3 leadership challenges in Britain’s National Health Service

The National Health Service (NHS) was established by Aneurin Bevan in 1948 with three core values:

  • That it meets the needs of everyone
  • That it’s free at the point of delivery
  • That treatment is based on clinical need, not ability to pay.

It became a unifying institution for a post-war populace struggling with austerity — and was built from the bottom up by workers from Britain and its colonies.

But today’s NHS managers are struggling to mitigate the impacts of austerity and Brexit without losing focus on the organization’s founding principles and compromising service delivery.

So here are three leadership challenges facing modern NHS managers.


The Windrush Generation of Caribbean immigrants played a crucial role in staffing the nascent NHS.

And this influx was later bolstered by staff from mainland Europe filling roles throughout the hierarchy.

But after the Brexit vote in June 2017, the number of EU nationals registering as nurses in England dropped by 92 per cent.

And stringent UK immigration rules mean the service struggles to recruit new nurses from outwith the EU.

The government claims it can train enough nurses to plug the gap — but in the meantime, NHS managers are supporting overstretched and under-resourced staff.


Brexit is occurring against the backdrop of austerity cuts imposed by successive UK governments since 2010.

Although cuts have impacted every public service, NHS boss Simon Stevens believes the service will struggle to deliver frontline services in the long term.

Critics also point out that government sustainability and transformation plans might actually be funneling money to the private sector rather than supporting crucial services.

Managers have the unenviable task of implementing politicians’ plans while attempting to reassure staff —junior doctors launched a series of strikes in 2016 protesting against controversial contracts introduced by Health Secretary Jeremy Hunt.

Facing the challenge

The NHS recognizes that high calibre management is crucial in this political climate — their leadership academy aims to train a new generation of capable bosses.

Although recruiting more frontline staff is essential, they’ll rely on supportive bosses who can also balance the books.

So students undertaking an online business management course might find their new skill set can fast-track them to an NHS management role.

And demands on managers are balanced by the fulfillment of working in a service founded on visionary principles that still provides excellent care for millions of citizens.

The long-term effects of Brexit and ongoing austerity are uncertain.

But whatever the outcomes, the NHS will be increasingly reliant on managers who combine diplomacy and emotional intelligence with sufficient business savvy.

When the new wave of austerity subsidies, these leaders will be steering a very different ship from the one Bevan launched back in 1948.

What challenges do you think the next generation of health managers will face? Share your stories in the comments section.


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