Why the ambitious vision of developing tomorrow’s leaders is quite a challenge at a time when the NHS is undergoing so much change. By Marcus Powell and Sally Hulks

The Secretary of State for Health last week called being a CEO in the NHS “one of the most difficult jobs in Britain”. Why would anyone be attracted to these jobs?

The answer can be found in our recent report, The Chief Executive’s Tale, based on interviews with experienced NHS leaders.

The report found that being a chief executive in today’s NHS is often a stimulating and rewarding responsibility. The opportunity to make a real difference to the lives of patients provides a strong motivation that is rarely on offer in other leadership roles.

The report also found that the pressures under which chief executives work have grown enormously. It’s essential that the intrinsic motivation of people to make a difference to people’s lives isn’t dampened by a system where all the usual leadership levers to act are removed.

We know there are some pockets of fantastic work across the system which the strategy is excellent at wanting to promote and yet there are obvious areas to improve.

If we want to keep and retain talented people and make health care as good as it can be, there is an urgent need to make sure that the culture of the NHS is designed to attract and retain the best people.

This is why the NHS’s new national leadership and improvement strategy, published last week, is really important. Its ambitious vision for compassionate and collaborative leadership and its focus on developing talent within the NHS is exactly the right approach. It offers the opportunity to become a beacon around which future leaders can be nurtured.

The strategy’s authors rightly acknowledge that it is likely to be greeted with some scepticism. People working in the NHS will ask themselves whether this is really the harbinger of change or just another document destined to gather dust on shelves.

We know there are some pockets of fantastic work across the system which the strategy is excellent at wanting to promote and yet there are obvious areas to improve.

The NHS needs to be given hope that the issue of talent management and leadership development is really understood. The short to medium terms actions that the strategy outlines we fully support and if delivered well will be a tangible demonstration that things will change.

However, the strategy is candid about the lack of new resource to deliver its vision. This is realistic but also challenging because at a time when the NHS is undergoing so much change, developing tomorrow’s leaders does require some investment.

If we want to keep and retain talented people and make health care as good as it can be, there is an urgent need to make sure that the culture of the NHS is designed to attract and retain the best people.

Another risk for the strategy is that change needs to start at the top if it is to stand any chance of success. Leaders of national bodies will need to behave in the kind of collaborative and compassionate way that has not always been the case. Actions, as always, will speak louder than words.

The difficulty is that the directive leadership style so common in the NHS can get short-term results. Leaders will need to resist the temptation to revert to this style the next time there is a target or deadline to be met.

This is particularly difficult because meeting those targets and deadlines is often vital for improving patient care and so it is important that leaders are held to account for this.

This means the challenge of keeping the focus on culture change when most of the benefits will only be realised in the medium term should not be underestimated.

We are, though, optimistic that this is achievable. And if the aspiration for a collective and compassionate culture were to become reality then it would have a profound effect on the NHS’s ability to care for people because the whole system would enter a virtuous circle that would result in higher quality patient care.

It would also create a much better working environment that, together with the great strengths the NHS already has – an abundance of passionate and committed people and the reward of having a positive impact on people’s lives - would add up to a uniquely powerful employer proposition.

The NHS needs to be given hope that the issue of talent management and leadership development is really understood.

It would mean people attracted by the chance to make a difference that a career in NHS leadership offers are less likely to be put off because they are unsure about the culture. It would mean that the best people already working in the NHS would be more likely to stay because it is a good environment to work in.

The job of an NHS chief executive would go from being, as Jeremy Hunt puts it, one of the most difficult jobs in the UK to one of the most sought after.

Improving the NHS’s ability to attract and retain talent would, in turn, improve the NHS’s ability to offer consistently excellent health care to the people it serves. We can see the impact of good chief executives working in NHS organisations that are already doing great work serving their communities.

The Care Quality Commission’s recent State of Care report found evidence that good leadership can reduce variation in quality of care and is essential for sustaining high-quality care, while services that improve tend to have leaders who promote an open and positive organisational culture.

This is why being a chief executive remains stimulating and rewarding and why investing in the leaders of the future must be supported.

Marcus Powell is director and Sally Hulks is assistant director of leadership and organisational development for The King’s Fund