Brilliant leadership in the NHS is music to my ears

There are many things I like about being retired. One of them is the possibility of living a life to a different drum beat. For me, this often means that everything that needs to be done, or I want to do (and sometimes happily the two things converge) gets done, but at a much less frenetic pace. I think I’m less obsessional about things these days as well. For example, whilst I still wake up at 5am every morning – no alarm clock required - I no longer feel the urge to go online, or get up straight away, and feel quite at ease enjoying a slower start. I have even found a way to tune out the mutters of ‘some of us have to go to work, again’ as J gets herself ready to leave for work.

Another thing I don’t do any more is update my CV every week. Yes, I used to be fairly obsessional about keeping it up to date. Even when there wasn’t anything to add, I would read through it and maybe tweak it a bit here and there. Academic CVs are peculiar. For a start they tend to be long. Mine runs to 28 pages and tells you nothing about me as a person other than I write and publish a lot, have spoken at countless conferences, taught, assessed and supervised the work of others, and sat on many committees, boards and even, just once, a thought leader group!

Late last year I had to rethink my CV. I had been approached by one of those pesky headhunters, who thought 28 pages was a lot of CV to get through. So, I rewrote it, and reduced it to just six pages, and this time you did get to see who I was: an academic, practitioner, manager and human being. Nevertheless, I didn’t get the job. Had I done, I would have been able to sleep at night knowing that everything on the CV was true, authentic and interesting. Unlike, it seems, Peter Knight. He was the former Chief Information and Digital Officer at the Oxford University NHS Foundation Trust. It was a Board level role, and he was paid £130,000 a year for it. Although he was said to be good at his job, he was also a fraud, claiming to have a Classics Degree on his CV when he didn’t.

Following an anonymous tip off, which sparked an investigation, he resigned from his job, and last week was sentenced to a two-year jail term and ordered to carry out 200 hours of unpaid work. I imagine he will also have to pay the trial costs and compensation for the salary he was paid. He declared that it was the recruiting firm that had added the line that said he had a degree. I doubt that very much and, in any event, it’s his CV and he must have known what was in it!

It is managers like him who frankly give managers and management a bad name in the NHS. Actually, I vehemently dislike the term ‘management’, particularly when it’s used as noun – as wonderfully illustrated by Hale and Pace here. And, I think, for too long, managers in the NHS have suffered a bad press. Who doesn’t remember the New Labour (2002) cry of turn ‘grey suits into white coats’ as a way of resolving all the problems of the NHS? In reality, there are not enough managers in the NHS. Study after study have shown this, yet the urban myth that there are too many managers persists like a blood stain on a white sheet.

Back in 2018, hospitals in England were recruiting managers at a faster rate than they were doctors and nurses. And whilst NHS Improvement claimed there were still too few managers, the Royal College of Nursing (RCN) called the increase ‘galling’ at the time. Perhaps they forgot how many of their members also had a managerial role – I know, a bit controversial, but I was once one of these folk and I think I did a fairly good job of managing those services for which I was responsible. In 2017, the NHS was ranked as the most safe, affordable and efficient service in the world by the US think-tank the ‘Commonwealth Fund’. The ‘NHS Long Term Plan’ notes that for every Great British Pound spent by the NHS, just tuppence is spent on managerial and administrative costs. That sounds like great value to me. Well, that is, if our managers and leaders are doing an effective job.

Given the ever-increasing complexity of providing contemporary healthcare, effective (and yes, efficient) managerial expertise is essential. But of course, we shouldn’t see this as an either/or situation. We need world-class nurses, doctors and allied healthcare professionals alongside world-class managers and leaders. If we can combine these roles in the future, so much the better. One of the colleagues at the University whom I most admired was a radiographer by profession, but also a wonderful researcher and a brilliant leader – hats off to you Peter! He demonstrated that it’s possible to be a healthcare practitioner and also deliver great leadership and transformational management.

In the NHS, managers make up just 3% of the total workforce. Elsewhere in the UK economy, managers make up 9.5% of the workforce. If we were able to find even just 1% of the next generation of Peters across the NHS it would cost just £500 million, which in an annual NHS budget of nearly £140 billion is rather a small cost. My belief is, unlike Tesco, Sainsbury and as of last week Morrisons, all of whom have reduced or plan to reduce the number of managers they employ, the NHS needs to invest in more, albeit infinitely better, managers.

Last word on effective management has to go to Julian Richer. He is the Founder and MD of Richer Sounds, the UK’s leading Hi-Fi music store. Last week I enjoyed listening to him on the Radio 4 programme ‘You and Yours’ where he was talking about his approach to management – which includes: no zero hours contracts, a pay gap that favours women, job perks (for everyone) that include access to holiday homes around the world, and a consistent donation of 15% of the profits to charities – which last year equated to nearly £10 million. As my friend and former colleague Umesh has said on many an occasion ‘happy staff means happy patients’.