A College strategy for professional development in leadership and management

1 / Purpose of paper

Council members are invited to:-

1)Comment on the relevant areas for the College to take forward

2)Agree key areas for future activity

2 / Background
  • Competency in leadership and management is fundamental to the work of a psychiatrist and underpins all aspects of psychiatric practice;
  • Leadership in mental healthcare involves leadership practices and organizational intervention in addition to personal behavioral style or competences;
  • Leadership and management competencies are clearly defined in the NHS Leadership Framework;
  • Leadership development should focus on organizations and systems as well as individuals and should be informed by the organizational context in which individuals work;
  • Leaders in mental healthcare should demonstrate:-
  • A commitment to promoting high quality care;
  • A willingness to collaborate;
  • An ability to adopt a wider perspective;
  • An interest in team and organizational rather than individual success;
  • A desire to strengthen their capabilities through continuing learning, training, and reflection.
  • Psychiatrists are uniquely positioned to provide leadership within mental healthcare teams, services and organisations.

3 / Strategic Plans

We propose:-

Establishing networks

  1. The formation of a National Leadership Network
  2. A national leadership network to facilitate high quality networking between psychiatrists holding formal leadership and management positions
  1. The formation of Regional Leadership Networks
  2. Regional leadership networks to provide members, of all specialities and levels, with opportunities for:
  3. Networking
  4. Accessing peer support (including mentoring and coaching)
  5. Sharing best practice regionally and, via the College, nationally
  6. Networks to be led and co-ordinated and sit within current divisional and national structures
  1. The creation of the role of Leadership Champion
  2. Named individuals might function as “leadership champions” within the regional leadership networks and offer members:-
  3. A point of contact and coordination around leadership development
  4. Signposting to leadership and management information
  5. Signposting to local and national leadership development opportunities, programs and events
  6. Introductions to allied individuals and organisations
  7. Leadership champions might be formally registered with the College and work closely with counterparts in primary and secondary care and leaders in postgraduate and undergraduate psychiatric training
  1. Meshing with external work streams
  2. The RoyalCollegewill develop close links with key national allied organisations in particular:
  3. The Faculty of Medical Leadership and Management
  4. User and carer groups
  5. Provider organisations

Establishing networks is vital to ensure that the College remains a flexible and responsive organisation that can reflect mental healthcare priorities and arrangements.

Continuing Professional Development initiatives

  1. The provision of leadership and management resources
  2. The College to provide its members with high quality leadership and management resources in the form of:-
  3. An online repository of leadership and management case studies which would:-
  4. Illustrate leadership and management best practice in mental healthcare and in each arena of practice (academic, research, clinical)
  5. Supplement the clinical examples offered in the NHS Leadership Framework
  6. Celebrate success
  7. Support for revalidation
  8. Model job descriptions for formal positional leadership and management roles
  1. The provision of leadership and management training
  2. The College to provide high quality face to face training in leadership and management topics
  3. Groups with specific learning needs around leadership include:-
  4. Psychiatrists making the transition to consultant grade
  5. Psychiatrists in formal leadership and management positions
  6. Those providing supervision to psychiatrists in formal leadership and management positions
  7. Those involved in teaching leadership and management skills
  8. College members have specifically requested access to:-
  9. Tools and training around commissioning in mental health and financial and resource management skills
  10. A formally accredited leadership and management course for psychiatrists

Curricula and competency issues

  1. Embedding leadership and management competencies in psychiatric practice
  2. The College should encourage and enable its membership to identify and achieve the relevant leadership and management competencies as described in the NHS Leadership Framework and its supporting materials
  3. Leadership and management competencies for psychiatrists should be embedded in:-
  4. Training
  5. Competency Based Curricula for Core and Specialist Psychiatry Training
  6. Annual Review of Competence Progression
  7. Workplace Based Assessments
  8. Membership examinations
  9. Continuing Professional Development
  10. College delivered CPD activities
  11. Appraisal
  12. Revalidation
  13. The College web pages

Raising the profile of leadership

  1. The importance of leadership can be highlighted and the work of the College publicized via:-
  2. Presentations at College events including the International Congress
  3. Publications on line and in print
  4. Regional and local networks
  5. Electronic resources
  6. There may be value in conducting an internal consultation or survey on members’ perceived leadership needs and known resources
  7. The College offers opportunities to be a professional leader via roles at Faculty and national level (including leadership of initiatives, committees, acting as champions and providing expert resources)
  8. Rewarding leadership achievement with College awards

4 / NHS reforms

4.1 - The context for reform

The government is reforming the way the NHS in England works. Under new plans GPs and other clinicians will be given greater responsibility for spending the NHS budget in England and increased competition with private and charitable sectors will be encouraged. Criticisms from MPs and health unions offered during recent “listening exercises” about the original proposed reforms led ministers to place their implementation on hold pending an independent review by the “Future Forum” chaired by Prof. Steve Field, former Chairman of Council, Royal College of General Practitioners. The Future Forum concluded that sections of the Health and Social Care Bill should be re-written and ministers have now accepted all of the proposed amendments.

