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Should more NHS organisations be led by people from clinical backgrounds?

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It’s certainly an attractive idea on first mention, which is presumably why Jeremy Hunt announced a new policy on it last month. But is it merely an example of something that sounds good?

In his keynote speech at the NHS Providers conference, the health secretary called for more nurses and doctors to be occupying positions “at the most senior levels” of the NHS.

He highlighted that currently just 34% of NHS chief executives in England had a clinical background, compared to 74% in Canada and the US, and 94% in Sweden.

The government would, therefore, introduce new programmes with Yale University in the US and universities in the UK to “fast-track” nurses and doctors into leadership positions, he said.

“Do clinicians make better managers in healthcare organisations?”

All sounds good, but do clinicians make better managers in healthcare organisations? Not necessarily I would say. I would argue that good leadership is not always something you can teach with a management course and often what makes a great nurse or doctor doesn’t always translate into a non-clinical role.

Don’t get me wrong, I’m not saying that nurses and doctors do not make great managers. It’s simply that being a clinician does not necessarily guarantee a good leader, in the way that the health secretary seemed to imply.

For example, at a lower level, there is the recurring debate around ward managers. It has been the NHS tradition to promote the best nurses into the roles of sister and charge nurse – but not always with success, because being a good clinician is different to being a good manager.

I would suggest the same is true with my profession. The best reporters and writers do not necessarily make the best editors.

“It was merely suggested that it was a good thing to have clinicians in senior roles”

Mr Hunt highlighted other countries as having more former clinicians in senior roles, but did not explain why he thought that was automatically a better thing to have or link it to better outcomes or patient safety etc. It was merely suggested that it was a good thing to have clinicians in senior roles.

Of course, there are some great examples already. As Nursing Times recently reported, Cathy Geddes has rightly been praised for doing a great job as interim chief executive of Mid Essex Hospital Services NHS Trust, having stepped up from the chief nurse role.

The government itself highlighted Dame Julie Moore, chief executive at University Hospitals Birmingham NHS Foundation Trust, as an example of a top performing manager with a nursing background.

Dame Julie was appointed to the role in 2006 and now also leads the turnaround teams for two poorly performing trusts in special measures. In 2013, she was included in the first BBC Radio 4’s Woman’s Hour list of the 100 most powerful women in the UK.

“In the past decade I remember quite a few chief executives from nursing backgrounds being linked to struggling trusts”

Actually, I’ve noticed more former nurses being appointed into senior trust positions over the last few months, although it’s probably just coincidence.

Just this month, it was announced that Dudley Group NHS Foundation Trust had appointed former nurse Diane Wake as its new chief executive, while it was revealed that Michelle McKay, a former emergency nurse from Australia, will take over at Worcestershire Acute Hospitals NHS Trust.

But, equally, in the past decade I remember quite a few chief executives from nursing backgrounds being linked to struggling trusts, particularly in community settings.

I would argue that the system is already nicely balanced. There are directors of nursing, chief nurses and medical directors at every level from trust boards to the top of the NHS structure, who are there to advise from their own expert position, in the same way as the number crunchers and other specialists in other management roles.

And of course, if more nurses go into NHS management that means fewer in senior positions within the profession itself. Likewise, for doctors.

“Of course, it’s not fashionable to defend NHS managers”

One can imagine that being a manager with a clinical background gives you greater intuition about care services and sympathy for staff. But does it make you a better leader or better at juggling finances or resources?

Of course, it’s not fashionable to defend NHS managers and it’s long been common for politicians – regardless of party – to score easy political points by arguing that the NHS is top-heavy with managers and that there need to be fewer of them.

It seems the new vogue is for clinicians in senior management roles – seemingly with the exception of the Department of Health of course, where they have just axed their nursing advisory unit.

Again, I return to my own situation for comparison. Would I prefer to have a journalist as my chief executive, rather than someone with a more business background?

Maybe I would, from a purely personal point of view. But does it make any difference to how well the company is run? I would have to conclude probably not. I suspect the same is true of the NHS.

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