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Finding the perfect leader

Lynn Young
Primary Healthcare Adviser for the RCN

Nurses are, with a bit of luck, enjoying the Autumn time and we also hope that the Secretary of State for Health, the Right Honourable Alan Johnson, is having a wonderful time in his new job.
Here, by reputation, is a man of the people who has risen from the ranks of school leaver, aged 15 years, to one of the most important jobs in the country. The Blair camp is demob happy and the Brown camp, with a brand new cabinet, is finding its way around the corridors of power.
Alan Johnson's health team is in place and nurses are advised to believe that fresh energy, thinking and action is just around the corner. So far we have been promised a comprehensive review of the NHS and with it a more listening approach, so that frontline clinicians and patients genuinely feel that they can be involved in the way their healthcare system develops.
Basically, Prime Minister Brown will strive for great improvements to be achieved and a disgruntled workforce transformed into a joyful and energetic one before the next general election. Rumour has it that an election may be held sooner rather than later, while the polls are riding high in favour of the present regime.
But, back to healthcare and who the new leaders with influence are. Readers will have heard the name of Professor Sir Ara Darzi bandied about, who has been appointed as new junior health minister, while continuing to work part-time as a surgeon. Meanwhile, Mr Johnson has announced that Sir Darzi will "establish a vision for the next decade of the health service".(1)
At the same time David Nicholson, NHS Chief Executive, says that he wishes to see clinicians on every shortlist of every NHS trust chief executive post. It is indeed possible that the NHS is trying its very best to appoint a significant number of doctors, nurses and therapists to key posts within healthcare and reward them accordingly.
Which brings me to the world of nurse leadership and how it is faring following the recent major reconfiguration of organisations. Following much lobbying from the RCN and agreements achieved with Department of Health personnel, strategic health authorities and most PCTs have appointed their nurse directors.
The point is though that the new PCTs have been told by ministers that they now have to concentrate their energy on being commissioning, rather than provider organisations. This being the case, we have for the main part got senior nurses at the commissioning tables, but as the move towards separating commissioning and provider functions bites into the system, it seems that we could be facing a lack of nurse leadership in the providing side of services.
If this is the case, the longer-term result could be a  disaster. Current health policy of developing services closer to home could be severely hampered if nurse leadership fails to flourish within the new community health provider organisations.
The RCN is maintaining a careful eye on where the nurse leaders are and what remits they have been given within their organisations. The truth is that we need superb nurse leaders at both commissioning and provider levels, particularly at a time when the redesign of services has to be achieved, if we are to meet the changing health needs of a different society.
Nurses, by reputation, are adaptable, flexible and leaders of change. Nurses need to develop confidence in sharing their skills and knowledge - particularly with the public and their patients.
The future patient is well-informed, competent, confident and well-placed to manage both minor illness and long-term conditions. People everywhere are ceasing to smoke while much more effort needs to be focused on young people and their dangerous binge drinking habits. We are facing a generation which sadly may witness far too many young people suffering from cirrhosis of the liver and/or diabetes. Premature death lies ahead for some while at the same time another section of the population is geared towards working with nurses in order to keep well, rather than being "done to" by nurses.

1. Stunkard A, McLaren-Hume M. Results of treatment for obesity: a review of the literature and report of a series. AMA Arch Intern Med 1959;103:79-85