The next few years will be the most financially challenging in the history of the NHS; costs are rising at a higher rate than inflation due to an ageing population, costs of new drugs and treatments and lifestyle diseases, such as obesity. To manage, the NHS is tasked will making savings of up to £20bn by 2015. This will require the NHS to become 4% more productive each year (reversing a decade long trend of declining productivity). If we fail to meet this challenge quality of care will suffer and rationing and waiting lists will increase. Ministers believe that redesigning how the NHS functions will help us to meet this challenge.

4.2 - Transition to the new NHS

At present local health managers, employed by 151 Primary Care Trusts (PCTs), control the majority of NHS spending. They use the budget to plan and buy (“commission”) services for patients including community clinics, hospital care and mental health units. The NHS reforms will transfer much of this duty to Clinical Commissioning Groups (CCGs). Responsibility for services such as dentistry and specialist care (e.g. neurosurgery) will be passed to the National Board – the body which will oversee the new system. Originally, the commissioning groups were to be known as “consortia” and led by GPs, however other professionals including hospital doctors and nurses will now also be involved. The changes outlined above are taking place during a “transition period” from the old to the new systems and both PCTs and the 10 regional Strategic Health Authorities (bodies which function as regional representatives of the Department of Health) are being phased out.

4.3 - Competition

The reforms are partly designed to promote healthcare involvement from the private sector and charitable bodies. This is not a new concept for the NHS; under the Labour government these organisations were encouraged to contribute, particularly in elective operations such as hip and knee replacements. Thus far, however, only 3.5% of these operations are undertaken within the private sector. In other areas of health care, particularly mental health, the role of other providers is more prominent. In total, £1 of every £20 spent in the NHS passes to a non-NHS provider. Controversially, the reforms will most likely increase this; detractors claim that the government is privatising the health service. Ministers have sought to allay this fear by agreeing to introduce competition in a more managed and balanced way.

4.4 - The cost of change

The reforms will cost an estimated £1.4bn and a significant proportion of this will be achieved over the next 18 months as more than 20,000 management and administration staff are made redundant from SHAs, PCTs and the Department of Health. The redundancies will cost up to £1bn but the reduction in staffing levels will save £5bn by 2015. An additional £400m will be spent in areas such as IT, estates and establishing the Clinical Commissioning Groups with the costs offset by savings.

4.5 - Timetable for change

In October 2011, the House of Lords voted to give the Health and Social Care bill a second reading. If the timetable for transition is adhered to the new Clinical Commissioning Groups will begin to take responsibility for the NHS budget in April 2013; however, under one of the concessions to critics, those areas that are not ready to take charge will not have to - instead, the National Board will take charge of the budget whilst the CCGs become fit for purpose.

The government has also announced the following:-

  • The establishment of “Clinical Senates”, comprising doctors, nurses and allied professionals, and these will advise commissioners on commissioning in the NHS and will play a key role in the authorisation of Clinical Commissioning Groups;
  • Monitor will function as an independent, pro-competition regulator of the health service responsible for licensing providers – including those from the private and voluntary sectors;
  • An independent national body called “Health Watch” will:
  • Promote the interests of NHS patients by representing the interests of patients as consumers to Monitor;
  • Represent the interests of patients to the NHS in strategic commissioning;
  • Monitor the NHS and disseminate information nationally and locally;
  • Pursue and refer individual or collective patients complaints;
  • Contribute to the public debate about the NHS at a national level.

4.6 - Key points about the NHS reforms

•The NHS has to save £20 billion by 2015 by becoming more productive;

•If we do not meet this challenge quality of healthcare may be compromised;

•Clinical Commissioning Groups (CCGs) comprising GPs, hospital doctors and nurses will be responsible for the budget from April 2013;

•CCGs will be overseen by the National Board;

•There will be increased competition with the private and charitable sectors;

•The reforms will cost £1.4 million and there will be 20,000 management & administration redundancies

Effective clinical leadership underpins the delivery of high-quality health care and will be fundamental to realising the potential inherent in the new health and social care bill, “No Health without Mental Health” and specialty specific health strategies.

5 / The leadership landscape

The pace of change in the NHS is rapid and the Royal College leadership strategy will most likely evolve in tandem with current and emerging national political, healthcare and leadership strategies. Strategic Health Authorities will be abolished in April 2013 and the organisations listed below will be providing oversight, organisation and input in the emerging leadership development landscape.

The National Leadership Council (NLC) ( was set up to underpin and champion the priority attached to leadership in the NHS and aims to ensure that the NHS system supports and fosters effective leadership, and to challenge where it does not (NLC, 2011). The Council is responsible for ensuring that the NHS has a systematic way of identifying and developing the leaders of today and tomorrow. It works to support world-class leadership talent and leadership development and to ensure that this exists at every level of the NHS. The Council is a sub-committee of the NHS Management Board, is chaired by the NHS Chief Executive David Nicholson, and has identified five priority areas for NHS leadership with specific work streams set up to focus on each. These areas are: Clinical Leadership, Board Development, NHS Top Leaders, Inclusion and Emerging Leaders.

