'Systems level leadership fit for the future: Lessons from Covid-19'
Professor Graeme Currie
Introduction
Responding to the immediacy of the crisis produced by Covid-19 is one thing, learning and recovery for a more resilient system in the future is another, not least learning and recovery for our healthcare system. Learning and recovery is essential for nations to cope with an anticipated second wave of Covid-19, as well as future pandemics.
Enactment of effective systems level leadership will underpin such learning and recovery. By systems level leadership, we mean leadership enacted across and downwards through relevant stakeholders so that their efforts are aligned and generate synergy towards learning and recovery. In essence, we require politicians and policymakers, scientific experts, frontline managers and professionals delivering care, if not the public in general to come together for learning and recovery in alignment and with synergy, for the learning and recovery towards a resilient system.
We should note that there is an interdependency between leadership enacted in the immediate crisis, and prospects for learning and recovery. Indeed prospects for learning and recovery have interdependence with the pre-crisis phase, that of preparing for a pandemic, not knowing when and where it will hit.
Leadership in context
Let’s consider the case of England and start with the immediate response to the Covid-19 crisis. The public and media expect a visible individual to enact leadership in a symbolic way in the immediacy of crisis. So we should not be surprised at our Prime Minister’s Churchillian stance. It is consistent with England’s pre-occupation with its past military successes (leadership must always be understood in its context), and it engages the wider public in efforts to address the crisis.
Distributing leadership
Following which, the Prime Minister, recognises that they alone cannot address the crisis. The Prime Minister recognises a double bottom line here, the dual imperative of ensuring public health and economic growth, and so brings relevant Ministers to the fore, Chancellor of the Exchequer and Minister for Health, with an emergency parliamentary committee, Cobra, advising on responses to Covid-19. At the same time, and despite some Minister’s previous dismissal of the value of experts, the Prime Minister recognises that addressing of Covid-19 needs to be evidence-based, so brings scientific experts to the fore, namely the Chief Scientific Adviser and Chief Medical Officer. Further, the Prime Minister seeks advice from two scientific committees, Nervtag and Sage.
Poor leadership preparation
Considering the above, the systems level leadership response might be deemed effective, except England lagged behind other nations in its lockdown response to Covid-19, reflected in and influenced by Prime Minister’s non-attendance at five Cobra meetings devoted to Covid-19 as the pandemic emerged. Indeed the problem started earlier than this, with preparations for pandemic crises reported as wholly inadequate. For example, there were obvious supply chain challenges regarding personal protective and testing equipment. In part, the nation’s emphasis upon Brexit precipitated such poor preparation, in part, years of austerity politics and privatisation of public services were partially to blame. Finally, the management of Covid-19 in care homes has proved a debacle, as hospitals directly discharged vulnerable patients into them without testing and as care home workers were left unprotected, often moving between care homes during their working week, thus acting as super-spreaders of Covid-19.
Blame game begins
The slow leadership response and the inadequacy of their preparation for pandemics such as Covid-19 is going to have consequences further down the line for learning and recovery. Indeed it already is doing. Influential commentators, such as the former editor of the leading medical journal, The Lancet, are already casting blame on the Prime Minister and government. Meanwhile, within the government, ministers, likely the health minister, and agencies, maybe Public Health England or NHS Procurement, are being held to blame. Scientific experts appear to be distancing themselves from government policy, even as they are being drawn in to provide evidence to shape government policy. We appear caught in a ‘culture of entrapment’, where blame and defensiveness will stymie learning and recovery. A public inquiry will no doubt follow within which blood-letting will ensue as stakeholders distance themselves from their public accountabilities.
Leadership heroes on the frontline
But let’s finish on a positive note. Regarding systems level leadership, frontline managers and professionals appear leadership heroes. Hospitals have been quickly reconfigured to cope with the pandemic crisis, with NHS managers and clinicians leading this. See the Panorama documentary about our local hospital, UHCW, filled with such heroes coming together in an aligned and synergistic way. Supplies have been procured at local level, with community groups providing personal protective equipment through sewing circles. However, all this is seemingly decoupled from political and scientific elites, and so the aligned and synergistic systems level leadership inclusive of the frontline is absent. But this gives me hope, that if we can avoid blame and defensiveness at higher levels, we will indeed emerge with distributed leadership that stretches from the political elite to the frontline of care and the community, which will aid system learning and recovery.