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.