Is It More Challenging Leading In The NHS Now?

Recently I have been conducting a series of interviews with those who currently are in or were previously in leadership roles in the NHS.

One of the questions I have been asking is whether leading in the NHS is more challenging than it was in the past.

There is without doubt consensus that leading in the NHS brings some real challenges. Some say that it is easy to look back and say how much easier than it was then.

There are some interesting themes arising and some of my own that I would offer.

Organisations Have Got Significantly Larger

The first combined acute, community and learning disabilities that I worked in had annual income of less than £50 million. These days it is unusual to find a trust with much under £200 million income, event a specific sector one.

Expectations Have Increased

So many things have moved at pace over the last 10-15 years. Look for example at technology. It would have been hard to imagine people speaking to each other across the globe, especially for free. As people get more in one area they expect more in other areas.

Life Expectancy Has Changed Significantly

This creates a whole new set of pressures and demands on the service. Not just in the hospital setting but in out of hospital services too.

The Global Economy Is Fragile

As result of the fragile state of the global economy there is less resource to allocate to health or sufficient growth in resources to meet all of the different pressures.

There Is A Difficult Balancing Act

Leadership teams and organisations are expected to meet financial, quality and activity targets. They are all interconnected. If the focus was just on one of these areas the job would be a whole lot easier.

Information Is More Freely Available

The internet has allowed it to be much easier for patients and relatives to research conditions, drugs and protocols than it ever was. This changes the dynamic between clinical professional and service user.

Media Attention Is Continually Increasing

Being such a huge organisation, the NHS is a great source of news for the media. Added to this there is easy access to social media for service users.

Events At Some Trusts Create Uncertainty Across The Whole Service

Mid Staffordshire NHS Foundation Trust highlighted some of the really significant consequences of losing sight of the core purpose. South London Healthcare NHS Trust where a Trust Special Administrator was appointed highlight the consequences of losing grip on operational and financial challenges.

The Reality: Leadership roles in the NHS have always been and will continue to be highly challenging, whatever is going on in the wider economy.

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