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Published 22 October 2015
As Sir Jonathan Michael retires from the NHS after 45 years, he speaks to Radhika Holmström about developing the organisation's leaders of the future, and highlights the vital role that integrated health and social care must play in years to come.
“I trained in the days of Richard Gordon’s Doctor in the House books and film,” says Sir Jonathan Michael. “I remember seeing the film before I went to medical school and thinking it was wonderful fiction. Then when I started work I realised it was actually a documentary.”
This September, Sir Jonathan bowed out as head of Oxford University Hospitals NHS Trust (OUH) after five years at the helm. He’s leaving, as he puts it, “with our house in order”. In fact, Sir Jonathan is not only leaving OUH but retiring from the whole of the NHS.
“When I look back on the hospital sector when I trained, and the NHS, it is so different now and so much better. We’ve moved beyond the welfare-based system where patients were almost required to be grateful for care to one where we are a service provider. I think the expectations of society have changed, and also the ability of the NHS to respond to that has also changed dramatically.”
The other huge shift, he feels, is towards integrating health and social care. “I think the NHS needs to move away from the distinction of what goes on within the hospital and what goes on more broadly in the community.”
At OUH, Sir Jonathan and his colleagues are already moving to that kind of delivery for elderly patients, in conjunction with Oxford Health. “It’s not an organisational merger, so the structures and accountability are still separate, but we’re looking to integrate services under a single alliance management team.”
The actual model for achieving integration is less important – in fact, he would prefer a much greater range of options to the two models presented in NHS England’s Five Year Forward View. “I think it’s more important to focus on the function rather than having the quality of the care constrained by the organisations.”
What does matter to Sir Jonathan is the quality of the leadership. He makes some important distinctions between “structural leadership” – where people are assigned responsibility by virtue of their position within a management structure – and “sapiential leadership”, where people have built up a huge body of knowledge and experience, and are turned to by others because of that.
Sir Jonathan believes very strongly that clinicians should play a key role in management and leadership, and that leadership should be more built into the overall training and professional development that clinicians receive. “The NHS Leadership Academy has been running some really good programmes, but it touches just a small percentage – and while we do need a central capacity, you cannot manage all the leadership for what is, after all, a virtual organisation.”