Even when you display personal courage and honesty, you cannot be an effective leader without the trust of your peers and the public, says Clare Gerada.

Courage and honesty are important to leadership, but these qualities alone are not enough to make a good leader. It’s only half the story. A leader can push through massive organisational change in the face of near-universal opposition. You could describe a leader who does this as courageous. You could also see it as stubbornness.

Of course leaders need courage, but it’s a quality that should come with a health warning. And so should honesty. It goes without saying that good leaders must be honest, but used indiscriminately it can be counterproductive.

Courage and honesty are nothing without trust. They are qualities we all possess to a greater or lesser degree. We can all aspire to be more courageous and honest than we are. The same can’t be said of trust. You either trust someone, or you don’t. Trust is the foundation of a healthy society. It influences all our relationships and institutions. When we trust someone, we have a firm belief in them. We believe them when they say they are going to listen, reflect and improve upon a plan.

We believe them when they tell us the NHS is safe in their hands and we believe they have the ability and competence to do their job well. So the leader who inspires trust carries a heavy burden of responsibility, because most of us are willing to accept the truth of what they say without evidence or investigation. Leaders abuse our trust at their peril.

Throughout the progress of the Health and Social Care Bill, I kept raising concerns about the emphasis placed on profit, competition and choice. I worried that the marketisation of healthcare risked undermining the basic values of our NHS. Values built on trust between doctor and patient; manager and doctor; all of us.

The trust tax

The NHS runs on trust. It is a precious and fragile resource, hard won and easily lost. It’s possible to measure the value of trust to organisations and it has been found to be very significant.

Management guru Stephen Covey says that when trust is low, in a company or a relationship, it places a hidden “tax” on every transaction. Every communication, interaction, strategy and decision is taxed, bringing speed down and sending costs up. We already know this – just think of up coding, think of gaming, and how much time has to be spent checking every invoice.

Trust in our NHS has been built over 60 years. Poll after poll shows the general public regards the NHS as one of the most trusted institutions in the UK. Last year’s MORI poll looked at the public’s trust in the truthfulness of various professions and found that doctors, at 88 per cent were the most trusted. At the other end of the scale, government ministers were only trusted by 17 per cent of respondents, with journalists faring slightly better than ministers, at 19 per cent. Bankers scored 29 per cent.

So in the NHS we have an enormous advantage. We start from a place of trust and we must make sure we continue to deserve and earn that trust as we take the NHS forward.

In these testing times, we need leaders who inspire – and deserve – our trust. Leaders must earn and keep the trust of those we lead and serve.

How can we do this? First, we can watch our language. When we refer to patients as “customers”, we risk losing sight of our patients as people. What will this do to the relationship of trust between us? Second, we must make sure care rationing is as far removed from the consulting room as possible. Patients must be confident that any decisions about their care are made in their own best interests, rather than those of the budget. Finally, we must challenge inequalities and unfairness wherever we see them.

So let’s come back to honesty and courage. We trust leaders who say what they think is right, even when they tell us things we don’t want to hear. We trust leaders who have the courage to put honesty above popularity. We trust leaders who act on their values, and use them as a compass to navigate through difficult times.

It’s a fine balance. It takes courage to trust people; to listen openly and genuinely to their opinions and criticisms, and to take them on board. Trust has to be modelled. If you don’t trust others, how can you reasonably expect them to trust to you?

We have to welcome dissent, disagreement and truth, however uncomfortable and inconvenient that may be. It means including the public in the debate, really listening to what they have to say and being prepared to re-examine our beliefs in light of changing circumstances and feedback.

Courage and honesty are important to leadership, but they’re not enough. It’s trust that makes the world go round.