Is the NHS leadership crisis actually a management crisis?

Over the past year much has been written about the NHS leadership crisis. A recent report stated that a third of hospital trusts have vacancies on their boards and a fifth have no finance director. So, we can safely conclude that there are indeed too many gaps at the top.

However, is it leaders the NHS needs, or managers? What exactly is leadership and how does it differ from management? Ask the man or woman in the street to name five great leaders from history and they will probably be able to rattle off a list of names from Alexander the Great to Winston Churchill. Ask for five great managers from history and you will be in for a long wait! This could be because the terms ‘leadership and management’ are constantly conjoined, and often used interchangeably, but they are actually different skills:

  • Leaders create vision and set direction. Managers organise people and resources to serve that vision / direction.
  • Leaders create their own authority. Managers have authority bestowed upon them.
  • Leaders are followed through choice. Managers are followed through the promise of extrinsic rewards.
  • Leaders seek change. Managers seek stability.
  • Leaders take risks. Managers minimise risk.
  • Leaders break rules. Managers make rules.
  • Leaders think radically. Managers think rationally.
  • Leaders are proactive. Managers are reactive.

With the above criteria in mind, consider the following quote from Stephen Bridge, Chief Executive of Papworth Hospital NHS Foundation Trust:

“I guess the perception of NHS provider chief executives is that we [have] similar sweeping powers to chief executives of multi-million pound corporations in the private sector, the reality is quite different – we have loads and loads of red tape, multiple stakeholders to consult and, frankly, not much delegated authority.”

It doesn’t take more than a quick glance to realise that what Bridge describes is more management than leadership. With everything down to (and probably including) the colour of the paper towels being dictated by Richmond House, what is left for a leader to do? The aforementioned Winston Churchill was principally a leader, which could explain why, when World War Two ended in 1945, people were looking for a different kind of person to manage the rebuilding of the country. That is not to suggest, of course, that an individual necessarily has to be either a leader or a manager. Most people will sit somewhere on a continuum between leader and manager, because to be effective both sets of qualities need to work in tandem. Leadership without management results in chaos, management without leadership results in stagnation.

However, with the NHS as it is currently structured, it has to be asked whether the real need is for inspirational leadership or effective management?

If you have any thoughts or suggestions sparked by these items please get in touch.