3rd June 2013 

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Just one will do     
News and Comment from Roy Lilley

The NHS's latest fad is annoying me.  Never was there so much snake oil and quackery.  In the name of St Francis, whose report seems to have taken on Biblical authenticity, 'leadership' is the new black.  It is fashionable.


Recommendation 214:


A leadership staff college or training system... to... provide... professional training in management and leadership to potential senior staff... promote and research best leadership practice in healthcare.


Ignoring a college is not a system and management is not leadership and research is a job for the Uni's, this muddle of a recommendation; that professional management should be improved, has been overshadowed by the more glamorous idea that leadership is the 'thing'.  Well is it?  Some say if you believe someone has to be 'in-charge', that is the core of organisational ineffectiveness.


Competent, sensible, qualified, experienced management is the quality the NHS is most short of.  Time-served managers have taken the cash and are way-gone.  The NHS' engine room is missing some oomph.


Good management enhances performance.  True.  It is also true that the NHS does not perform at its full potential.  There are further gains to be had and most of them can be achieved by better management; 'precision management'.  More accuracy and truthfulness.   


I mean truthfulness in the sense that as investment in the NHS is overtaken by demand, enhancements in performance, that translate into productivity gains, have a ceiling. It is at this point 'leaders' often acquire the Kamikaze Syndrome and frankly, we've had enough of them.


Precision management takes organisations in a different direction.  Decisions that lead to a greater level of truthfulness, or frankness about what is achievable, will define the 'new reality'.


Truthfulness emerges as a key competence when an organisation is faced with the unachievable.  Soldiering-on, to protect reputations and careers, not confronting the real issues leads to an environment fertile for fraud, fictions and fabrications.  Obfuscation, cover-ups and smokescreens disguise the actualit� and defer the inevitable. 


I'm coming to the conclusion precision management is more important than leadership.  


There seems to be an assumption that high performing managers, at the top of the NHS, are 'leaders' that ambitious managers should mimic.  We have to discover their secrets, their mysteries and their magic.


I doubt there are any secrets.  There is no mystery and certainly no magic.  Most of the current top bosses gained their reputations and status at a time when the NHS enjoyed unprecedented periods of increased funding.  How much 'leadership' does it take to run a hospital when, year-on-year, there is more and more money.  Sure, it takes ambition, planning skills, ideas and the ability to deliver but few at the very top of the NHS have had their 'leadership' tested.


Since 2010, when the money ran out, how many scandals, budget-busts and data cover-ups have we seen?  How many Chief Executives have left, moved-on or got the sack?  They have been exposed by the upward pressure of the bottom line.    


Mark Britnell, the man most likely to succeed the Big-Beast, tells us there are maybe 40+ hospitals that have borderline outcomes and red hot finances.  They will probably not survive intact.  He is right.  The lack of precision management has been exposed by the twin forces of demand and finance.  I'm tempted to say their Board members have been 'coasting'.   (I know... Ouch!). 


The next phase of the NHS, post 2015, when it could be looking down both barrels of �50bn savings, will test NHS management talent to to destruction.


Leadership?  It's pretty clear; the NHS is in free-fall.  Around one in ten senior 'leadership' roles are vacant.  At the top, no one is leading the NHS.  No amount of 'leadership training' is going to fix this in time to do anything useful.   


The Big-Beast is in the departure lounge looking out of the window.  Le Tache travels First Class and looks down on everyone else. LaLite looks at the front page of the Daily Mail and goes in whatever direction it blows him.  This time it's a new inspector.  I expect him to announce an inspector to regulate the inspectors regulating the inspector who inspects the regulators any day now.  No one is impressed, not even the readers of Daily Mail.


Leaders are visible, have a vision and share it often.  They create the time and space for those around them to be the best they can be.  They have integrity, get people excited about coming to work and have the ability to stand back and solve a problem.


An army of new leaders?  Too late.  Right now, just  one would do

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