Guidance for NHS trusts and foundation trusts: assessing the well-led key question

Page last updated: 1 May 2024

Capable, compassionate, and inclusive leaders

We have inclusive leaders at all levels who understand the context in which we deliver care, treatment and support and embody the culture and values of their workforce and organisation. They have the skills, knowledge, experience and credibility to lead effectively and do so with integrity, openness and honesty.

What does good look like:

The trust’s leaders have the experience, capacity, capability and integrity to ensure that the trust’s strategy and plan are put into practice through practical actions to benefit patients and address risks to quality (including safety) and performance. The board has an appropriate mix of skills and experience to enable its members to exercise effective and visible leadership, including clinical leadership, across the trust.

Leaders at all levels within the trust promote and demonstrate a culture of health, wellbeing, safety and compassion at work. This enables individual members of staff and teams to perform at their best, and is reflected in care for patients.

Leaders influence and promote equality and human rights in their roles. They demonstrate and actively encourage compassionate, inclusive and supportive relationships among staff so that they are all respected and valued equally. Leaders proactively seek out and listen to the views of the people they lead and demonstrate an understanding of their role in preventing and detecting closed cultures early. When something goes wrong, people are informed and supported, and the duty of candour is followed.

Leaders across the trust routinely consider the holistic health and wellbeing of staff in the way they communicate and the language they use, in strategic and operational plans, and performance reporting.

Leaders seek to ensure a safe and secure working environment for staff and proactively manage and mitigate risks. They support staff to be empowered, understand discrimination and its effects and how to build equity in their roles. This helps to develop the skills to test innovations to deliver high-quality care for all.

Leaders at all levels understand and demonstrate their responsibility to model positive behaviours through leading with integrity, openness and honesty. They understand that successful leadership is not just about what they deliver as an organisation, but how it is delivered. The trust has development activities and interventions for leaders that are centred around their principles and behaviours, to help leaders learn more about what exemplary behaviours entail.

The trust proactively sustains compassionate, inclusive, collaborative and capable leadership through its:

leadership strategy and development programmes
processes for effective selection, retention, deployment and support
succession planning.

These are visible to staff. Leaders actively encourage and support staff at all levels to develop themselves and they provide opportunities through formal and informal training.

Further detail and context:

The role of leaders

Capable, compassionate and inclusive leadership can have a positive impact on the wellbeing, productivity, effectiveness, recruitment and retention of staff at all levels of an organisation. NHS England’s Culture Leadership Programme states that compassionate leadership in practice means:

leaders listening with fascination to those they lead
arriving at a shared (rather than imposed) understanding of the challenges they face
empathising with and caring for them
taking action to help or support them.

Good leadership occurs in different styles and guises, depending on the leader and organisational need and context.

The NHS People Plan states that inclusive cultures depend on inclusive leaders. Within the plan, the NHS People Promise sets out the importance of compassionate and inclusive leadership in making the NHS a place where all feel they belong and where there is no tolerance for any form of discrimination, bullying or violence. Our Leadership Way describes the compassionate and inclusive behaviours that leaders at every level should demonstrate, structured around the themes of curiosity, compassion and collaboration, and the NHS Constitution describes that NHS values for leaders at all levels to promote.

Leadership, safety and wellbeing

The health and wellbeing of NHS staff has an impact on the quality of patient care, organisational efficiency, and the ability to deliver regulatory targets. Risks to the health and safety of health workers can also potentially lead to risks, harm and adverse outcomes for patients.

Trusts can compare their organisation with what ‘good’ looks like in the NHS Staff Health and Wellbeing Framework and develop a strategic organisational action plan.

Wellbeing guardians look holistically at the organisation’s health and wellbeing activities. They have an important assurance role at board level as their purpose is to question decisions and behaviours that might affect the wellbeing of staff. They also challenge the board or senior leadership to account for its decisions and their impact.

The NHS growing occupational health and wellbeing together strategy forms a roadmap and mandate for leaders to improve health and wellbeing services for staff to keep them safe and healthy, and empowered to provide good care for patients. As set out in the NHS Violence prevention and reduction standard, leaders have a responsibility to protect staff from threats and violence at work.

The Patient Safety Strategy sets out the role of leaders in demonstrating and fostering a positive safety culture. This includes the role of the Patient Safety Specialist, who provides dynamic and expert patient safety leadership, and the broader leadership team in ensuring the voices of Patient Safety Partners are heard up to board level. The executive lead with responsibility for patient safety also has a specific role in supporting Patient Safety Partners.

Best practice / guidance

Link to regulations

Regulation 18: Staffing

Regulation 19: Fit and proper persons employed

Regulation 7: Requirements relating to registered managers

May also consider: Regulation 5: Fit and proper persons directors

Capable, compassionate, and inclusive leaders

What does good look like:

Further detail and context:

The role of leaders

Leadership, safety and wellbeing

Best practice / guidance

Leadership standards

Capable leadership tools and resources

Leadership behaviours

Health, safety and wellbeing resources

Inclusive leadership

Link to regulations