Leo makes managers kings of jungle

September 27, 2002

With the public sector set to be a flashpoint at the Labour Party conference, The THES takes a look at the ways in which higher education informs policy.

The NHS Leadership Centre is working with universities to produce a crack team of executives to steer the health service through radical change. Claire Sanders reports.

Bringing down waiting lists and unblocking beds may seem a million miles away from delivering music to the masses, but Mark Davies, chief executive of the North Hampshire Hospitals National Health Service Trust, found that talking to BBC radio managers as part of an NHS leadership course gave him a new perspective on more than just Atomic Kitten.

"For chief executives faced daily with tensions between centralisation and decentralisation - how to develop local initiatives and yet ensure uniform waiting times - it was fascinating to see the same issues at play in the BBC," he says.

He saw other parallels. "How do people at the top communicate effectively with a diverse group of employees? And how does an organisation such as the BBC allow individual talents to shine within a corporate environment?" Davies was taking part in a course run by the NHS Leadership Centre with Lancaster University. The centre, set up as a result of the 2000 NHS Plan to "deliver a step-change in the calibre of NHS leadership", is at the heart of the government's plans to modernise the public sector. It aims to produce entrepreneurial leaders who can manage change across professional boundaries and across the public, private and voluntary sectors.

It reflects major changes in the public-service workforce, including the increase in private business interests, an issue likely to create controversy at next week's Labour Party conference. Earlier this month, the Audit Commission's report on recruitment and retention noted that over 20 years, the proportion of the workforce employed by the public sector had dropped from nearly 30 to less than 20 per cent, although the numbers working in the sector had increased. More than 10 per cent of the workforce is working in the public sector but employed by a private company. The report found a workforce overwhelmed by bureaucracy, complaining of unmanageable workloads due to serious staff shortages, a lack of autonomy, feeling undervalued and dissatisfied with pay. It concludes that the "impact on staff of the shift to a mixed economy of provision needs to be actively managed".

This is where the centre, and other leadership centres such as the National College for School Leadership and the Defence Leadership Centre, come in. The aim is to work collaboratively to allow leaders in different public-sector areas to share experiences, to gain an international perspective and to learn how to work with the private and voluntary sector. But the centre has had a rocky start. Its first director, Barbara Harris, had to be replaced after concerns were raised about the Royal United Hospital, Bath, which Harris ran for eight years. The centre announced this week that Penny Humphris, the acting director, has been appointed director.

Crucial to its success will be its ability to engage with the universities that will educate tomorrow's public-service workers and provide leadership courses. To date, it has been an uphill struggle.

"We have found it difficult to get a good dialogue with leaders in universities," says Karen Lynas, a programme director at the centre. "We have made a number of overtures to universities in a number of areas, but have not had much response."

The centre was recently awarded a major contract to deliver a clinical strategies programme - aimed at preparing nurse directors for chief executive posts - through the Insead business school in France. Insead won the tender because it adapted to the centre's needs. "Insead did not turn up telling us what we needed. They were more flexible. They looked at how we could work together," says Jean Faugier, director of the national nursing leadership programme, which was set up just before the leadership centre and is now incorporated within it.

Despite the difficulties in getting some UK universities to play ball, Faugier says it is working successfully with several universities and institutes - including the King's Fund, the Open University, Lancaster University and the Centre for Healthcare Development and Management at Leeds University.

And its record so far may be a taster of what the NHS University could do. Indeed, it is not yet clear whether it will merge with or work alongside the NHSU.

Already 32,000 nurses and allied health professionals have gone through the centre's leading empowered organisations (Leo) programme in the past two years. "The centre is not just about training chief executives," Faugier says. "It is crucial to have leadership at the clinical face. Leo is now the biggest leadership course in the world."

The centre is also working with 112 NHS trusts to deliver the Royal College of Nursing clinical leaders programme. In January, this will be extended to 100 other trusts. "We have had health professionals from all fields on these courses," says Faugier, adding that almost all programmes include reference to the private and voluntary sector. "I worked for many years in the voluntary HIV and Aids sector. That sector was very quick on its feet. By the early 1980s, the patient voice was being heard at the top and policies influenced," she says.

She says that she would like to see more health educators on the courses. "The development of nursing lecturers has been neglected since they entered higher education. The pressure to teach and build up research is so enormous that personal development gets neglected."


Mark Davies, chief executive of the North Hampshire Hospitals National Health Service Trust, attended the senior chief executive development programme run by the NHS Leadership Centre with Lancaster University.

He said: "I've been a chief executive for about ten years, and the idea of the course was to refresh and renew.

"The participants were all NHS chief executives but we were sent into a number of different organisations to see what the common management problems were."

In his time as a chief executive, Davies has seen significant changes - but he admits that progress can be slow. "I manage a medium-sized acute trust with 2,500 staff. I want my staff to be comfortable with taking risks, with developing new initiatives. But for years the NHS has been a risk-averse, hierarchical organisation with people working firmly within their own professional boundaries. It takes time to change that."

Many of the middle managers at the trust attend courses, run by charity Common Purpose, aimed at leaders from all sectors of society. The charity is also used by the NHS Leadership Centre.

"We put our good middle-management people through the courses and they sit alongside people from Sony, computer companies, the council, the local higher education college, and they come back enormously enthused and impressed by the similarities between the sectors," Davies says.

He feels, however, that the changes in leadership that the NHS and other public-service organisations are pushing are not yet reflected in undergraduate education.

"I hold out a lot of hope for the future as I believe changes are afoot, but few of the doctors, nurses and other health professionals are fully prepared for this new interprofessional environment," he says.

Davies is working with the new generation project at Southampton University to develop these skills. Southampton is a leader in this field seeking to develop common learning programmes for all those going into the health service.

Davies chairs a working group on the project and is seeking to set up multi-professional placements in trusts and social services. "This is enormously complicated and has huge organisational implications for the trusts. In the future, we will see medics tutored by social workers, or nurses tutored by physiotherapists. The point is to get people to think outside professional boxes."

He describes the development of partnership skills as the biggest change under new Labour. "I am about to have a meeting with directors of social services and primary-care trusts on how to transfer people out of hospitals. It is a fraught issue and the meeting won't be easy. But the goodwill, the sense of partnership is there and that is crucial."

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