8 | | OCTOBER 2023IN MY OPINIONThe backbone of UK healthcare--the National Health Service (`NHS')--is funded from central taxation, free at the point of delivery. This underpins a need for cost-effectiveness on a population level while protecting the quality of care. We need to be cost-efficient, but not `cheap' ­ there is plenty of evidence that the most cost-effective way to treat someone is do it right the first time. It has long been shown that good leadership, particularly good `clinical leadership,' helps with this and also associated with better outcomes. But how do we do that? With the NHS in a `perfect storm' of increasing demand, a backlog of untreated patients, and an exhausted, demoralised workforce, how can we best engender and develop our clinical leaders in this post-pandemic world? I suggest it falls to four main points of focus. If these are agreed, then local, regional, and national strategies can be devised around real strategies to address them, underpinned by aligned policy, with concrete actions to enable progress and support cultural change. 1. Empowering Clinical Leaders. It is axiomatic that we want our leaders to be capable of making the changes needed to improve things...but so often we let our systems get in the way of this. Bureaucracy can prevent agile decision making and rapid change, and this can disengage otherwise enthusiastic clinicians. Organisational culture and resistance to change often play a role too. Lack of resources - investing now to reap rewards in the future - is a perennial issue in a cash-strapped service: however good an idea is, you can't fund it with money. These obstacles were best illustrated by the pandemic itself. The absence of systems to deal with the crisis, or established ways of working that could be applied to it, allowed change that normally takes decades to be affected in days or weeks, with agile and clinically-led decision-making. What was obvious also was the lack of financial constraint--the loosening of purse-strings meant things previously financially impossible were readily funded; there were many things we couldn't have, but immediate funding wasn't one of them. 2. Innovation. This disruption of normal processes and the need for new ones allowed for significant innovation during the pandemic. From converting scuba masks into respirators to OBSTACLES TO CLINICAL LEADERSHIP IN A POST-COVID NHSBy John Bolton, BSc (Lond) MD (Brist) FRCS FRCS (Urol), Deputy Chief Medical Officer & Medical Director (Ops), Consultant Urological Surgeon, Bradford Teaching Hospitals NHS Foundation TrustJohn Bolton
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