An NHS leadership team for the future

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Executive summary

All healthcare systems recognise the importance of the clinical workforce in delivering high-quality care. An ageing population, a growing burden of chronic disease and rising costs hasten the need for reform. One year ago, the Five Year Forward View set out to address these demographic, financial and quality pressures. It proposed new, integrated models of care with a radical push on efficiency, a better relationship with patients and communities, and a greater emphasis on prevention and public health. Visionary leadership will be essential to realising its aims.

Developing clinicians as the ‘agent for change’ has never been more important. This report seeks to evaluate how the NHS is preparing future clinical leaders for this responsibility. The NHS has access to 50,000 junior doctors who are among the highest performing young people in the country. It is an unparalleled resource in comparison to many corporations and organisations operating in the UK today.

An international body of evidence demonstrates the value of clinical leadership. The Francis Inquiry into failings of care at Mid Staffordshire NHS Foundation Trust highlighted the detrimental impact clinical disengagement can have on the quality of care patients receive.

There is a need for greater clinical engagement and leadership at national and local level. In contrast to healthcare systems internationally, few NHS hospital CEOs have a clinical background. In most trusts 10-20 per cent of consultants are in formal leadership roles. These clinicians are largely responsible for quality and rarely for major budgets.

In order to address this, the NHS must first make leadership an attractive option for clinicians. At present, progression in medical careers continues to undervalue leadership. Creating a culture which values clinical leaders requires changing the language and understanding of what it means to be a leader, centred on a shared commitment to high-quality care.

Secondly, clinicians must be placed at the centre of the ‘value agenda’. Clinicians have significant purchasing power; the NHS currently spends £3 billion on products and consumables selected by clinicians, but with variation in outcomes and costs. Effective clinical leadership is required to reduce waste and to address the growing challenge of overdiagnosis and overtreatment.

Thirdly, medical schools must accelerate the incorporation of healthcare management into undergraduate curricula to equip future clinicians with leadership acumen. The tradition of healthcare management being restricted to senior clinicians can be reversed, starting with educating medical students and continuing with opportunities for clinicians-in-training.

Lastly, the NHS needs to take a system-wide approach to developing the clinical leaders of the future. High-performing organisations in other sectors have made a unified ‘high-potential’ talent management programme a priority. In contrast, strategic direction of the development of clinical leaders is divided between a number of national and local leaders. The NHS requires an aligned clinical leadership talent management pipeline, combining clinical practice with leadership experiences and training. This novel approach would allow the NHS to consistently develop clinical leaders and match them with service requirements.

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