All too often, we consider leaders to be those whom we ‘look up to’ or those ‘heroes’ that have been placed upon a pedestal. However, we often forget the people who are quietly making things happen—leaders in their own right—we only ever notice those that shout about their endeavours.
There are thousands of definitions of leadership; but in its basic form, it's about getting someone to do something, because they want to do it. It's about subtly influencing a person or group of people, so that they want to achieve your goal. In this form, it sounds mischievous but this is why we often don't see the leaders. If you've been influenced to do something, you now want to do it—you don't see the influence. Clever!
Yet it's those people that influence us that improve our working lives. We can sometimes forget to thank them, or not even realise how they're helping. Leadership has been a consistent presence in the ambulance services throughout the past and present, and will also continue in the future. As simple as this sounds, it isn't—you do need coaching and education to enhance your skills as a leader and manager. We can use the analogy of a sports person: like them, we only get better with training, practice, education and coaching.
When the NHS was created, there were 146 separate ambulance services in England. Over the years, this has reduced to 51 in 1974; 40 in 1995; 12 in 2006; and by 2010, the current number of 10 ambulance services (Pollock, 2015). Imagine the number of managers in those services over the years. Has that number actually decreased with the reduction in services?
Perhaps those most senior roles have decreased; but on a fundamental level, the total number of staff has increased. It could be anticipated therefore that the number of managers has as well. But is a manager actually a leader? Absolutely not! When compared to other services, the ambulance service does not have a standardised structure similar to the police or fire service. In the police service, there is specific training for each role and a multitude of tests to pass before you progress, and it has been this way throughout the past. The ambulance service does not have this format: it could be argued that past leaders have not had any formal education to become leaders or managers. Perhaps this was due to the fragmentation of ambulance services nationally, and no real emphasis on the requirement of education for managers. Has this changed?
Formal education packages for commanders now exist; however, there is no standardised structure requiring formal education to become a manager or leader. There is still a high proportion of accidental managers across ambulance services, and this may be the primary cause of issues faced across the country.
Presently, with the emphasis on ‘command’, it is often forgotten that, 98% of the time, this style isn't required, and a more transformational approach is needed. Transformational approaches empower staff to be their best and allow them to have input into their services. A vital element of this is that staff know who their manager is—anecdotally, this isn't currently apparent. It is often perceived that managers are only seen when there is a problem; yet for these managers to be leaders, they need to praise staff when things go well.
Notwithstanding the above, there are most likely pockets of excellence in ambulance services that achieve all of this. However, is it consistently applied and is it shared across the entire service?
A review of every ambulance service's Care Quality Commission (CQC) report suggests that only four services have ‘Good’ leadership, while the other six have ‘Bad’ leadership. None are considered ‘Outstanding’ for the well-led domain, which is highly concerning.
Perhaps the immediate future needs a formal approach to manager and leadership development—a consistent national approach that is mandated for all appointments. This will take time to establish, as often ambulance services want something bespoke. However, programmes exist that can support the immediate improvements required before a national approach is developed.
More research into leadership across ambulance services is required but, right now, there are two key areas required by leaders and managers: courage and passion (Layland, 2018). Encompassing these will support the improvements required across services but, more importantly, demonstrating these values to staff will empower them. In future, a formalised structure that is easily recognisable, similar to that of the police, will support clear progression and improved leadership and management in paramedic practice.