“I’d like to see an NHS where health professionals support patients to be the leaders of their own health care.”

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In her latest blog, senior programme lead, Clare Price-Dowd, reflects on the pioneers of nursing and how leadership in the NHS, and in nursing, has changed over time.

When I joined the NHS in 1983 the first nurse leaders I encountered were very much of the Hattie Jacques in Carry On Matron ilk, though not all were quite so scary, thankfully. But although there was a hierarchy, each ward had a team, which everybody felt part of. Housekeeping, for example, wasn’t contracted out at that time. We knew the housekeepers’ names and they knew ours.

The NHS’s 70th birthday earlier this year made me think about some of the great leaders in nursing. Four great figures spring to mind:

  • Mary Seacole: a tenacious person, Mary Seacole got herself out to the site of the Crimean War in the 1850s, despite having her help refused twice by the British Government. She cared for wounded soldiers and was posthumously awarded the Jamaican Order of Merit in 1991. I think she used her unique dual heritage—she was part Scottish and part Jamaican—her knowledge of herbal medicine and dogged determination to succeed. And, of course, her legacy lives on in the NHS Leadership Academy’s Mary Seacole programme, for those new to leadership
  • Florence Nightingale: she was, and still is, the person most people see as the epitome of the nurse. People forget that she was also an incredibly clever statistician. Although coming from a wealthy family, she chose to serve as a nurse during the Crimean War. But it’s not what she was destined for. As a skilled statistician, she used models and theories to influence others to make changes to health care
  • Edith Cavell: I talked about courage in one of my previous blogs, and Edith Cavell is the nurse who epitomises that for me. She pioneered nursing techniques in Belgium during the First World War, treating soldiers regardless of their nationality, and then became a member of the underground network. She helped allied soldiers to escape to safety in Holland, which at the time was a neutral country. She was captured, tried for treason and executed. Edith Cavell to me is the absolute epitome of two of the ‘6 Cs’, courage and compassion. It didn’t matter where patients were from, she would care for them and she ultimately lost her life as a result of her courage
  • Kofoworola Abeni Pratt: the very first black nurse employed by the NHS, Kofoworola Abeni Pratt was originally discouraged from being a nurse but moved to the UK in 1946 and began her nurse training at the Nightingale School at St Thomas’ Hospital in London. She returned to her native Nigeria later where she was appointed matron of University College Hospital—the first Nigerian actually to hold that position—and became the commissioner for health for Lagos in the 1970s. She was given the Florence Nightingale medal and is an honorary fellow of the Royal College of Nursing. She really paved the way for lots of other people to see that it was a great thing to be both a nurse, and a black nurse.

These four women are the real founders of nursing, the pioneers who turned nursing into the profession we see today.

I also think of the Windrush generation and the massive contribution they have made to the NHS. They are heroes, but despite being the people who have made the NHS tick along, they are often hidden and unrecognised. It’s so sad now to see so much discrimination highlighted by the research that led to the introduction of the Workforce Race Equality Standard (NHS England, 2018). We need to appreciate what the Windrush generation went through and support all nurses from all backgrounds.

 

Leaders of the future

I’ve seen leadership change massively. Has it changed for the better? Absolutely.

We’ve gone from transactional to transformational leadership, which develops and supports others, and leaders are less afraid of sharing or letting go of power. Leaders are supporting and developing the next generation coming through. But one trap not to fall into is thinking that one single person can transform things from bad to good or good to great. We see people hailed as a transformational leader when in reality they are empowering others at all levels to act and the cumulative effect is transformation brought about over a long period, not a ‘miracle’ by one individual.

Leadership is moving from ‘the person in charge’ to being truly distributed among teams, which I think is absolutely the way that it should be. I genuinely believe future leaders need to appreciate that the knowledge is not held with them, that people coming through collectively hold far more knowledge than you or I will ever have and we need to embrace that. The leaders of the future will need to:

  • Lead at system level, not just in their own environment but across health and social care and, indeed, all industries that work together to promote health
  • Understand and be able to work with complexity and ambiguity—health care is not a neatly packaged, small environment like it used to be
  • Appreciate that knowledge is not held with them but with others and support patients to be the leaders of their own health care

There are people working in the NHS who have never known life without a mobile phone or computer. Their reality is very different to mine. I remember life without a mobile phone and certainly the stress the very first computerised patient appointment system caused in the GP surgery I was attached to.

I read recently that the power in the future is going to be held by people who can ask the right questions. We live in a data age. Data that can tell us all sorts of stuff is everywhere. Details on conditions and a wealth of statistics are all at our fingertips, so the power is going to be held by people who know what questions to ask of that data. When answers are available, they’re going to be the ones that shine.

And while we know the NHS is huge—the fifth largest employer in the world—health care is so much bigger. We’re already part of a global set of leaders, whether we realise it or not. We draw on data not just from our own environment but from what’s happening across the world on a daily basis. We’re as comfortable getting an answer from the other side of the world, from something that’s happening in Australia or in the USA, for example, as we are from getting an answer on our doorstep. This is the stuff of the future.

 

I’d like to see an NHS where health professionals support patients to be the leaders of their own health care. And where patients are totally self-determining with the support of professionals. That is the way we will tackle the big challenges.

 

Everything I have learned I owe to those people who took the time to invest in me, and to support me through the hard times. Isaac Newton said: ‘If I’ve seen further than other men, it’s because I’ve stood on the shoulders of giants.’ And while I’ve got to a reasonably senior position in the NHS, in the organisation I’m working for, I absolutely know that it’s because I have stood on the shoulders of giants, especially the nurse leaders I’ve mentioned above, who have gone before me.