Mike Chitty

Helping realise development since 1986

leadership

The ‘Impossibility’ of Working in the Current NHS: Sacrifice to a Primitive God

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by Rachel Gibbons (2025)

Reviewed by Mike Chitty

Rachel Gibbons’ recent contribution to Psychodynamic Practice offers a lucid and unsettling diagnoses of NHS organisational culture. Moving beyond typical accounts of staff burnout, under-resourcing, and institutional inertia, Gibbons draws on psychoanalytic and symbolic frameworks to reveal the deeper currents that trap health professionals in a cycle of sacrifice and despair. Her core thesis is that working in the NHS today is not merely difficult, but psychically impossible, unless one submits to being ritually sacrificed to maintain the illusion of a benevolent, functional system.

The ‘Primitive God’ of Sacrificial Health Work

At the heart of Gibbons’ argument is the symbolic function of sacrifice. She contends that NHS workers, particularly those in caring roles, are not merely overworked, but sacrificed. Their wellbeing, values, and often sanity are consumed in service of an institutional mythology that cannot bear to confront its own incoherence. The “primitive god” in this case is the organisation itself, sustained not by functional governance but by ritual acts of devotion and denial.

Sacrifice is not a metaphor but a defence mechanism. It keeps the wider system stable, even if it means destroying those within it. The sacrificial offering is the emotional and moral integrity of frontline workers, those whose care is most authentic and whose suffering is most repressed.

Psychodynamics: Splitting, Projection, and Denial

Gibbons makes good use of psychoanalytic concepts to explain how this dynamic is sustained:

  • Splitting: Staff and systems alternate between being idealised (“heroes”, “angels”) and denigrated (“troublemakers”, “burnouts”), rather than being seen in their full humanity. This fragmentation protects the system from integrating contradictory truths.
  • Projective Identification: Organisational anxiety is offloaded onto individuals, who are then punished or marginalised for manifesting it. This is particularly visible in the treatment of whistleblowers and dissenters.
  • Denial: Leaders and institutions deny systemic trauma by overemphasising strategy, data, and performance management, mechanisms that conceal emotional and moral breakdowns beneath a veneer of rationality.

The result is an emotionally broken culture that expects moral performance without moral support, a theatre of virtue sustained by suffering.

Implications for Leadership and Organisational Culture

One of Gibbons’ most important contributions is her challenge to prevailing models of NHS leadership. Rather than calling for better metrics or resilience training, she calls for psychic and symbolic honesty. NHS leaders, she argues, must become aware of the unconscious dynamics that animate their institutions: the roles they play in sacrificial rituals, the stories they tell to justify harm, and the fear of confronting institutional grief.

She invites leaders to:

  • Develop emotional literacy, able to name and work with shame, guilt, and projection.
  • Hold spaces for collective reflection, not as a form of managerialism, but as a way of honouring moral experience.
  • Resist the myth of heroic individualism, which feeds the sacrificial logic, and instead embrace relational and collective leadership.

In doing so, she implicitly aligns with broader movements that seek to embed ethics of care and process-relational thinking into public service cultures.

The ‘Impossibility’ Reframed

To call working in the NHS “impossible” is not to suggest it cannot be done, it is to suggest that, under current conditions, it can only be done by engaging in forms of self-abandonment that ultimately dehumanise. Those of us who work with colleagues who have sustained NHS careers will recognise this phenomena. Gibbons reframes this impossibility not as a failure of individuals, but as a systemic indictment. She names the collective delusion: that we can continue to expect quality care, moral integrity, and emotional labour from professionals while denying them the psychic and structural support they need.

Her paper, then, is less a critique and more a call to consciousness, to notice what we have repressed, to question the gods we serve, and to remember that care cannot survive where sacrifice is demanded.

A Leadership Ethic for the Post-Sacrificial NHS

For those working in leadership development, Gibbons’ insights offer an urgent provocation: our leadership paradigms must evolve. The NHS cannot be reformed by better targets, slicker dashboards, or even more compassionate rhetoric if it continues to rely on unconscious rituals of self-sacrifice. Instead, what is needed is:

  • A shift toward collective responsibility, where care is not individualised but shared.
  • A refusal of martyrdom, cultivating leadership that names its limits and honours its own needs.
  • The development of psychodynamic fluency in leadership education, recognising that what is not spoken still shapes what is done.
  • The cultivation of process-relational awareness, where institutions are seen not as machines to optimise, but as evolving fields of relationship to be tended.

