Let’s start with the simple and obvious. The inception of the NHS was one of the most remarkable enactments of leadership for the common good, in the history of the United Kingdom, and arguably far beyond. So as the NHS reaches sixty-five, why on earth should we talk about it and leadership and death in the same conversation?
It was leadership that made the NHS happen in the first place, and it has been leadership, clinical and non-clinical, and at every level, that has seen it through to today. I don’t mean by one or even a few people, or in any one particular style; I mean by hundreds of thousands of NHS staff, decade after decade, individually carrying out a variety of leadership actions day in and day out, building on the original vision.
And build on it we have. If not, how could anyone have written an organisational Constitution that rings as true for us today, and with such passionate eloquence, as it would have done six decades ago? Which other organisation could do that so powerfully and plausibly? Surely with such leadership and commitment, the future must be bright?
Not necessarily. “At 65”, the NHS perhaps faces a greater threat than it ever has before. Not from economics, or technology, or climate change or demographics. Ferocious as all those challenges are, the lesson of history is surely that barring supervolcano eruption, asteroid impact, earthquake or tsunami, it is human attitudes and behaviours that are uniquely able both to create catastrophes and to overcome them.
The real threat the NHS faces comes from not from outside, but from within each of us. It’s a threat that is generated by human attitudes and behaviours, given focus by some kinds of leadership. Overcoming it will require the conscious exercising, within and outside the NHS, of other behaviours and other leadership styles. Oddly, we can understand this more easily by exploring how we respond to the idea of reaching sixty-five.
What does that phrase mean to you? To some it may evoke the dream of a well-earned retirement and the opportunity to pursue long-neglected interests; a second or third career; a new lease of life; strength in maturity. To others, it may forbode an impending loss of status, income, social contact and meaning; unconsciously, perhaps, one may sense the start of a gloomy decline as the years, and the legacy of a career of overwork and some indulgence, take their toll.
We are not a society currently renowned for the respect we accord the old; aside from the worry and the care and the demand on resources that we often associate with them, they also remind us of the unease we may have with our own ageing and the at-best stealthy approach of death.
So as the NHS becomes old enough to retire, how do we relate to it? Do we listen patiently to its familiar and repetitive conversations, smile politely, and then get on with the real business? Do we work out how to encourage it to retire quietly without causing a fuss? Do we worry about how we will afford to care for it (and who will do it?), as it goes into the sunset of its years, at the same time as we try, alongside our increased pension contributions, to pay for a nice house, a good holiday, and the children's education?
Maybe the attitudes and behaviours that threaten the “ageing” NHS are not so different to those that colour our attitudes to aging and the elderly: a mix of boredom (you can’t tell me anything new at your age), misguided complacency (we have fought and won the battles that inspired you in the past), selfishness (I need whatever I decide I want and can’t be tied down by your needs) and underlying them, some deep fears about suffering, mortality and the human condition (will we be in pain, incontinent, infirm? Lose our job/looks/limbs/life?).
These are fears that we must contain if we are to function; but we collectively have fewer ways to do so than when the NHS was in its infancy. Then, religion, and more rigid societal structures, held (for a while) those fears. Nowadays they seem to be manifested in desires for perfection of outcome and experience, intolerance of risk or error, and a focus on our individual journeys to healing rather than any collective one.
Indeed, with its almost-religious status and its widespread societal affection (we all remember the Olympics opening ceremony), the NHS comes close to being the container for all our hopes and fears around death and disability. The likely impact of this on important behaviours such as kindness and compassion, in society and within the NHS, has been discussed elsewhere in detail1.
So one lesson, for all in the NHS including for its leaders, is that how society views and reacts to death will shape individual interactions and the behaviours of teams, organisations and the wider system. But another lesson for us all as human beings, with an added poignancy for leaders in the NHS, is about the inevitability of death…. not only as humans, but of ourselves as leaders.
Just look at the extraordinary events at Wimbledon in the last week when leader after leader has fallen unexpectedly, or at the consequences of political, healthcare, or business scandals, or at the final moments of great leaders in their role or their life….whatever your leadership role, sooner or later it all ends, and it quite often ends badly.
There is no specific reason to predict the imminent demise of the NHS, and many reasons to fight hard to prevent it. But leaders across the NHS might usefully reflect on what this landmark age for the NHS could mean if we adopted a healthy attitude to the inevitability of the death of all things, and the sharpness of focus that can give to life lived. We might:
- Act with urgency every day (Kotter2) [because time is short]
- Be a clock builder, not a time teller (Collins and Porras3) [because we will never complete the work alone in our own leadership lifetime]
- Remember that leadership is situational, relational, and non-hierarchical (Goffee and Jones4) [and act accordingly, because we will never get enough of it to go around or be able to deliver it all ourselves]
- Constantly seek to free ourselves of misconceptions and narrow mindedness
- Look for wisdom in all, young and elders alike
- Cherish kindness and compassion, and challenge our leadership styles to nurture these remarkable attributes
Maybe even the NHS will all end. The question is how do we want to act with that possibility in mind, to prevent it or to ensure that somehow, its great purpose survives? What kind of legacy can we build and create for the future?
I hope we will all wish the NHS well as it celebrates its 65th birthday. I hope that with commitment and distributed leadership, it can continue for many decades to come into a long, healthy, vigorous, surprising and innovative maturity; like a loved, inspirational, wise, and supremely experienced elderly relative, who occasionally needs some help and still has so much to give.
If we believe in leadership at all, we have to believe that how the NHS turns out will be largely up to us, and to the strength of purpose we can create and sustain as leaders.
Happy Birthday, NHS!
- Intelligent Kindness. Ballatt J. and Campling, P. RCPsych Publications 2011
- A Sense of Urgency. Kotter, J. Harvard Business School Press 2008
- Built to Last. Collins, J. and Porras , J. Random House Business Books 1994
- Why Should Anyone be Led by You? Goffee, R. and Jones, G. Harvard Business School Press 2006
