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'Spot the visible difference – or see outdated NHS leadership'

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The Health Foundation, like many other commissioners of and commentators on leadership, has been looking at leadership throughout the workforce.

This had led us to asking questions about the characteristics of leadership by individuals and within teams. It has also led us away from outdated ideas of a leader being male and heroic.

Some recent experiences have made us reflect on leaders’ desirable qualities.

The first was attending a national conference for senior healthcare leaders. This two day event consisted of 24 presentations, of which only four were by women. In addition, out of the invited audience of more than 120, fewer than 40 were women. Very few of those attending or presenting appeared to be less than 50 years old and only a handful belonged to a visible minority group.

Of Health Service Journal’s 2010 list of the 100 people with the greatest influence on health policy and the NHS, fewer than 20 were women. And, while some headlines said the list reflected the increasing power of clinicians, it appeared to include only three nurses - Peter Carter, the chief executive and general secretary of the Royal College of Nursing, Anne Milton, the minister for public health, and Patrick Geoghegan, chief executive at South Essex Partnership Foundation Trust.

Shortly afterwards, one of us spent an afternoon with a group of future health leaders on a master’s programme. In contrast to the examples above, most of the students were female and under 30, and nearly one third were from a black or minority ethnic background. So, maybe, the future looks more diverse than the present.

Do these visible differences matter? Do leaders in high performing organisations have particular characteristics and, if so, what are they? Is it likely that leaders’ attributes, behaviours and capabilities are associated with a certain gender, ethnicity or age group? How should health leaders be selected and supported? How should organisations adapt to welcome leaders who bring new perspectives and practices?

The coalition has yet to set out its plans for developing leaders beyond the need to identify and support clinical leaders at all levels, and saying that the National Leadership Council will support clinical and managerial leaders through NHS changes.

It is likely that there will be a greater focus on leadership development for clinicians, particular for GPs in consortia. It is unclear where this will leave investment in the leadership development of other clinicians such as nurses.

A lot of literature in health and beyond shows that having a diverse senior management team is likely to result in organisational success.

For example, one of the most successful US healthcare organisations - Kaiser Permanente - has the most diverse board of directors of any major US corporation, with just under half of its directors being women and half having a BME background. In addition to quality and business benefits, a diverse leadership team enables a wider range of people to bring their perspective.

Figures from the National Nursing Research Unit suggest that approximately 90% of student nurses are women and 25% have a BME background. Organisational change is required. We need to ensure that the full range of talent in the workforce is developed.

To achieve this, today’s leaders will need to create a truly inclusive environment that allows all - regardless of age, gender or ethnicity - to flourish.

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