Such a shift would require leaders not only to learn new skills, but to undergo a kind of moral and emotional reckoning: a willingness to listen to the unspoken, to disrupt sacrificial norms, and to reimagine care as something grounded in shared vulnerability rather than heroic endurance.

Conclusion

Rachel Gibbons has written a rare thing: a paper that is both clinically astute and politically courageous. By drawing attention to the unconscious sacrifices demanded by NHS culture, she gives voice to what so many feel but dare not name. In doing so, she opens the door to a new conversation, one in which care is no longer confused with suffering, and leadership becomes an act of deep, relational responsibility.

Her paper deserves to be widely read, not only by clinicians and psychotherapists, but by health leaders, policymakers, and anyone seeking to restore soul and sanity to public service. For those of us working at the intersection of ethics, process, and leadership, her work is not only insightful, it is indispensable.

If you would like to explore this paper further and its implications for your leaders or leadership please do get in touch.

Love’s Leadership; Lost or Found?

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Leadership is a toxic word for many.

While for others it seems like the holy grail. The missing ingredient in failure. The magic that leads to success. A thing worth obsessing about and building a multi billion pound industry, and healthy livelihoods in.

What is Leadership?

Leadership has no widely agreed definition. It is a word that is used to describe and explain a wide range of phenomena in:

  • politics, culture, work and leisure from the global to local,
  • organisations of all sorts,
  • networks, communities, associations and ‘social movements’

Leadership is found in just about every aspect of human endeavour. But only because we look for it. Or its magical explanatory powers.

It comes in a bewildering choice of varieties:

  • Transactional
  • Transformational
  • Digital
  • Directive
  • Affiliative
  • Participative
  • Clinical
  • Patient
  • Citizen
  • Distributed
  • Distributive
  • Collective
  • Charismatic
  • Dictatorial
  • Evil
  • Benevolent
  • Adaptive…
  • I could go on, probably for ever

But perhaps, like Phlogiston, it doesn’t really exist?

Doers Leadership even Exist?

After all it is a word that allows us to label something that we can’t actually describe. A bit like love. And for me, leadership is an expression of togetherness and love. And no matter how hard we try our expression is imperfect. But we can reflect. Learn, change and get better.

Leadership, like love, is a gift that has to be given and received. Neither are straightforward. Plenty can go wrong. It probably will. But this is part of the process. It allows it to deepen and mature.

For me, leadership is a collective process that creates a future that is different to the present. Good leadership creates more sustainability and fairness. Not so good leadership leads to an insecure future and grave inequalities. It is heart-breaking that in our current narrative Leadership is too often judged in much narrower terms, and in fact inequality and environmental harm are things that can be created as long as the price is right.

Leadership and Leaders

We have a generation of gifted leaders working hard, being heroic, making great progress. Providing us with GOLD command. But it would seem we also have a generation of evil and malevolent leaders spreading division and oppression, shirking and profiteering.

See what I did there?

I shifted from LEADERSHIP – that social process that we are all engaged in to some extent, to LEADERS. The anointed few, with special powers of high office, high skill, high imagination or high finance who we can choose to love or loathe. This lets us escape from thinking about our role in this. It supplies us with heroes and villains and allows us to play the victim. The age old drama triangle plays out and nothing changes.

We must resist the temptation to act as if Leadership is a special set of behaviours that Leaders, those other people, do.

Leadership is not power. It is not authority. It is not what ‘the bosses’ do. It is the ultimate inclusive process. We are ALL more or less complicit in it. It is a social process that we all contribute to. Sometimes through our silence and compliance.

Human civilisation is fragile, brutal, powerful and hate filled. It is also beautiful and loving. In my home city of Leeds, in spite of a strong economy, inequalities have worsened. Life expectancies have stalled or are going backwards. Even before Covid hit. And if look at the global level thinks look even worse.

Has it all gone wrong?

Leadership has not been getting most of us to a better future. Even those that have made a lot of money from it aren’t any happier. And aren’t living any longer. And even if they were living longer and more happily, while the rest get left way behind, how long could that be sustained? Socially? Environmentally?

