We spoke to several NHS executives over the weekend following Sir Jim Mackey’s letter urging leaders to increase their visibility in emergency departments this winter. Their responses reflected both support and reflection: many acknowledged the value of being present on wards, while also recognising that today’s NHS leadership roles often pull executives into strategic programmes, regional negotiations, and financial firefighting. The result is that, in some places, the fundamentals of supporting staff on the shop floor have slipped.
Evidence from frontline staff suggests the impact is real. In A&Es across the country, many nurses and junior doctors report they have never met their COO or CEO. This does not mean leaders are disengaged, but rather that the demands of system leadership have stretched them thin, often leaving little time for direct engagement with those facing the brunt of winter pressures. Sir Jim’s reminder is therefore timely: visibility is not a luxury, it is a foundation of effective leadership.
Executives were quick to point out that walking the floor does not, on its own, fix issues like overcrowded wards, rising costs, or elective backlogs. Yet it plays an important role in connecting strategy with reality. Being physically present allows leaders to see bottlenecks first-hand, hear directly from staff, and grasp the unintended consequences of national policy decisions on day-to-day care. One COO put it simply: “You cannot redesign processes or support flow if you never see the reality for yourself.”
This idea is not new. Successful organisations in other sectors have long understood the value of visible leadership. Retailers like Waitrose and M&S became known for managers who walked the shop floor, listened to staff, and stayed close to customers. In healthcare, the principle is even more vital. The shop floor is not a place of transactions, but of life-and-death decisions, clinical risk, and staff resilience. Leadership that is present is leadership that understands.
Sir Jim himself is proof of this approach in action. As chief executive of Northumbria Healthcare, he built a trust that was repeatedly rated among the best in the country by patients, staff and The Times. That reputation did not come from strategy alone, but from embedding a culture where senior leaders were visible, engaged, and accountable to staff and patients alike. His call today is less about optics than about sharing the lessons of a model that has worked.
The executives we spoke to agreed on one thing: winter 2025 will be exceptionally tough. Bed occupancy is running at over 90 per cent, elective recovery has slipped behind plan, and emergency care standards remain stubbornly difficult to shift. Walking the floor will not solve these systemic problems, but it can improve morale, sharpen decisions, and demonstrate that leaders are shoulder-to-shoulder with staff.
The test, as ever, is follow-through. Visible leadership must be linked with the authority and resources to act on what is seen. Staff will not be convinced by theatre; they will be reassured by leaders who listen, acknowledge constraints, and then use their position to drive change.
Sir Jim’s reminder is a call to learn from the best. The NHS needs leaders who can think strategically and act locally, who can manage the system while still standing with staff in the corridor. As winter approaches, walking the floor is not just a gesture, it is a discipline that strengthens teams and grounds decisions in reality. At its best, it is a model of leadership the NHS cannot afford to forget.
