We must embrace the challenge but be realistic about what is doable | Niall Dickson

Niall Dickson

How should an organisation such as the NHS Confederation position itself given the current pressures on the service and in the current uncertain political times, asks Niall Dickson, chief executive of the NHS Confederation.

I think we should take our cue from the 
report we published this week from a cohort of new Chief Executives we have been supporting over the last two years. Their approach acknowledges the massive strain under which the system is operating and the scale of what is being demanded but seeks to embrace the challenge.

Alongside that they argue that if we are to deliver the NHS Long Term Plan, we need to foster and exhibit a different style and approach to leadership throughout the system. One which is less organisationally focused and more embracing of the wider system. One which is much more determined to be inclusive and diverse, and to build new relationships with staff, drive clinical engagement and involve patients and communities to help shape the future. And one which thrives on partnerships with a wide variety of organisations in the private, public and voluntary sectors.

This will require a different mindset – there is nothing in what they are proposing that is essentially new or which has not been done by enlightened leaders in the past, but their reflections point to a combination of attitudes, attributes and ambitions which suggest we are now growing a new generation of leaders.

At the report’s launch on Thursday, at an event we held with the King's Fund, some of this was questioned by those who wondered whether such a ‘softer’ approach to leadership in some way diminished accountability or distracted attention from delivering on performance targets and sound finance. The answer of course is that this is not a matter of ‘either or’, it must be ‘both and'.

The focus must relentlessly be on outcomes, with a determination to transform the experience of staff and deliver new models of care.

There were also legitimate questions about accountability. It is one of the less developed areas in the NHS Long Term Plan and yet it will be crucial both for the effectiveness and legitimacy in implementing its objectives. 

We have begun some work on this with local government leaders – if you would like to be involved do drop me a line.

In short then, we need to be realistic about what is doable, point to and lobby as hard as we can on the areas of unfinished funding business (education and training, social care, public health and capital) but also celebrate what is being achieved and send a message, like those CEOs, of hope over pessimism. 

And yet alongside this message, have we not also reached a stage where we should be managing public expectations more effectively?

The governing party always wants to overstate its achievements and promise more than can be achieved. Their opponents invariably overstate the doom and gloom and in turn exaggerate what might be possible under different leadership. The level of discourse is often poor and to be frank, just now there is not much discourse at all.

Perhaps then this is also the moment to be clear that we are all pretty much agreed about the direction of travel and the case for transformed services. It is a great moment when exciting things can and will be done. But at the same time should we not call for a grown-up debate which involves being straight with the public about what can and cannot be delivered over the next five or ten years? (Because even if we had the money, we have not got the people to do everything!)


Later this week we will be at the Manchester Central Convention Complex for our annual conference and exhibition. The numbers registering to attend are up again and I do hope to see as many of you there as possible.

Ahead of the conference, we will launch a major report based on members' views on implementing the ambitions of the Long Term Plan alongside a report from the Health Foundation updating the seminal report on funding which we commissioned last year.   

We will also be publishing a joint report with the the Association of the British Pharmaceutical Industry (ABPI) on cross sector collaboration. If you or any of your team still haven’t booked, there is still time – call us on 0844 800 5987 or go to www.nhsconfedconference.org/

Diversity is not optional

You may have seen the report from our new BME Leadership Network this month which highlighted that chair and non-executive appointments on the boards of NHS Trusts in England have become less diverse over the last 15 years, with fewer women and people from BME backgrounds occupying the positions.

Please do read the 
report if you haven't seen it.

It is a sign that unless active steps are taken in this area, it is easy to clip back. While NHS England and Improvement have been working incredibly hard to improve diversity, through initiatives such as Workforce Race Equality Standard and the Workforce Disability Equality Standard, we still have some way to go.

Put bluntly, we are not doing well enough and there are some basic steps we can take which are set out in the report. 

If any of your staff would be interested in being part of the 
BME Leadership Network please press on the link.
The aim is to encourage and support existing and aspiring BME leaders, improve understanding of equality, diversity and inclusion, and demonstrate how this will help deliver better care for all.

Crisis in care

The failure of various governments to get to grips with social care was laid bare by the powerful BBC Panorama programmes in Somerset. The plight of the carers was as harrowing as the plight of the recipients of care. Every one of them was a someone in great need for whom the labels health or social care were meaningless bureaucratic distinctions.

And of course we know social care’s nightmare is our nightmare too. As part of our Health for Care coalition we have just published a survey of MPs which demonstrates that in spite of all the distractions they are aware of the crisis and they are seeing some impact in their work with two thirds reporting increasing number of constituents bringing cases to them.

More than three out of four, including more than half of those supporting the governing party agreed there was a crisis in social care. If you are interested in finding out more go to please see our 
Crisis in Care survey findings.
We are also keen to encourage local leaders to lobby their MPs and to team up with local politicians to exert pressure on the government and the Treasury in particular.


I had a fascinating visit recently to University Hospitals Coventry and Warwickshire NHS Trust.  Along with four other Trusts they are working in collaboration with Virginia Mason in Seattle, taking forward a form of Lean which empowers staff and enables them to redesign services.

There are of course many continuous improvement methodologies, and there seems to be real merit in adapting approaches (as they have done here) but this joint project is worth watching and learning from.

I was particularly impressed by the creation of a space for staff to reflect, share and solve problems. As the treadmill goes relentlessly round, finding ways to allow staff to think and reflect has to be the way forward.

If you would like to discuss any of these matters, or anything else, then please do get in touch via niall.dickson@nhsconfed.org

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