the leadership challenge
David Smithard is a Consultant in Geriatric Medicine at Lewisham and Greenwich NHS Trust, a Visiting Professor at the University of Greenwich, and the Triple Helix Editor
In this edition of Triple Helix, we explore the struggles and rewards of being a Christian in leadership and management in healthcare. The National Health Service (NHS) is a large complex federation of organisations, each managed by a team of professionals with the sole purpose of delivering healthcare, free at the point of use, to the UK population. The management of the NHS and each of its constituent parts is complex. The NHS employs 1.38 million staff,[1] and is the tenth-largest employer in the world, behind institutions such as the Indian and US Ministries of Defence, Walmart, and Amazon.[2]
The management structure comprises a myriad of employees and contractors, including clinical staff from all health care professions. The foray into management aligns with career progression in nursing, whereas for medical staff, the management role has often been seen as an add-on (General Practice Partnership excepted). Some people come to management as a planned move, full of expectation. Others fall into the role, either because there is no one else or because something needs to be done. Becoming a hospital manager can be seen as ‘going over to the dark side’. It is a challenging role that can be all-consuming. For many, it is seen as a poisoned chalice rather than an opportunity to innovate, influence, improve patient care, and be a witness.
Whatever the level of leadership you are involved with, there is a commonality in the pressures and demands of the system in which you are leading. There is a demand to deliver a service within a constrained budget, amid increasing public expectations and demands from commissioning and funding bodies. All want to achieve the same end: to deliver the best care for their patients that they can.
Despite the NHS budget in England in 2024/25 being £204.7 billion, about 11.1 per cent of UK GDP,[3] the NHS has always struggled to function within its financial envelope. Managing an organisation of the size and complexity of the NHS is difficult. The Government and the electorate expect any organisation involved in healthcare to be safe and efficient. The NHS is under constant scrutiny by elected officials, the media, and the general public. The Department of Health and Social Care (DHSC) expects each organisation to record and report its performance against a set target.[4]
This can cause angst and internal conflict (and at times, moral distress) for managers having to perform what appears to be unreasonable public relations exercises or report a version of the ‘truth’ that puts a more positive spin on a negative situation (see Mark Pietroni’s article in this edition). It can be challenging to represent Christ amidst these pressures. Remembering that the person in front of you, whether a patient, a member of a committee or a hospital board, is created in the image of God, just as you are, is not always easy. When voices are raised and accusations fly around, we should avoid gossip (Proverbs 16:28), but turn the other cheek (Matthew 5:29), make our replies graced with salt (Colossians 4:6), and show love to others (Ephesians 4:2).
Being a clinical (or non-clinical) manager may not be easy, but it is a challenge that we should not shy away from. The potential to have a positive effect on patient care can exceed any frustrations, and if God has called you into a management role (Ephesians 2:10), he will be there with you and will protect you in times of trouble (Isaiah 41:10,43:2).
Finally, to quote Angela Wilkinson from her article in this edition (p17-18), ‘Wherever he has put you, whatever your sphere of influence is, use it to serve him wholeheartedly. Remembering that he who promised is faithful.’
