A Different Kind of Leadership for the NHS

Over the last few weeks we have seen the unfolding story of a health secretary in a battle with Junior Doctors (of which there are 53,000). Under-girding the entire debate is a manifesto promise made by the Conservative government that they will deliver a 7/7 NHS. There has been a misuse of statistical evidence by the government to inform this position and indeed we do already have a 7/7 NHS.


In order for this promise to become a reality, the government must face up to certain facts, which are obvious for all to see. Firstly, the NHS is underfunded and rearranging pay agreements with junior doctors who are already underpaid is grossly unfair and will not achieve the desired affordability. Secondly, the NHS is understaffed (we already have one of the lowest doctor to patient ratios in the EU). Thirdly, morale among NHS staff is low, and much of this is due to staff being used as fodder to drive the system, rather than cultivating a system in which they are cared for, can flourish and can influence change in the system where it doesn’t work. Pushing more work for less pay will not drive up morale! Fourthly, the slashing of local government budgets is causing a social care crisis that has huge implications on the ability of the NHS to function. Fifthly, public health budgets have been reduced to a bear minimum at a time when we know we need to have wider conversations with the citizens of the UK about how to take greater care of their own health and the health of their communities in order to make the NHS sustainable. Sixthly, the problems with weekend care in our hospital systems are a result of a lack of support staff and services available over weekends and a crumbling social sector which blocks up hospital beds. Needless to say, the situation is complex.



imagesAnd so, given such a complex problem, how should the system be lead and managed? With an iron rod? With bullying, top down hierarchy? With “visionary” leadership that knows how to do the “right thing”? With the defeat odownloadf the ‘militant’ junior doctors? What kind of system is the NHS? It is not a linear, predictable system, but rather something far more akin to a human body, a living, organic system. Meg Wheatley in her book, “Leadership and the New Science” writes powerfully about the folly of trying to manage complex systems as though they respond to the theories of Descartes and Newton – they simply don’t behave that way. And so, this kind of system cannot and will not respond best ┬áto competition, targets, inspections and beating its members into submission. No, it will respond best to collaboration, to the right environment in which people can thrive. It requires the kind of leadership that will listen, that will work in partnership, that will host good conversations and find a way through together. I do not see that kind of leadership from the department of health.


imagesThe NHS is a national treasure. Yet, this government, with only 36% of the national vote, from an antiquated and unjust ‘first-past-the-post’ voting system, is driving through ideological changes that it has no true mandate from the people to execute. This kind of political behaviour exposes more than ever the abuse of sovereign power and the need for something totally different. We need leadership, but we need a new kind of leadership, a leadership that is loving, compassionate and kind, collaborative, listening imagesand releasing, a leadership that believes for the best and a leadership that invests in the kind of health service we need to deal with the health inequalities we see. We need that kind of leadership now. We need a different kind of government and a different kind of politics now. It is emerging in the margins, but we need leaders at the centre with a new kind of heart.

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Walk Out, Walk On




I’ve recently returned from a fantastic holiday in one of my favourite places – La Belle France. It was a wonderful time of relaxation, restoration, reconnection and reflection. My summer reading was the quite simply stunning book, “Walk Out, Walk On”, by Meg Wheatley and Deborah Frieze, recommended to me by Prof Stuart Eglin. It resonated with me, provoked, challenged, encouraged and envisioned me and I heartily recommend it as a MUST read, if you haven’t done so already.

It flows in the same stream as ‘The Art of Hosting’ and is refreshing in its style – one of learning, rather than teaching, an invitation instead of an instruction manual.

The basic premise of the book is this: many of the current systems we have, “are failing to create solutions to the very problems they were created to solve.” They have become large, over-organised, lumbering bureaucracies that stifle creativity and use people to support and uphold the structures, rather than releasing the people and supporting them to live and work more resiliently.

When we recognise that a system is failing, we can spend an enormous amount of time and energy trying to put sticky plasters on it, attempting to fix and repair what is there. Perhaps this is because we are afraid to let go, perhaps because we develop a kind of idolatry or sentimentality towards what was or we simply cannot imagine a different way of being. But there are pioneers who look for new alternatives and they fall into two types.

1) Some will look to create new alternatives within the structures and help the old transition into the new.

2) Others will create new alternatives outside of the old system and invite others to slowly join as they discover new ways.

Both pioneering types are vital – and share the same core DNA – they are ‘Walk Outs’. What is vital is that they don’t just walk out, but that they walk on to reimagine a different future. Walk Outs are not motivated by greed or power, but by love and kindness, recognising the damage caused by the current system and looking for an altogether better way.








Walk Outs can often feel quite isolated and alone, but once they begin to find each other, connection and community become key ingredients to finding the way forward.









This challenges our management school and well rehearsed ideas in western thought about how growth and change occurs within organisations and systems. We do not need to continually look for maximising growth and profit. There are alternative motivations and more sustainable futures than the ones we are currently choosing.

My personal focus in the next few blog posts will be to apply this to the NHS and healthcare at large. I will take each chapter in turn and draw out some of my learnings from the amazing communities around the world brought to life in this book to help reimagine what healthcare is for.

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