation is massive, of equal size, we are told, to the foreground organisation. Its personnel may never meet a patient. Leading it may require a different set of personal values and beliefs to the leadership required to lead the foreground organisation. In the foreground is the classic ideological conflict between the professions and the bureaucracy, requiring sensitive and acute skills to bridge the gap and keep everyone going in the same direction. Leaders in the foreground organisation really require the skills knowledge and experience at all three levels A, B and C, with a lot of experience at levels A and C to be truly good at the job. The lack of these skills is fairly clear at the moment, and provides some explanation as to why certain imports from other organisations find it hard to succeed in the NHS. Equally, of course, exports from the NHS also can find it hard to deal with organisations that are not multi-professional and complex. Ultimately, it seems to me at least, the attributes of individuals are key, and become the foundations on which to build the skills knowledge and experience at levels A, B and C. Whether they are successful will depend on the cultural foundations of the organisation they are leaders within, and that's a whole new ball game.
  Derek Mowbray, from Linkedin

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• Anonymous | 16-Feb-2010 9:46 am

  Leadership should be developed throughout the NHS. I have a background in nursing and strongly believe that these frontline staff with patients 24/7 are the true leaders and should be developed further
  Ann Girling, from Linkedin

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• Anonymous | 16-Feb-2010 9:48 am

  I agree with Ann with the proviso that the same is true for many other professional groups.
  
  One of the reasons leadership in the NHS appears chaotic is that many of us struggle to break out of the traditional mindset in which leaders are seen as heroic figures providing a unitary vision and objectives for the organisation.
  
  It seems to me that frontline staff in the NHS (like others in many parts of the public sector) have to deal with three distinct sets of leaders - political leadership, managerial leadership and professional leadership. All are valid but too little effort goes into ensuring consistency of approach - and where necessary resolving differences. In a highly unionised environment many staff also have a distinct set of leadership themes offered by the unions (and in some respects the BMA and the Royal Colleges act as unions as well as professional bodies).
  
  By political I do not mean only Westminister politicians but others in a range of governance roles who necessarily concern themselves with public needs and wishes. Foundation governors and PCT Non Executives (and others) fall into this category.
  
  Eric Galvin, from Linkedin

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