So perhaps we still have a lot to learn about the thing that we label ‘leadership’.

Where do I start?

We can start with a more committed, generous, imaginative and thorough attempt to describe what we think we are putting the label on, and what we think that thing is for. And a reaffirmation that we intend this thing called ‘leadership’ to take all of us to a more secure and fairer future.

And a recognition that we all have a part to play. Gifts to contribute and gifts to receive.

Are you ready to start your leadership journey?

Me and White Supremacy – part 1 – White Privilege

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The Basics – White Privilege

In what ways do I hold white privilege?

In many ways. If I am at a meeting, especially of senior leaders, then most of them will share my gender and ethnicity. When I see role models in the media many of them will be white. If I apply for a job or bid for work it is highly likely that those selecting will be from my ethnic groups. Since childhood to be white was to be ‘the norm’.

Growing up in the 60s in the rural home counties any skin colour but white was seen as a rarity. I had to choose whether to be racist or anti-racist. Arthur Ashe or Buster Mottram? National Front or Anti Nazi League and Rock against Racism? It was not a choice my black school mates had.

When I go through Peggy Macintosh’s list of the items that structure white privilege in a day to day and very practical way – yes they all apply. All the time. And they work differently in different contexts and at different times. Even when I lived in a rural village in The Gambia in sub-saharan Africa my white privilege was still with me.

The fact that I can afford to take my own skin colour for granted is an enormous white privilege. It was never a source of worry or fear. Or pride for that matter. I could safely ignore it. However by ignoring my skin colour I was also blinded to the power of whiteness. To my own white power.

I thought white power was a ridiculous, white supremacists’ chant rather than something that directly and unfairly benefitted me.

What negative experiences has white privilege protected me from throughout my life?

I have always had easy access to the culture of my own ethnic group. Even when I lived in sub-saharan Africa, while I physically did not see many white people in the village I could easily tune the radio to access my own culture. So I never felt that my culture was denied or absent in my life. It was always the dominant culture. The successful culture. It has only been in recent years that China has emerged as a global power to seriously threaten the dominance of Caucasians.

I was in The Gambia for just over a year, and for much of that time it was quite difficult to meet another white person. There were a couple of Peace Corps in the village and generally The Gambia was full of ex-pats, but generally I lived and socialised with Gambians; Mandinka, Wolof, Jola, Serahule and Fula. And I learned that Gambia is the shape it is because of the way Africa was divided post war, largely using rulers and compasses, ands how the imposition of borders in the Sahara had made apparently made very little difference to the day to day life in tribal West Africa. I remember walking one day up to the border with Senegal. Just sand. But even here my whiteness protected me from some of the racism that black Africans from other countries received from Gambians. I remember one teacher had walked from Cameroon to the The Gambia to take up a teaching post and he got a hard time because he was not of the Gambia or from one of the local tribes. I was protected from all that because of my association with power and money that came with my skin colour.

I don’t think I have ever been discriminated against unfairly because of my ethnicity – again even in West Africa to be white was seen to bestow power; education and access to networks and resources.

I have never been subjected to violence because of my skin colour. For my politics and football allegiances yes – but never skin colour.

In what ways have I wielded my white privilege over black, indigenous and people of colour?

I find this question hard to answer. I know I have often been invited to speak with BAME networks and feel guilty when I am the white man at the front of the room teaching the BAME networks about power and empowerment. I always feel conflicted in this work as historical power structures are re-created. I have always tried to name it and to talk about it – but even my choice to do that is an exercise in white privilege.

I don't like the acronym BAME but don't know what else might work.
Layla F Saad uses BIPOC meaning Black, indigenous and people of colour but again that does not feel appropriate for me to use.  Getting used to the inadequacy of words, their clumsiness and the vulnerability they bestow on the user who as at the edge is another thing that those of with white privilege, using our first language to explore our concepts of race,  perhaps don't experience that often.

In political processes I have always supported the candidates who most closely fit with my political beliefs rather than perhaps vote for the person or party most likely to pursue racial justice. I wold NEVER vote or someone who was overtly racist – but I perhaps have never gone deeply enough into the record of politicians on anti-racism.

I have competed with BAME people for jobs and tenders without ever really considering the privileges I enjoy in that competition.

What have I learned about my white privilege that makes me uncomfortable?

