Firefighting vs. Leading: Why NHS Leaders Feel Stuck in Survival Mode

Most NHS leaders don’t set out to firefight. They start with vision, purpose and commitment. But somewhere along the line, the spark fades. Days become a blur of meetings, rota gaps, operational pressures, and urgent crises that leave little space for strategic thought. You end the week exhausted and oddly unsatisfied — as though all that effort hasn’t really changed anything.

This sense of “stuckness” is not a personal failing. It’s a symptom of a system in flux.

The NHS Long Term Plan and the subsequent NHS England Workforce Plan (2023) have set in motion one of the biggest structural shifts in decades — moving care from hospitals to communities, digitising services, and focusing on prevention rather than treatment. These are bold, necessary ambitions. But structural reform on this scale takes time, clarity, and leadership bandwidth — three things in short supply when most leaders are simply trying to get through the week.

At the same time, financial pressure is tightening. In 2024, the Health Foundation reported that NHS budgets, when adjusted for inflation, have effectively fallen by around 2% in real terms, while demand continues to rise. In practical terms, this means fewer resources, frozen posts, and an expectation that “efficiency” will fill the gap. It’s no surprise, then, that 44% of NHS staff report feeling unwell from work-related stress (NHS Staff Survey, 2023) — the highest figure since records began.

When the system runs on thin margins, firefighting becomes the default mode. It feels necessary, even noble: responding quickly, fixing problems, keeping the show on the road. But firefighting, by its nature, is reactive. It doesn’t create space for learning, innovation or culture-building — all the things that actually make services sustainable.

A BMJ Leader study in 2022 found that NHS managers spend nearly 70% of their time on meetings and operational problem-solving, leaving little scope for reflection or team development. Yet the King’s Fund (2023) found a strong correlation between leadership cultures that prioritise coaching and reflection and those with better staff retention and patient outcomes. In short, the more time you spend leading — rather than reacting — the better your team and your service perform.

But creating that space takes courage. The NHS has long equated visible busyness with dedication. The leader who blocks thinking time, cancels unnecessary meetings, or takes time for their team’s development can be misunderstood as “not pulling their weight.” In reality, they’re doing the hardest thing of all: protecting capacity to think and lead.

If you want to break the cycle, start small. Block one hour a week for strategic reflection — and defend it fiercely. Review your diary: which meetings truly need your presence? Which could be shortened, delegated, or replaced with a written update? Invest time in coaching your team so they can take on more responsibility and stop every issue bouncing back to you.

Firefighting might keep things afloat, but it won’t move them forward. The NHS needs leaders who can lift their gaze above the flames — who can step back long enough to shape the systems, culture and strategy that stop the fires starting in the first place.

Because in a time of structural reform and shrinking budgets, what the NHS needs most isn’t more urgency — it’s more leadership.

Why Working Harder Isn’t Getting You Further

Why Working Harder Isn’t Getting You Further in the NHS

Most NHS women leaders I coach tell me the same story. They’re working harder than ever, racing from one meeting to the next, firefighting problems, replying to emails late into the night. Yet despite this relentless effort, they end each week wondering what difference they’ve actually made.

It’s a paradox many recognise: the harder you work, the less progress you feel. And it isn’t simply about personal time management or motivation—it’s about the system you’re operating in.

Research consistently shows that NHS staff are at higher risk of burnout than the general population. A survey by NHS Employers found staff were 50% more likely to suffer from chronic stress than people in other sectors. Burnout doesn’t just drain energy, it also reduces effectiveness. In fact, psychologists call this the “diminishing returns of effort.” Push harder, and each extra hour produces less value than the one before.

This is compounded by the way the NHS measures and rewards its leaders. According to The Broken Ladder report (Investors in People, 2025), 80% of NHS managers are promoted for technical expertise, not leadership ability. The result is a culture where “doing more” is valued over “leading better.” In practice, that means leaders are buried in tasks rather than developing people, shaping strategy, or creating space to think.

To make matters worse, many leaders never receive formal training in how to lead people in such a complex system. A Financial Times analysis recently revealed that only one in five NHS leaders has had senior management training in the last five years. Without support, leaders default to what feels safe: working harder, putting in extra hours, and saying yes to everything. But those behaviours rarely lead to recognition or promotion.

And yet, the women I work with also carry another set of unspoken pressures: the need to prove themselves, the fear of being judged, the discomfort of taking up space. These internal voices combine with systemic pressures to keep women trapped in a cycle of overwork, invisibility, and exhaustion.

So if harder isn’t working, what will?

The answer lies in shifting from effort to impact. That doesn’t mean slacking off. It means recognising that the best leaders aren’t the ones who carry the most, but those who create the conditions for others to succeed. It means being brave enough to delegate, to prioritise, and to protect time for thinking.

A few simple practices can help start the shift. Try ending each day with five minutes of reflection: what went well, what drained me, and what will I do differently tomorrow? Map your team’s strengths, and delegate tasks that play to those abilities—this not only lightens your load, but helps your staff grow. And most importantly, protect your energy. Boundaries around rest and family time aren’t indulgent; they are essential for effective leadership.

The truth is, the NHS doesn’t just need women who work harder. It needs women who lead with clarity, influence, and purpose. And that starts when you stop equating effort with impact, and begin working in ways that truly move the needle.

Celebrating investment in leadership development

March 26th 2025 was the celebration day of the end of a year long program for system leaders working in a range of organisations that support health.  Two cohorts came together who work at different levels.  The day was about reflection of learning, celebrating achievement and networking.  An absolutely essential part of a leadership program that sometimes may not be seen as necessary.  These were just some of the reflections that demonstrate the impact of investment in leadership development:

“I am now more conscious about my career and how to take more control over where I want to go”.

”The course has helped me understand who I am and who I want to be”.

”I have been able to deliver things that would have been difficult in the past and others have noticed”.

”I was aware of the theory but the program helped me understand how to apply it in my work”.

”I understand my values and how they impact who I am as a leader”.

”I am more confident about who I am and what I want”.

”I have moved from feeling “less than” to feeling “equal to”.

Listening to this feedback was a joy and it was a privilege to have facilitated on this program.

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