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How can citizens lead the health system of the future?

6 November 2015

People in Health West of England's Hildegard Dumper asks how citizens can play their part in shaping and leading the health system of the future. Hildegard is chairing a session on cities, health, people and leadership on 17 November, as part of the health strand of Festival of the Future City.

This is part of a series of blogs, where key players in Bristol's health sector write about a health related subject of their choice. If you want to contribute, email

On 17 November at the Watershed we will be debating whether the citizens of the future need to be more engaged in shaping the world they live in – the services they receive, the systems and structures that make it possible to live the quality of lives we lead. The question is whether the current models of leadership enable this to happen and do cities need to be led differently in the future to encourage engagement?

The NHS Five Year Forward Plan has described a vision of the NHS as a social movement. This relies on each and every individual playing their part and taking responsibility for the success of the NHS as active citizens. However the challenges are great. The health sector has a very hierarchical structure with a very top-down approach to leadership. Within it is a culture of working where the people at the top of the hierarchy drive forward decisions, often with little consultation with the people around them. Working collaboratively is still a new approach, with many staff not having the skills or experience to work in this way.

The evidence suggests that the current model of leadership is not effective and does not make it possible for the full diversity of society to be involved. Take for example the failure to engage women in leadership positions in the NHS structures – 80 per cent of staff in the NHS are women, whilst just 40 per cent of chief executives are women and 20 per cent of medical directors. This arguably indicates that the leadership models within the NHS are not ones that women feel comfortable with. Others are likely to feel the same.

So what kind of leadership is needed? How can the public support the vision as set out in the Five Year Plan?

One way to change the culture of working within the NHS is to encourage more people to understand how the NHS works and contribute in a constructive and positive way. People in Health West of England is building up a pool of trained and skilled people to work alongside us to help design and steer the work of the health sector in the West. These people have the potential to become ambassadors to health staff and the wider community, the friends and family around them. Our emphasis is less on individuals in leadership positions, but more about having a pool of people with a range of experiences and perspectives that work with us to improve NHS services. I am looking forward to hearing from others in the panel and in the audience about what models they think we should be adopting.

Book to attend Cities, health, people and leadership now.

How can citizens lead the health system of the future?
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