The NHS is quite simply huge. It is the UK and Europe’s biggest single employer and the fifth largest organisation in world. Responsible for the healthcare of over 64 million people, and with an annual budget of more than £100 billion, it goes without saying that its leadership is of great importance.
Despite this, the health board’s management has received much criticism as of late. NHS Highland, for instance, needed a £2.5m loan just to break even last year, with this discrepancy blamed on poor leadership. The request for extra funding by NHS Highland is a first for the service in 11 years and came despite an increase of £5m to its budget in 2012/13. Without this brokerage, there could have been serious repercussions for patients.
Clearly, management has made significant errors and budgetary oversights. Indeed, the biggest problem was overspending, particularly at the Raigmore hospital in Inverness, which rose from £600,000 to £9.6m in just three years. The very fact this continued year on year despite extra funding suggests a culture of complacency over budget management within the board.
What’s more, slow progress was made to address the causes of this excessive spending at Raigmore, exacerbated by underspends made elsewhere in NHS Highland to compensate.
To make things worse, management were unable to provide details of the sequence of events that led to the request for extra funding, and when brokerage was agreed to which, bringing into question how informed the board were when they did so.
Essentially, there are too many senior positions to fill without enough good managers to fill them. Throw into the mix the recent departure of the board’s temporary finance director, who was paid £47,000 a month despite a government order to halt excessive pay for short term contracts, and you’ll have what many are calling an NHS leadership crisis.
So what needs to be done? For a start, senior management positions need to be made more attractive with appropriate remuneration packages to incentives doctors and clinicians to take on leadership posts.
There have also been suggestions that the NHS, and wider healthcare industry as a whole, needs to move away from the out-dated idea of a single leader to a more collective system of leadership. One thing is clear, if the NHS wants to overcome the challenges it is facing, it will need a much stronger leadership.