Leadership shapes organisations. It lays down the culture, influences decision-making and ultimately affects the quality and safety of care that people receive. Across health and social care, recent appointments at the highest levels of government and regulation signal the start of an exciting new chapter. Whilst change is daunting for many, others embrace it as an opportunity to affect a new vision, strengthen services and rebuild confidence.
The Care Quality Commission (CQC) has recently appointed Emily Miles as its new Chief Executive, while at the most senior leadership level, the Government has confirmed a new Prime Minister and a new Secretary of State for Health and Social Care. Although each role has different responsibilities, they share a common purpose: providing clear strategic leadership at a time when the health and care system faces some overwhelming challenges.
The appointment of Emily Miles is particularly important for health and social care providers. She joins CQC following one of the most difficult periods in the regulator’s history. As independent reviews identified serious operational failings arising from a major organisational and digital transformation programme, she joins as the regulator seeks to recover from declining inspection activity, inconsistent assessments, registration delays and problems with internal and external IT systems. While CQC has made some progress in addressing these issues, rebuilding trust with providers, the public and its own workforce remains an ongoing priority.
Whilst Emily Miles does not have a background in frontline healthcare, she brings with her extensive experience of leading complex public organisations through periods of change. Whilst her CQC predecessor, Ian Trenholm joined the CQC following previous experience that generated some debate around his transformational leadership credentials, she has successfully led national regulatory organisations, managed large-scale transformation programmes and worked across government departments during periods of significant reform. At a time when CQC’s greatest challenge is organisational recovery, strong, consistent leadership is exactly what is needed.
Leadership, however, is not only important at national level. It is fundamental within every health and social care provider.
Whether in a GP practice, independent healthcare clinic, care home or homecare service, effective leadership creates the conditions for safe, high quality care. Yet leadership is about far more than leaders alone: effective leaders don’t simply set a strategy, they inspire, empower, and enable their teams and stakeholders to create a joint vision and bring it to life. It is this that creates lasting impact across the whole service.
Strong leaders will establish clear expectations, support teams, encourage learning, manage risk proactively and ensure that governance systems are embedded throughout the organisation. They create cultures where staff feel able to raise concerns, innovate, learn from incidents and continually improve the services they provide.
This is why leadership has always been a central theme within CQC regulation.
Under the Single Assessment Framework, leadership is reflected throughout Well-led, particularly Shared Direction and Culture and Governance, Management and Sustainability. Inspectors not only look at policies and procedures, but want to understand how leaders communicate with staff, use information to improve services, learn from feedback and create an open, positive culture. Effective leadership is not simply about business plans and strategy: it is demonstrated through everyday interaction, decision-making and accountability.
Conversely, weak leadership can have significant and even dangerous consequences.
Poor governance often leads to poor care, unmanaged risks, ineffective incident reporting, low staff morale and closed cultures. Numerous inquiries into health and social care failures have highlighted that poor leadership is frequently an underlying cause, even where frontline staff are committed to delivering good care. When leaders fail to provide direction, oversight or support, the quality and safety of services can quickly deteriorate. This is why changes in leadership matter.
New leaders bring fresh perspectives, new ideas and challenge established ways of working. Importantly for Emily Miles, Andy Burnham and Yvette Cooper, they have the opportunity to rebuild confidence where it has been lost. For the CQC, effective leadership is vital. It is key to rebuilding confidence in regulation and, more importantly, to ensuring that people receive safe care from the providers it regulates.
For government, strong leadership is needed to address workforce pressures, improve access to care and support the long-term sustainability of health and social care services.
For providers, these appointments serve as a timely reminder to reflect on their own leadership. CQC does not only assess whether services have the right policies in place, it assesses whether leaders create environments where those policies are understood, implemented and continuously reviewed and improved.
Strong leadership alone cannot solve every challenge facing health and social care, but without it, meaningful improvement is unlikely to succeed. As the sector enters a period of national renewed leadership, there is an exciting opportunity for organisations across primary care, independent healthcare and adult social care to demonstrate the positive impact that effective, visible and accountable leadership can have on the people who matter most: the people who rely on their services every day.