The Francis report into the Mid Staffs NHS foundation trust identified poor leadership as a key factor in the disastrous failures in patient care. It recommended the creation of a "leadership staff college to provide common professional training in management and leadership to potential senior staff".
Since this college should have a "physical presence" – a virtual organisation is ruled out – it will take a long time to establish. It will take even longer to deliver skilled leaders and the college will be forced to focus on senior managers; it would be a miracle if such a college could make any measurable impact on the NHS in the next decade.
Yet it is clear that improving leadership skills needs to be addressed with greater urgency. The nature of healthcare and the way it is delivered is set for radical change over the next decade. These changes will mean leadership roles are devolved down to more junior professionals and across a wider range of disciplines. As a result, it is not only senior managers who will need leadership training but clinicians at all levels.
Strategic initiatives such as community-based care, the use of clinical pathways (the standardised care provided for specific conditions), telemedicine and the pressures of an aging population will increase the need for clinical leaders, often at junior levels, to co-ordinate the delivery of care to patients.
For GPs, the challenge will be to move away from a culture of referral to one where they take ownership for all of the patient's care and provide strategic co-ordination of the care pathways used to treat patients with multiple conditions. Within this framework, the practical day to day treatment may well be managed by a more junior clinician.
They too require skills such as planning, prioritisation, decision making, influencing, as well as knowledge of multi-disciplinary team working, and the ability to mentor and learn from others. Leadership needs to be a central part of clinical education.
All these pressures underline that now is the right time for the NHS to give leadership training greater priority. A new body, Health Education England (HEE), has been established that operates through 13 local education and training boards (LETBs). Training strategies are under review and we should expect changes in the content and delivery of training within and across professions as LETBs flex their muscles.
As ever, some will say that a greater emphasis on leadership training might be desirable, but no money is available and boosting it would be at the expense of vital clinical training. There are two key responses to this. Firstly, HEE will spend £4.8bn annually – just 1% of that could provide initial training for up to 100,000 NHS leaders each year.
Secondly, leadership training would improve patient care not undermine it. Good leadership skills result in better clinical outcomes by ensuring that correct values and standards are maintained, that clinicians are motivated and can focus on using their talents for the benefit of patients.
To achieve a lasting boost in leadership, the LETBs need a two-pronged strategy. Firstly, they need to meet the immediate needs of the NHS by delivering training to the existing workforce. They need to work with employers to identify those in leadership roles and deliver appropriate training to them. The NHS has recently set up a leadership academy, which has made a start on developing programmes for some of the mid-level professionals.
To meet longer term needs, HEE and LETBs should work with royal colleges, universities and medical schools to build leadership skills into the initial professional training. It should be built around the core NHS values and ensure that newly qualified professionals start with skills they can build on as their careers develop.
This is essential because good leadership is necessary to deliver high quality 21st century healthcare. Just as patients would not want to be treated by untrained clinicians, they should not be expected to receive treatment in facilities led by those who have had no training in leadership.
Stephen Brooks is a specialist in people, change and leadership, and Anthony Surley is a specialist in talent management and healthcare at PA Consulting Group
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