Dr Nicky Eddison, Charlotte Colesby, and Russell Hanks

Numerous reports have found a large-scale failure of management and leadership in the NHS, often with serious consequences^1–6. Thus, the need for effective leadership in healthcare has come under increasing scrutiny with research emphasising the importance of high-quality leadership in ensuring positive, innovative, and caring cultures¹. Leadership has multiple interpretations, it is rarely defined and explicit references are vague and unclear⁷.  There are a plethora of opinions on what good leadership looks like and while there is much leadership training available, there is no standardised training for leaders in the NHS. There are many leadership theories, and each leader brings their own experience, skills, and personal characteristics alongside knowledge to their role.  Where examples of excellent leadership are observed it is usually due to the endeavour of the individual as opposed to structured training and talent management. Although recent reports have offered recommendations to address this⁶.

The NHS has committed inordinate amounts of time and money in an attempt to change and re-structure⁸. It was the Griffiths report in 1983⁹ which was the catalyst for the introduction of general management in the NHS, accompanied by the famous quote “if Florence Nightingale were carrying her lamp through the corridors of the NHS today, she would most certainly be searching for the people in charge”⁹. Following the Langsley reforms and the introduction of the Health and Social Care Act 2012¹⁰ alongside the promise to “direct more money to the front line”¹¹ and purge it of bureaucracy, a reduction in NHS management was targeted¹². Between 2010-2017 the number of NHS managers fell by 18%¹³. Today, the NHS still has only 2% of its staff in senior leadership positions, significantly below the national workforce average of 9.5%¹¹. This has led to claims it is one of the most undermanaged organisations on the planet¹¹, despite evidence highlighting the positive impact management and leadership has on performance in healthcare¹².

It has been acknowledged that the allied health professions (AHPs) are in a prime position to effect change at every level of the NHS, with the encouragement to fill formal leadership positions alongside doctors and nurses¹⁴. AHPs have demonstrated their capacity to rapidly transition from clinical positions to senior leadership roles. However, there is a dearth of exploration into the nature of these leadership journeys or how AHP leadership development and career progression might be supported. As a result, many AHPs may be ill-prepared for leadership positions⁷.

The training and support a leader receives are vital because the role of a leader presents a range of challenges, often with no clear resolution. Leaders find themselves juggling an array of complex and wicked issues which they may not have faced previously. Thus, management is the equivalent of déjà vu (seen this before), whereas leadership is the equivalent of vu jàdé (never seen this before)⁸.

This NHS is currently facing an enormous leadership challenge. The recent NHS staff survey highlights the level of stress present in the workforce with 46.8% of staff stating they have felt unwell as a result of work-related stress¹⁵. As a result, there is an ever-increasing catalogue of instructions on what managers and leaders must do to help mitigate the huge issues the health and care sector faces and improve the health and well-being of staff (see figure 1).  It appears very little thought is directed at supporting the leaders tasked with this monumental challenge. Consequently, leaders can often find themselves facing problems alone, believing the false narrative that a leader must be a panacea for all work-related issues and the old adage that ‘it’s lonely at the top’.

Figure 1: Eight key workplace factors that will have an impact on the wellbeing¹⁶

Support for AHP service managers

In an attempt to create a network of support for AHP service managers, in 2021 the authors of this article formed a support group. The AHP service management support group provides an opportunity for AHP service managers to meet on a regular (quarterly) basis, to discuss any issues they might be facing and have the opportunity to reach out to leaders in similar positions to share their experiences and discuss solutions.

Specific aims of the group include:

• To share ideas and solutions
• To learn from each other
• To share evaluation and outcomes
• To discuss evidence-based practice and practice-based evidence to support decision making
• To identify blockers and potential solutions
• To provide peer supervision
• To provide updates on courses and training available
• To invite key stakeholders to deliver presentations

• To allow staff new in post access to experienced service leads

An important element of the support group is peer supervision, which can be defined as “Supervision and consultation in individual or group format, for the purposes of professional development and support in practice…includes a critically reflective focus on the practitioner’s own practice”¹⁷. Peer supervision differs from clinical supervision in that it does not require the presence of a more experienced, qualified, or senior colleague¹⁷. Research has shown that effective peer supervision can have benefits for both the organisation and the individual, including a reduction in stress and anxiety, an increase in job satisfaction, and staff retention¹⁷. Furthermore, the Health and Care Professions Council (HCPC) with whom all AHPs must be registered in order to practice, support the case that registrants should be participating in supervision as part of their practice where possible¹⁸ and state in their standards of proficiency that registrants must “understand the importance of participation in training, supervision, and mentoring”¹⁹.

Peer supervision for members of the AHP service management support group is optional and occurs after the main meeting.  It provides a confidential and supportive environment to share and discuss issues members are facing, providing the opportunity for feedback, reflection, and shared experience.

Staff who have attended the meetings have provided positive feedback

If you are an AHP service lead at The Royal Wolverhampton NHS Trust or Walsall Healthcare NHS Trust and you would like more information about the AHP service management support group, please contact the authors of this article at:

N.Eddison@nhs.net, charlotte.colesby1@nhs.net, and russell.hanks@nhs.net.

References

1. Dixon-Woods, Baker, Charles, et al. Culture and behaviour in the English National Health Service: Overview of lessons from a large multimethod study. BMJ Qual Saf. 2014;23(2):106-15.
2. Fuller C. Next Steps for Intergrating Primary Care: Fuller Stocktake Report.; 2022.
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19. Health and Care Professions Council. Standards of Proficiency: Prosthetists and Orthotists.; 2013. https://www.hcpc-uk.org/standards/standards-of-proficiency/physiotherapists/. Accessed August 16, 2022.