LEADERSHIP AND MANAGEMENT
The leader of one of the UK’s largest acute trusts, Professor Stephen Smith, explains the difference between management and leadership to National Health Executive.
resources are tight. Now, more than ever before, it requires good leadership with senior managers needing to see their or- ganisations through some very difficult de- cisions – financial and operational.
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“This is a question about the differences between leadership and management,” says Professor Stephen Smith, chief execu- tive of Imperial College Healthcare NHS Trust and Pro Rector (Health) at Imperial College London.
“One of the great debates has been over whether we actually have leadership in the health service – we have lots of man- agement, but do we actually have leader- ship? It is within the leadership aspect, where there is, if anything, something of a deficit within the NHS. It chimes with the Secretary of State’s view that there are pro- fessionals – doctors, nurses and managers
he health service faces change on an unprecedented scale at a time when
– who run these services on behalf of the public, but that it is leadership which they need to provide, particularly at this time of substantial change.
“Management is also very important and you must have exceedingly competent managers – but it is always important to discriminate between leadership and management.”
There have been a number of schemes emanating from the Department of Health which are intended to improve and pro- mote leadership in the NHS, such as the National Leadership Council, the NHS Leadership Awards and the Top Leaders Programme.
Professor Smith explained: “The Department of Health has really begun to understand this question – and it has been a difficult one for many years. If you go back 30-40 years, there was a view that
the medical profession had led medicine before and effectively run the hospitals with a matron and a secretary who was effectively the management wing. It was then recognised in the 1960s-70s, during the Griffiths Report, that there was just not enough management in the health service.
“There was plenty of leadership, with some of it perhaps not being the right direction, but not enough in the way of management and so it was Griffiths who then introduced it to the health service.
“However, I think that over this genera- tional shift we may have lost some of that leadership aspect. Doctors are no longer allowed the sort of iconic leadership which they at one time craved – and which I don’t believe was particularly good for the health service – but while we have spent a lot of effort introducing management to the health service, we have also lost a bit of the leadership at the same time.
“But over recent years the health service has begun to recognise this and it is epito- mised in the policy of the current govern- ment. The Secretary of State has made it very clear that he believes clinical profes- sionals are well trained and well educated – which is even more important – and that we should let them exert their leadership positions.”
As the Government moves to reform the health service, senior management must realise they are integral to that process and that this change is to be expected.
Professor Smith advised: “We have to remember that this is the National Health
32 | national health executive Mar/Apr 11
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