The Academy of Medical Royal Colleges ( comprises the Presidents of the Medical Royal Colleges and Faculties and this group meets regularly to promote, facilitate and where appropriate co-ordinate the work of the Medical Royal Colleges and their Faculties.

The Faculty of Medical Leadership and Management ( is a new UK-wide organisation that aims to promote the advancement of medical leadership, management and quality improvement at all stages of the medical career for the benefits of patients. Revalidation for doctors will be introduced during 2012 and the FMLM is developing support for participants and appraisers focussing on leadership elements of each doctor’s role including those of doctors with a substantial leadership and management commitment. The FMLM is developing standards for management and leadership and supports those involved in management and leadership education.

The NHS Institute for Innovation and Improvement ( a range of products and interventions to help build leadership capability and capacity across the NHS.

The Academy and the NHS Institute are collaborating on a UK-wide project called “Enhancing Engagement in Medical Leadership” which aims to promote medical leadership and help create organisational cultures where doctors seek to be more engaged in management and leadership of health services and non-medical leaders genuinely seek their involvement to improve services for patients.

The Academy and the NHS Institute have published “The NHS Leadership Framework” (NHS LF); this is an overarching framework describing leadership capabilities, competences and behaviours in the NHS. The NHS LF relates to all doctors in the NHS, is described in more detail in the following section.

Medical Education England ( provides independent expert advice on education and training and workforce planning for doctors, dentists, healthcare scientists and pharmacists.

6 / NHS Leadership Framework

6.1 – Overview of the NHS Leadership Framework

The NHS Leadership Framework (NHS LF; is an overarching framework describing leadership capabilities, competences and behaviours in the NHS. It is underpinned by a consistent set of guiding principles which reflect the values of NHS staff as captured in the NHS constitution and represents the foundation of behaviour for staff throughout the NHS.

The NHS LF relates to all staff in the NHS irrespective of their professional role, function or level and comprises 5 core dimensions. The 5 core dimensions relate to the 5 domains of the Medical Leadership Competency Framework and Clinical Leadership Competency Framework plus two more for senior leaders intersected by 5 levels to enable leaders to understand their progression/development from self to leading systems:-

  1. Demonstrating personal qualities: Effective leaders need to draw upon their values, strengths and abilities to deliver high standards of service. This requires them to be demonstrate effectiveness in Developing Self Awareness, Managing Themselves, Continuing Personal Development and Acting with Integrity.
  1. Working with others: Leaders work with others in teams and networks to deliver and improve services. This requires them to demonstrate effectiveness in Developing Networks, Building and Maintaining Relationships, Encouraging Contribution, and Working within Teams.
  1. Managing services: Effective leaders are focused on the success of the organisation(s) in which they work. This requires them to be effective in Planning, Managing Resources, Managing People and Managing Performance.
  1. Improving services: Effective leaders make a real difference to people’s health by delivering high quality services and by developing improvements to services. This requires them to demonstrate effectiveness in Ensuring Patient Safety, Critically Evaluating, Encouraging Improvement and Innovation and Facilitating Transformation.
  1. Setting direction: Effective leaders contribute to the strategy and aspirations of the organisation and act in a manner consistent with its values. This requires them to demonstrate effectiveness in Identifying the Contexts for Change, Applying Knowledge and Evidence, Making Decisions, and Evaluating Impact.

There are two additional dimensions which may apply to all leaders but particularly apply to senior leaders.

  1. Creating the vision: Effective senior leaders create a compelling vision for the future, and communicate this within and across organisations. This requires them to demonstrate effectiveness in developing the vision for the organisation, Influencing the vision of the wider healthcare system, Communicating the vision and Embodying the vision.
  1. Delivering the strategy: Effective senior leaders deliver the strategic vision by developing and agreeing strategic plans and ensuring that these are translated into achievable operational plans. This requires them to demonstrate effectiveness in Framing the strategy, Developing the strategy, Implementing the strategy, and Embedding the strategy

Staff will exhibit a range of leadership behaviours across these 7 dimensions dependent on their context. Intersecting these dimensions are 5 levels of leadership. These are broadly progressive and are designed to illustrate the stages of development as a leader.

Level 1: Leading as a professional involves building personal relationships with a range of colleagues, often working as part of a multi-disciplinary team. L1 leaders need to be able to recognise problems and work with them to solve them. The impact of the decisions leaders take at this level will be limited in terms of risk of a successful outcome.

Level 2: Leading others involves building relationships across and within teams, recognising problems and solving them. At this level, leaders will need to be more conscious of the risks that their decisions may pose for self and others in terms of a successful outcome.

Level 3: Leading services involves networking across teams and departments. Leaders will challenge the appropriateness of solutions to complex problems. The potential risk associated with their decisions will have a wider impact on the Service.