Centre of attention

After a stuttering start, the NHS Leadership led by, under Penny Humphris, is beginning to make headway. Lyn Whitfield reports

No-one could accuse Penny Humphris, director of the NHS Leadership Centre, of limited ambitions for her new organisation.

In five years' time, she would like to see 'leadership embedded as part of every organisation's strategy' and 'a cadre of leaders with an international reputation'.

Indeed, she hopes that 'people will be coming to the UK' to see how the NHS links leadership to service improvement.

Realising how this may sound, she laughs and adds: 'A strategic goal enables you to see where you want to go: you might not get there in a straight line, but you know where you are heading.'

The leadership centre has had a long gestation. Andrew Foster, then at the NHS Confederation, told MPs four years ago that it was discussing the establishment of a 'leadership academy' with the NHS Executive.

Mr Foster, now NHS director of human resources, suggested an academy could help to change the culture of NHS management - then still obsessed with 'buttoning down costs' - raise standards and help to heal an emerging rift between managers and clinicians.

The idea resurfaced as the 'leadership centre for health' in the NHS plan, published in July 2000. The plan claimed the centre would 'deliver a stepchange in the calibre of NHS leadership' and the '40,000 leaders at every level' needed to deliver modernisation.

The idea was strongly endorsed by Professor Sir Ian Kennedy, then head of the Bristol Royal Infirmary inquiry and now shadow chair of the Commission for Healthcare Audit and Inspection. In his final report on the baby deaths at Bristol, he said the centre should 'offer guidelines as to the leadership styles and practices which are acceptable... and those which are not.'

He also urged the centre to 'identify and train' people in the NHS capable of taking on leadership roles, to 'take a firm grip on myriad existing programmes' and to put 'a much greater emphasis on multiprofessional programmes'.

The NHS plan promised that the centre would be 'in place' by April 2001. It was, but only just - its first permanent director, Barbara Harris, was appointed that month, with many of the details still to be worked out.

Then the centre suffered a setback when Ms Harris left in December, following a critical Commission for Health Improvement report into her former trust, Royal United Hospital Bath. Ms Humphris, a well-regarded NHS manager, took on the director's job in January last year and was appointed to the substantive post in September.

Despite having the appearance of a rocky start, Ms Humphris insists she found 'hugely committed' staff in place when she arrived, some new programmes up and running and plenty of 'good ideas'.

Her first priority was to 'take stock of what had been done and what needed to be done' and to talk to people in the NHS about how the centre should be aligned with their plans and priorities.

That done, she could draw up her strategic direction.

Ms Humphris believes one of the leadership centre's key roles should be 'leading the development of thinking about leadership in the NHS; what we mean by leadership and how it should be developed'.

She is also completely committed to matching the centre's work to the modernisation agenda and to developing more multiprofessional programmes. These will be delivered, as now, by a range of private and public sector providers.

However, Ms Humphris still sees a role for the centre in 'doing innovative things' - such as piloting ideas. Finally, she says it has a role in researching and assessing 'what works well in leadership development' and what does not.

'It is important that the centre makes a real difference to the NHS, ' she says. 'It is easy to think that leadership development is 'a good thing', but it is only good if it drives service improvement.'

Ms Humphris started her career as a national management trainee in the 1970s. She worked her way up to unit general manager before leaving the NHS for three years to work for accountants KPMG.

Then, in 1991, she became director of provider development at Wessex regional health authority under Ken Jarrold, who went on to become NHS human resources director and is now chief executive of County Durham and Tees Valley strategic health authority.

Ms Humphris says she was 'always' interested in management training and development, but this took on concrete form in Wessex, where Mr Jarrold established a regional system of personal and organisational development.

Ms Humphris left Wessex in 1995 to become chief executive of Portsmouth and South East Hampshire HA, overseeing its merger with Isle of Wight HA in 2001.

The Leadership Centre is part of the Modernisation Agency, which Ms Humphris says is important 'for getting the service improvement aspects in place'.

