Grow your people, or watch them leave: a lesson from inside the NHS

By Carole Gilling-Smith, CEO, Founder and Medical Director of the Agora Clinic.

Scaling people, not just systems: what can the NHS can teach us about poor leadership? Leadership isn’t about holding the spotlight. It’s about passing the torch. Nowhere is that more urgently needed, or more visibly lacking, than in the NHS.

Over the past decade, the NHS has been under intense pressure to scale – more services, more patients, more demand. In the rush to grow capacity, their focus has been on expanding systems, infrastructure and bureaucracy. But in doing so, they’ve neglected something far more important: scaling people.

The NHS has seen a quiet but consistent loss of talented professionals and key workers – nurses, doctors and scientists who’ve walked away, not because they lacked skills, but because they lacked support, investment, or opportunity. Many of these brilliant people have joined my team at the Agora Clinic, so I hear their stories. Eighteen years ago, I did the same – to set up my first Agora fertility clinic in Brighton. The tragedy is that many of us didn’t want to leave. We were burnt out and just couldn’t see a future in a system that treated personal development like a luxury, rather than a necessity.

That is why at the Agora Clinic, I have made sure we prioritise our people, invest in them and give them a structured career path. And they repay us ten-fold! The biggest reward is that our patients feel the love our team has for its work – it’s palpable the moment you step through our doors.

The power of investing in people

I recently reflected on this after my nurse manager, Simone Wernbacher, shared how a leadership course at Roffey Park I had sent her on, as well as a book she had been inspired to read whilst on the course, had completely reshaped how she saw herself and her role and her nursing team. Just a year ago, Simone was only beginning to explore her leadership role. But I saw the spark in her. We gave her time for development, space to learn and reflect, and the trust to step up and take responsibility. In just 12 months, she’s grown into one of the most effective and inspiring fertility nurse managers I’ve had the pleasure to work with.

Inspired by her experience at the Agora Clinic, she’s done exactly what good leaders do: passed the torch. She’s lifted her whole team with her, investing in her nurses and healthcare assistants, helping them find their confidence, encouraging them to lead and take responsibility for different fertility programs we offer such as egg freezing, egg donation or surrogacy. She’s created a culture where no one is left on the bench; everyone is given a role, a voice and the opportunity to grow.

And the results are real: higher morale, better retention, improved care, and a team that takes pride in showing up and stepping up. And the drum roll moment came at our Annual Agora Awards in December when our nursing team were awarded with our ‘Team of the Year Award’ and Simone with our ‘Leadership Award’!

Emotionally intelligent leadership

What Simone embodies – and what we need more of especially in healthcare – is emotionally intelligent leadership.

This isn’t about being soft. It’s about being self-aware, empathetic and able to recognise that people aren’t cogs in a machine but are key to driving the machine. Emotionally intelligent leaders don’t hoard power, they share it. They don’t fear talent, they grow it. And they don’t see staff development as a threat, they see it as the foundation of any successful service. I view my role as CEO of the Agora as one in which I am there to serve my people, as well as my patients. The more my team grows and individuals shine, the prouder and happier I feel!

A culture problem, not just a funding one

While much of the conversation seems to focus on lack of funding and rising demand as the core issues facing the NHS, the reality is, and believe me I discuss this with many colleagues who still work there, we also have a big leadership culture problem. Too often, leadership in healthcare is passed to inexperienced managers who spend too much time focusing on being in control, changing processes and protecting their position. The fear of being replaced or overshadowed leads some to hold others back, rather than raise them up. The result? They lose far too many brilliant people to burnout or boredom. We don’t need more hierarchy in the NHS. We need more humility. More mentorship. More people willing to invest time, energy, and trust in the next generation of leaders.

Time for a cultural reset

It’s sad to see that the NHS has reached this breaking point. Scaling the system while ignoring the people who make it work has cost them, and us as service users, dearly. We’ve seen rising waiting lists, falling morale and an increasing disconnect between the values that brought people into the NHS and the reality that makes them leave. It’s time for a cultural reset.

One where development is not a reward for the few, but a responsibility to all. Where learning is part of the job, not something squeezed in on a day off or in the evening. Where growing your team is not optional, it’s expected.

In sharing my observations on the NHS, I hope to encourage local business minds to think differently about a healthcare system we all passionately believe in and want to see change for the better and I want to encourage an honest conversation about the importance of people scaling. Whether you’re running a hospital, a tech startup, or a local retail chain, the same rule applies: if you want your business to grow, grow your people first.

What we can all learn

As businesses and leaders, we must regularly ask ourselves the following questions:

• Who in our team is ready for more – but hasn’t been given the chance?

• Are we building systems that make people feel seen, supported and invested in?

• Are we creating pathways for growth, or just asking people to work harder for the same reward?

Scaling people takes time. It takes resources. It takes emotionally intelligent leadership. But the return is far greater than any process improvement or operational fix. Because when people feel valued and developed, they don’t just stay, they thrive. And they bring others with them.

If the NHS is to survive the next decade, it won’t be saved by strategy documents or reorganisations or yet more investment. It will be saved by the people who still care enough to stay and by leaders who care enough to grow them.

Let’s stop managing our people like costs and start scaling them like the future depends on it. Because it does.

If you want to be a part of this important conversation, or ask me more questions, please do get in touch, I’d love to hear from you!

www.agoraclinic.co.uk