Alliance Manchester Business School - AMBS
Article By
Sarah Jane Marsh

Sarah-Jane Marsh

National Director of Urgent and Emergency Care and Deputy Chief Operating Officer at NHS England.

Last Word

Sarah-Jane Marsh reflects on the keys to management success.

I recently had the pleasure of delivering the annual Teddy Chester lecture at AMBS which is held in memory of the first professor of social administration at The University of Manchester and one of the early founders of Manchester Business School.

I must say I wish I had known about Teddy a lot earlier in my own career. Back in the 1950s and 1960s Teddy was a pioneer in management development across the NHS, using the latest evidence and research as he worked with policy makers and clinical leaders. This way of working is just as important today as it was more than half a century ago.

Teddy was also involved in founding and leading the NHS Graduate Training Scheme which I myself graduated from some 20 years ago, and what I learnt in my own management training has certainly served me very well in my career since.

For instance, my first NHS role was as a planning manager at Walsall Hospital where I learnt just how important it was to work closely and effectively with those clinical leaders who have a real vision for the NHS. My role was all about enabling that vision and giving clinical leaders the tools and support they needed.

Imposter Syndrome

My experience in Walsall gave me the desire to move into a more senior management role, initially as Chief Operating Officer at Birmingham Children’s Hospital and then as its interim Chief Executive. I won’t deny that as an early thirty-something I found those first few years in such a senior role very daunting. For quite some time I had major imposter syndrome, feeling as if I somehow didn’t deserve to be in the role. Such feelings were only accentuated when I used to turn up at meetings and senior health staff would brush past me unaware that I was the person actually in charge of the meeting.

Those experiences certainly toughened me up for future challenges, none more so than during the pandemic when I was asked to do some national work for the NHS on staff testing which turned into the biggest challenge of my career. We quickly discovered that the diagnostic industry across the NHS was nowhere near as developed as we thought it was. That we had massive procurement problems. And that carrying out 25,000 Covid tests a day on staff was a scary thought.

Test and Trace

But we rose to the challenge, so much so that I was then asked to become Director of Testing at NHS Test and Trace. Looking back, every day felt like a week and they were undoubtedly the most pressurised seven months of my life as we sought to build a huge infrastructure without any workforce in what was a highly charged political environment.

From a management point of view I had to take decisions extremely quickly and I don't think any management training programme could quite prepare you for the scenario which faced us. But my own training certainly taught me the skills I needed to be as nimble and as quick-thinking as possible.

One of the legacies of the pandemic for the NHS today is that many of our workers are understandably feeling exhausted which, as a leader, brings its own set of challenges. Dealing with this means drilling down and finding out exactly why people are feeling as they do on a day-to-day basis. You have to go in carefully and start conversations differently.


So, what have I learnt so far about management in my NHS career? Here are just a few things I have picked up along the way:

  • Clinical leadership is absolutely vital but it doesn’t mean managers cannot be challenging

  • We underestimate the importance of management and the skillset required to take people with you and organise resources

  • Only if you are clear on the problems can you paint a picture about how things can be better

  • Don’t always await instructions, you can do things your own way too. Don’t look at other people and wish you could be like them

  • We need to be training and learning together and constantly looking at the evidence

  • Management development shouldn’t be a one off and you have to keep yourself up to date

  • Mentoring has a huge role to play in helping managers

  • There should be no hierarchies. The person who may know the answer may very well be the least paid person in the building

  • Believing that you are making a difference and being authentic in your leadership is crucial. 

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