It employs 55 people, mainly from offices in London and Manchester, and is not expecting to expand. Ms Humphris wants to work closely with staff with leadership development responsibilities, based in SHAs or other appropriate organisations, to 'get a feel for what is happening on the ground'.

The centre has a budget of£27m, of which£18m is available for leadership development. The rest goes on salaries for people on the management training scheme.

The MTS, which is due to expand this year, is one of the best known programmes for which the centre is now responsible.

It also oversees the chief executives' development programme, which is due for a relaunch (see box 1), the HR development programme and the 'leading empowered organisations' programme for nurses and other health professionals.

The HR development programme is relatively new - the third cohort has just started - but Ms Humphris already wants to extend it. She says a 'whole range of directors' already use it, because of the importance of workforce issues to director-level jobs.

The leadership centre is likely to become more visible this year, as these programmes expand and new ones roll out, linked to Managing for Excellence in the NHS, a document unveiled by NHS chief executive Nigel Crisp at the end of last year.

The centre has already commissioned France-based international business school Insead to develop a fast-track leadership development programme for people with a clinical background, which should cater for 100 people over 15 months.

And it is planning a highprofile launch for a new programme to recruit senior managers from outside the NHS into relatively senior jobs (see box 2).

By the end of the year, Ms Humphris says she would like the centre to be 'delivering the national programmes; working with strategic health authorities to support service improvement; and building up a body of knowledge about what works nationally and internationally in terms of leadership development'. And after that, it seems, the sky's the limit.

Box 1: career management and succession planning for senior managers

Planned and supported career progression for senior NHS managers and the development of a pool of people to draw on for the top jobs are two linked ideas that have been discussed for at least a decade.

In the early years of the Labour government, there seemed to be a career development initiative a year, starting with Executive Choice in 1997, while then health secretary Frank Dobson talked about creating a 'cadre of highly trained professionals' for some of the most demanding posts.

The latest version of this is NHS Leaders , a 'career management and succession planning scheme'. People on the scheme will be able to record information about themselves on a protected website. Boards and appointing officers can then draw on this information when identifying candidates for posts. There will also be more systematic appraisal and development.

The scheme will be open to 1,000 people, including chief executives and senior doctors. In time, strategic health authorities will be expected to develop similar initiatives.

'It is based on best practice in the private sector, ' NHS Leadership Centre director Penny Humphris says.

'You should be able to see who the best person is to, say, take over at University College London Hospitals trust when [chief executive] Bob [Naylor] decides to move on to higher things - if there are any!'

The scheme would not do away with open advertisement, but Ms Humphris says it is a 'corporate innovation for the whole NHS, from which the whole NHS should benefit'.

Box 2: NHS Gateway to Leadership

One of the most innovative new programmes to be overseen by the leadership centre was launched very quietly last year.

NHS Gateway to Leadership, a management training programme, is designed to bring senior managers into the NHS at just below director level.

Advertisements in broadsheet newspapers and other 'upmarket' media last September attracted an astonishing 1,200 responses for 42 places.

National programme lead Simon Bird says the applicants came from 'an incredibly broad range' of blue-chip international companies, merchant banks, the armed services and other public sector organisations, such as the police.

'Making massive generalisations, there are two groups of people who applied, ' he adds.

'There are those who recognise the skill involved in modernising the NHS and see this as a work challenge. But at least two-thirds made some reference to values - and the way in which the NHS links with their personal values.'

The programme developed out of Managing for Excellence discussions on how to overcome barriers to bringing people with a range of skills and experience into the NHS.

It is aimed at people with at least four years' experience of leading a large department and with a 'record of achievement'. Recruits are guaranteed a starting salary of£40,000, though Mr Bird says one programme entrant is taking a pay cut of£30,000.

The 18-month programme will offer training and support through five residential courses and six learning sets, which will give people a chance to swap experiences and build professional networks.

Some of the 'most able' people are likely to move on to higher-level jobs before the end of the programme. Others will have to make their own way - though Mr Bird thinks it unlikely that NHS organisations will just say goodbye to senior people at the end of 18 months.

The leadership centre is planning a big launch for the programme this March, with a longer period of advertisement and selection before a second wave next year.