The Real Challenges Of Leading In The NHS

Leading in any organisation is a challenge. The NHS in no exception. From the outside looking in, it might seem obvious what needs to happen.

When I first worked in the NHS in the early 80’s things were very different. Hospitals were a whole lot smaller. Life expectancy a whole lot shorter and of course there were not the technological advances or research that there is today.

These days the picture is very different. Not only has there been a huge change in life expectancy, there has also been a huge change in the wider environment. Technology is one of these areas which have changed the way in which we function day to day. It’s also resulted in a desire for instant results.

So what are some of the real challenges of leading in the NHS?


Even what might be deemed a small organisation in NHS terms is huge compared to most other organisations. It’s not just at an organisation level that there are significant differences in size. A Directorate in a hospital can often be the equivalent of a medium sized private company.


If you are a major retailer for example you are dealing with large scale processes. Yet it is fair to say that there is not necessarily the complexity that there is in an NHS organisation.

Numbers Of Non Clinical Leaders

We are forever hearing that there are too many managers. Again this is debatable in my view. If you look at the number of non clinical leaders, we are actually looking at a very low percentage. Often these leaders have a huge span of responsibility.

In many ways you really need a Board that focuses on the moving forward agenda and another that focuses on the here and now agenda. Yet it’s fair to say that this sort of structure would probably be hugely criticised if ever put in place.

Moving Goalposts

Anything where there is public funding there is a lot of meddling from politicians. Often the NHS becomes a bit of a political football. In addition the priorities of each party mean that those trying to lead are faced with ever moving goalposts or priorities.

Media Attention

Public funding brings with it public scrutiny. Some would say that’s a fair trade. The trouble is in an organisation delivering the volume of services the NHS does every day, naturally some things are going to go wrong. It’s easy to feel that things are a lot worse than they really are.

Hands Tied Behind Your Back

A commercial business can decide it’s strategy, what markets it operates in and those that it won’t operate in. In many ways they are determining their own destiny.

In the NHS there is quite a lot that leaders at a local level have at best limited influence over while still being accountable.

The Desire For Instant Results

Change in any organisation takes time. Sometimes it can seem like leaders in the NHS are expected to deliver instant results- especially when it comes to making change.

While it is hugely rewarding leading in the NHS, don’t underestimate the real scale of the challenge of leading in the NHS.

Goals and Achievements help health professionals to become even better leaders.