Sir Alan Langlands, former Chief Executive of NHS London, gives his opinion on leadership and management in the NHS.

1. The King’s Fund
NHS Leadership
‘an ongoing conversations between people who care
deeply about something of great importance’ Anon
Alan Langlands
24 March 2011

2. Perspectives from an old timer
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 background
 context
 substance
 process

3. CONTEXT
Constancy of purpose
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… the purpose of the NHS is to secure through the resources available
the greatest possible improvement in the physical and mental health of
people:
 promoting health
 preventing ill health
 diagnosing and treating injury and disease
 caring for those with long-term illness and disability who
need the service of the NHS.

4. CONTEXT
Results
_____________________________________________________________________________________________________________________
equity
 measuring progress
 finding the best trade-offs
£
efficiency excellence responsiveness

5. CONTEXT
All change
_____________________________________________________________________________________________________________________
legislative change
 the economy
 demography
 science and technology
 the swing from the
collective to the
individual
 changes in the burden
of disease
 challenges for the
professions
system change organisational
change

6. CONTEXT
Government or market-led
_____________________________________________________________________________________________________________________
government
 the imperative of the cash
limit and the need for
control
 the power and influence of
the professions
market public

7. Avoiding victimhood and
maintaining control
_____________________________________________________________________________________________________________________
Department of Health
Monitor
and ministers
Care Quality
Accountability
Commission
Strategic Health
Funding
Authorities
Foundation Primary care
NHS trusts
trusts trusts

8. Thinking through anatomy AND
physiology
_____________________________________________________________________________________________________________________
Accountability Department of Health
Funding
and ministers
Care Quality NHS Commissioning
Monitor Board
Commission
Foundation trusts and other GP commissioning
healthcare providers consortia

9. SUBSTANCE
Equity and excellence
_____________________________________________________________________________________________________________________
 competition
 choice
 quality improvement
 higher standards
 a focus on outcomes

10. SUBSTANCE
Quality
_____________________________________________________________________________________________________________________
 safe: avoiding harm
 effective: proven benefits
 person-centred: respectful and responsive
 timely: avoiding harmful delay
 efficient: avoiding waste
 equitable: minimising variations

11. SUBSTANCE
Safer patients
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 clinical deterioration
 ventilator
Perioperative care
General ward care
associated
management
Critical care
Leadership
Medicines
pneumonia
Leadership
 central line
bloodstream
infections
 MRSA bloodstream
 anti-coagulation
medication
Safer Patients  surgical site
infections

12. SUBSTANCE
Healthy lives, Healthy people
_____________________________________________________________________________________________________________________
 a life course framework for tackling the social determinants of
health
 local government and local communities at the heart of improving
health and well-being
 a cross government approach – mental health, tobacco control,
obesity, sexual health, pandemic flu preparedness.

13. SUBSTANCE
Nurturing the scientific basis of
health services
_____________________________________________________________________________________________________________________
‘… finally after 60 years, the NHS has ended its casual relationship
with science and technology. The opportunity to translate basic and
clinical research into local, national and global therapeutic and
healthcare benefits, and to link information from a wide range of
medical and non-medical sources using electronic patient records to
ensure better treatments, improve patient safety and advance medical
research, are opportunities which must not be squandered.’
Alan Langlands: 5 July 2008

14. Malaria
Public health expenditure
HIV/AIDS
Private health expenditure
Diabetes

15. PROCESS
Aligning supporting strategies
_____________________________________________________________________________________________________________________
Quality improvement
Leadership and Governance
Critical care
Estates and equipment
Leadership
Financial stewardship
Human Resources
Management
Information Management and IT

16. PROCESS
Human resources management
_____________________________________________________________________________________________________________________
Quality improvement
Employee Employee
Leadership and Governance
Resourcing Relations
Critical care
Estates and equipment
Leadership
Financial stewardship
Effective
Communications
Education
Pay and Reward
Training and
System
Development
Information Management and IT

17. PROCESS
Promoting principles of good governance
_____________________________________________________________________________________________________________________
Promoting values
for the whole
Leadership and Governance
Performing
effectively in organisation and
Critical care
Financial stewardship
clearly defined demonstrating
functions and good governance
roles Focusing on the through
organisation’s behaviour
Engaging stakeholdersand on making
purpose and
accountability real outcomes for
citizens and
service users
Developing the
Taking informed,
capacity and
transparent decisions
capability of the
and managing risk
governing body to be
effective

18. Conclusion
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 clear purpose
 carefully defined results
 understanding the limitations of structural change
 a focus on quality, outcomes and safety
- public health
 a wider perspective
- science
- global responsibility
 align support strategies
 invest in leadership and governance