Step forward

Leadership is needed at all levels of the NHS at times of budget constraints and reorganisations. So why do physios fight shy of the concept? In the first of our new series, Daloni Carlisle investigates

Step forwardWould be leaders don’t have to look far for development programmes in today’s NHS. And promptings to take them up come from all quarters. In June last year the NHS Confederation warned that the NHS should expect an £8-10 billion cut in real terms in the three years from 2011 and said this represented ‘the greatest ever leadership challenge for the NHS’. ‘The need for strong leadership and radical quality and efficiency is greater than ever,’ argued the Confederation’s report Dealing with the Downturn: Greatest Ever Leadership Challenge for the NHS? It called for ‘courageous decisions’ to reshape services. This echoed the call from the then health minister Lord Darzi, in June 2008, for clinicians to become leaders at all levels of the NHS. ‘Compared to health organisations in the US, the NHS has very few clinicians in leadership roles,’ he said in High Quality Healthcare for All, the final report on his 12-month review of the NHS. ‘There will be investment in new programmes of clinical and board leadership with clinicians encouraged to be practitioners, partners and leaders in the NHS,’ he said. Announcing the establishment of an NHS Leadership Council to be chaired by the NHS chief executive, Lord Darzi urged practitioners to ‘step up, work with other leaders, and change the system where it would benefit patients’. ‘Making change happen takes leadership,’ he said. ‘It is essential to our expectations of healthcare professionals of tomorrow.’

Educational help

Many PCTs and trusts run leadership programmes for staff, and the NHS Confederation, the King’s Fund and the Health Foundation operate national schemes. But how many physiotherapists are involved? Is leadership regarded as really only for doctors and nurses? ‘I think as a group we are reticent,’ says Karen Middleton, chief health professions officer for England and a chartered physiotherapist, who represents 12 allied health professions.

New ground

This could be something to do with being autonomous practitioners, she feels. ‘Nurses, whether they are going into the acute sector or community, have to work around doctors,’ she says. ‘AHPs are autonomous and work independently. I think, and I include myself here, that we do not develop the softer political skills of influencing and working with others to get where you want to,’ But she has no doubts about the need for AHPs to become leaders in clinical and management spheres. ‘We do bring something different to the table,’ she says. ‘No other clinical groups work at the interface [between home and hospital] like we do, and that is where the productivity gains are to be made.’ ‘We are going through one of the most significant periods of change and difficulty that we have ever seen in health and social care. We need people who are able to innovate and to enable,’ she says. Doing their best for patients requires physios to overcome their resistance to anything labelled leadership, she says. And the results can be impressive. Of the 428 AHPs who took part in the Leadership Challenge she organised last year, 196 were physios. And the six strong winning team included five physios.

Rise to the challenge

Karen Middleton hopes to secure funding for Leadership Challenge 2010 and is fighting for physios to be able to apply for senior stratategic posts. She sees structural barriers to physios, and other AHPs, taking on leadership roles. The move towards multiprofessional teams in healthcare means physios may no longer be managed by physios. Karen Middleton does not have a problem with this but is annoyed by job descriptions for team managers, and directors of patient care, which specify a nurse for the role. It is up to all AHPs to challenge these, she says. ‘I want them applying for these jobs’ she urges. Then, she adds, ‘If they do not get them it would not be because they are not allowed to apply, but because they are not good enough.’

Potential of new roles

Jackie Anderson, head of physio at King’s College hospital, agrees that physios have not fulfilled their leadership potential. ‘People are so are so clinically trained that they do not recognise they have leadership skills,’ she says. ‘If I say to say to someone they have the potential to be a leader they are reticent. They do not see it as an integral part of their role.’ She welcomes new roles such as consultants. ‘Consultant roles are leaders,’she says. ‘They are go-getters taking services forward.’ But she is concerned that physios are not fulfilling their leadership potential at local level. Provider units may now have a band 7 physio with no managerial responsibility as the most senior physio. ‘No managerial responsibility, no influence,’she says. And, some PCTs are cutting clinical lead jobs, leaving the band 7 physios in provider units with no one to turn to for a professional lead, she points out.  It is common, and mistaken, to think of clinical and leadership roles being entirely separate. Training and experience give physios a range of skills applicable to several domains. The desire to do your best for patients that drew you into the profession in the first place is the best possible starting point for considering a leadership role. Taking on greater management responsibilitymay change your day to day acitivities and shift relationships with colleagues. But the objective of more efficient services and better care for individuals remains constant. Time, perhaps, to see what opportunities are out there, investigate the training available and step forward. FL

What is the essence of leadership?

  • Ann Green, chair of CSP Council : ‘Leadership is about getting the support of others and trying to enable them to make things happen.’
  • Claire Marshall , head of physio services at Heatherwood and Wexham Park hospitals trust, Slough, and the physio member of the National Leadership Council, established last year to implement the Darzi review: ‘Vision and motivating people to come along with you.’
  • Jackie Anderson, chair of the Association of Chartered Physiotherapists in Management: ‘You can be a leader without Being a manager but you would be a pretty poor manager without leadership skills.’
  • Karen Middleton, chief health professions leader: ‘Maximising potential and enabling others to develop and do better.’
Clinician leader, Karen Middleton justifies the title of England’s top physio. After qualifiying in 1985 she spent several years ‘getting on with my career and progressing in my profession’. ‘If that helped patients then great. But it was not consciously what I was trying to do,’ she says. Her turning point came when she managed a user-consultation project in 1996 in Tower Hamlets, London. ‘It was a user consultation for people with severe disability and as I listened to their stories I realised I was not sure whose needs we had been meeting previously. It was a lightbulb moment.’ The project led to a new interdisciplinary service for people with disabilities and left Karen Middleton a changed person. ‘From then on I put the patient at the centre of everything.’ She moved into management, managing nurses, and a progression of jobs took her from local to regional management and then the Department of Health. In 2004 she graduated from the European Leadership Programme at INSEAD, the business school in Fontainebleau, France. While acknowledging that she is now far from everyday care, she sees much scope for influencing change. She cites moves towards the extension of prescribing rights to physios and persuading Lord Darzi to talk about ‘clinicians’ rather than doctors and nurses as proof that leadership can always affect patient care.

Action points

  • Grasp any leadership development opportunities with both hands
  • Read the leadership material produced by the NHS Institute for Innovation and Improvement
  • Develop your leadership skills through involvement with the CSP, such as standing for council or taking an honorary officer’s role in a special interest group
  • Find a mentor
  • Look at any transferable skills in your home life such as chairing the PTA or school governorship
  • Don’t be afraid to manage other professions
  • Challenge job descriptions that unnecessarily require a registered nurse, then apply for them

Forthcoming articles

  • Moving to multiprofessional management
  • Building confidence
  • Leadership at every level
Daloni Carlisle

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