New framework for clinical senior leadership published

NHS England has released a framework to help NHS leadership gain new perspectives on the barriers and challenges facing the recruitment of more clinical leadership. The framework has been endorsed by several healthcare bodies including the Royal College of Nursing, the Royal College of Midwives, and the Royal Pharmaceutical Society.

The framework is formed from five key principles including: widening perspectives, building confidence, talent management, practical levers, and organisational culture. It is also a development of the NHS Long Term Plan.

Dido Harding, Chair, NHS Improvement said: “Clinicians from all professional backgrounds have a lot to offer as senior leaders. Supporting these talented people, who are already working in our organisations, to make the most of their potential is an opportunity too important to neglect.”

The guide aims to set out the obstacles that people face in securing senior leadership roles when they have a clinical background. Having a “clinical” role in the guide is defined as: allied health professionals (AHPs), doctors, healthcare scientists, midwives, nurses, pharmacists, psychologists, social workers. Social workers are included in this list in accordance with the NHS Long Term Plan, which pushes for greater collaboration between the health service and the social care network. The list is not exhaustive.

The first key principle of the framework – building confidence – addresses the uncertainty staff may feel when applying to a clinical leadership role. This lack of confidence could be down to two main factors listed in the framework – a perceived and/or actual lack of competence for the role or anxiety, uncertainty, and fear of the unknown. Leaders are encouraged to ask questions that may help address these issues, such as, ‘how are you preparing clinicians as they take on new roles?’, as well as providing some practical advice, such as supporting staff by clarifying expectations and offering to monitor their workload.

Case studies are included in the framework and are based on real-world examples of leaders breaking down these issues. Shane DeGaris, Group Deputy Chief Executive Officer, Barts Health NHS Trust, said he personally recommends talking to key/influential people who have followed similar journeys and considering the mainstream leadership programmes.

The second core principle of the framework is “widening perspectives” and is aimed at increasing awareness in the space. The guide says: “Seeing role models from all clinical professions across all areas of the NHS – some professions are under-represented at senior levels, which can lead people to think that opportunities do not exist. Clinicians working in these roles can promote their work to encourage others, especially as new models of integrated care become established. All senior leaders can regularly test who is missing from the table.”

Three key questions are set out to help increase perspectives: How are you helping clinicians to understand the breadth of available career options? How is your senior leadership team creating or identifying opportunities for clinicians to develop leadership careers? And how are you supporting clinicians to network outside your organisation? The guide recommends professional leads reporting to board members and discussing the transferability of clinical skills to increase awareness.

A case study cited in the framework is from Kay Fawcett, Non-Executive Director, Derbyshire Community, Health Services NHS Foundation Trust. It states: “Having worked as an executive board member for many years as part of her career in nursing, Kay had seen first-hand what non-executive directors bring to organisations. Keen to continue to contribute to the NHS after she retired, Kay sought out non-executive director roles both inside and outside the NHS, as a way of making the most of her experience and continuing to learn.”

The barriers to comprehensive talent management include perceived and/or actual lack of training for the role and lack of time for development in the current role. Advice to improve talent management includes creating stretch assignments, and appraisal training for senior clinicians’ supervisors, and installing multi-organisation approaches for people on rotations/placements.

The penultimate part of the framework addresses the practical levers that will be needed to improve the representation of clinical staff in leadership roles. The guide is clear that financial reward is a significant barrier for staff looking to move into leadership roles and advises that: “Creative use of reward and pay schemes can go some way to maintaining pay levels and creating cultures where taking on these responsibilities is specifically valued.” Additional advice includes offering flexible working arrangements and greater recognition in staff awards.

The final part of the framework addresses issues around organisational culture. The framework cites a lack of trust or negative environments as contributing factors to organisational culture issues. The framework outlines “a lack of obvious emphasis on prioritising the value of clinicians taking part in the management and leadership of organisations – and diversity more generally – can reinforce negative assumptions.”

A list of next steps ends the report and encourages organisations to use the guide and to contact the NHS for feedback on their experiences of using the guide. The next steps are listed below:

  • Find out at what levels different clinical professions tend to ‘hit a ceiling’ in your organisation and explore why that might be.
  • Hold a board or system leadership workshop using this framework to agree your priorities and strategy for increasing professional diversity at senior levels.
  • Nominate executive and non-executive leads at the organisation and system level to champion the clinical leadership agenda.
  • Run internal multi professional meetings or focus groups to explore this
    framework and what staff think are the greatest opportunities.
  • Discuss this framework with your line manager or head of profession to see what opportunities may be available to you and you colleagues.
  • Share good practice about what you’ve already been doing, or what you learn as you experiment with making changes.

To read the framework in full, please click here.