For students of leadership and management, these are interesting times. Two very different people, in very different worlds, have been teaching those open to learning.

It is an unlikely pairing – Barack Obama and Spurs manager Harry Redknapp. The NHS can learn a great deal from these two examples.

There are many clever and impressive definitions of leadership and management. Mine are simple. Leadership is showing the way – knowing what to do next – and is therefore not dependent on role or seniority. Management is the responsibility for the use of resources and is dependent on role and seniority.


First, the Obama lesson. The president-elect is not yet a manager. Until now he has not had the responsibility for the use of resources. However, for me and for millions of people across the world, he is a leader because he seems to have a credible view of what to do next and every intention of showing the way.

Chief executives and directors are managers. Many are among the most powerful managers in their areas and control vast resources. But they are not necessarily leaders.

Being appointed to a post does not endow you with the ability to show the way and to know what to do next. Unfortunately their masters do not seem to understand these differences and they place on chief executives, in particular, a daunting burden of expectation. This is not helpful.

True leadership

Chief executives need to understand that, for all their formidable management responsibilities, they are not necessarily leaders and, if they do not know what to do next and have difficulty in showing the way, their job is to create an organisation in which leaders are encouraged and listened to at every level.

In a healthy organisation, leadership comes from all levels – from clinicians, frontline staff, patients, carers and the voluntary and independent sectors.

And so to primary care trusts. PCTs are, potentially, very useful organisations. They can work with others – most notably communities and local authorities – to improve the health of the people they serve. They can also shape services by setting out clear service specifications and care pathways and by deploying resources. But it is not sensible to burden them with the expectation that they will be the leaders of the local health service.
Locally, leadership is just as likely to come from foundation trusts and their vast array of expertise and knowledge and from local authorities and communities. I suspect that the leadership potential of PCTs is being harmed, and not enhanced, by the burden of expectation placed on them by world class commissioning.


Second, the Harry Redknapp lesson. It is simple but powerful. Managers control resources, but if they wish to be leaders they must show the way and know what to do next. To improve performance, they need to enthuse and inspire as well as manage. Whatever is going right for Spurs, and however long it lasts, for the moment Harry is doing the business.