The NHS is failing. There are increasing numbers of older patients with multiple co-morbidities, including frailty and dementia. 70% of NHS spend is on preventable conditions. Yet health is still focussed on interventions and passive care rather than facilitating exercise, nutrition, environment and culture.¹ Similarly, healthcare leadership suffers with financial constraints, burdensome targets and overwhelming workload.NHS staff feel undervalued with burnout, low morale, inadvertent bullying or being set up to fail (Glass Cliff phenomenon). Perhaps the current paradigms could be challenged?

A new approach is needed, focussing on:

• Clear values, to get people through tough days

• Knowledge about how health really works including primary and secondary prevention and iatrogenic illness

• Skills: Understanding that good ‘leadership’ requires ‘management’ skills, involving people, change, projects, finance, education, IT and communication.

• Aiming for precision and clarity:

• Being clear about expectations helps reduce bullying

• Having defined job roles reduces unconscious bias

• Identifying what is not possible

• Empowering and valuing all individuals

• Ensuring that highly skilled workers (eg doctors) can focus on decision–making and handling uncertainty, with some other tasks delegated to ‘Doctors’ Assistants’²

• Using team–working and the community to support anyone having a ‘below average’ day

• Getting all NHS staff to work on the prevention agenda, advocating environments, expectations and practicalities to improve health.¹41% of over–65s are classified as ‘inactive’.Lack of fitness is reversible and reduces their need for social care.³ Health workers are ideally placed to work on goals, habits and practicalities with individuals, communities and wider organisations (including education, transport and sport).

• All management decisions should satisfy the bigger picture as well as the detail (eg building cycle parking and having flexible working policies)

References

1. Exercise: the miracle cure(2015, Academy). www.aomrc.org.uk/publications/reports-guidance/exercise-the-miracle-cure-0215

2. Doctors’ Assistants. https://healthmanagement.org/c/healthmanagement/issuearticle/award-winning-new-doctors-assistants-freeing-time-in-acute-nhs-hospitals

3. McNally, et al. Focus on physical activity can help avoid unnecessary social care. BMJ2017;359:j4609. https://doi.org/10.1136/bmj.j4609 or on www.scarlettmcnally.co.uk