I think the thing that makes me most uncomfortable about it is that it is slippery, evasive, structural as well as personal and difficult for me to see. Whiteness is like an invisible superpower. I feel like a fish coming to terms with water.

I was involved to small degree back in the late 70s and early 80s with movements like Rock against Racism and the Anti-Nazi League. However I realise now that while that was helpful in uncovering and combatting overt racism it did little to explore and reveal the more subtle and structural racism that patterns our society. That pattern me. It was as simple as ‘good white people and their black allies’ against the ‘bad white people’.

Whenever I try to work in a way that I hope is ‘anti-racist’ it feels like an expression of privilege and hubris. Even writing as honestly as I can about the reflections prompted by the book I have this nagging sense of doubt. Doubting my own intentions in this exercise of privilege.

Who am I to think I can help? Especially uninvited…

But then who would I be to do nothing?

Leadership – helping people find what they want…

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Managers and leaders know that most people are looking (consciously or not) for a number of things. These include:

  • autonomy – the freedom to decide what they should do, when they should do it
  • some control over their own future
  • a chance to plan, act and succeed
  • to improve things – to make them better
  • to take some responsibility – to enjoy it – to seek it
  • to be active rather than passive – to have an orientation towards action – rather than reaction to the instructions and orders of others
  • to be a person rather than a human resource – a cog in a machine
  • to be creative and autonomous
  • to be acknowledged, recognised and valued by others.

Managers and leaders can establish relationships with people that help them to look for, and find, these things. People develop, talent flourishes, relationships improve and performance can excel. This group of people usually respond very well to the introduction of effective management and leadership as they it offers a vehicle for accelerating progress.

However some people are not looking for any of this.

They do not want freedom, or responsibility. They want instructions, structure and clarity. They want other people to do the thinking and the creativity. They want to be the foot soldiers – doing an honest days work for an honest days pay. They do not see life as a vehicle either for their own self development or creative expression. They are not looking for self-actualisation but security and control. This group can be very resistant to leadership, seeing it as an intrusion. They are likely to resist development, and accept change grudgingly, if at all.

There are several things to consider here:

  • the first type of response is deemed ‘healthy’ – for society , the organisation and the individual. In these circumstances it is likely that people will thrive. The relationship is synergistic – what is good for the individual is likely to be good for the organisation and vice versa.
  • the second type of response is not ‘healthy’. It is a defence mechanism. It leads to staleness, frustration and at best mediocrity. It is characterised by a loss of synergy – the perception being that what is good for the organisation or society will not be good for the individual and vice versa.
  • the type of response that we find depends, in large part, on management and leadership style. For decades leadership has encouraged people to respond passively to direction to follow the ones who ‘knows the way and shows the way’. Some of it may be driven by personality or by experiences from the past or from outside the work context – but in most cases the response we get tells us much about our own management.

Go to the people

Live with them

Learn from them

Love them

Start with what they know

Build with what they have

But with the best leaders

When the work is done

The task accomplished

The people will say

“We have done this ourselves.”

Lao Tsu (700 BC)

Want to develop your own leadership and management skills?

Find out How to Be an Outstanding Manager…

Leadership and its Development…part of the problem?

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Cast your mind back to a time before this tiny virus had us in its grip.

How were we doing?

If there was an end of term report card what might it say?

Well, of course, we have worked hard. We have been industrious. Much has been achieved.

  • The world has been shrunk. Men on the moon. Women in to space
  • Massive improvements for many in medicine, health and wealth
  • A greater choice of consumer goods than ever and more sophisticated financial products and services to help us own them

But it is not all puppy dog tails and sweet, sweet roses.

  • Globally we have millions of people without enough food and shelter fleeing wars and discrimination – running from their fellow humans
  • Habitat being destroyed and species extinction running at alarming rates
  • Climate collapsing, with real fears that sea level rises will make the floods caused by increasingly warm winds carrying higher than level moisture levels look like April showers
  • Plastics, visible and invisible inside our bodies and in every place on earth
  • Widespread deplorable practices of animal husbandry required to provide us with affordable volumes of flesh, milk and eggs
  • An accumulation of capital, wealth, by a few massive corporates, celebrities and billionaires. While millions live and die in poverty with little or no chance of escape
  • Societies patterned by unfair discrimination
  • Air that is not safe to breathe. Water that is not safe to drink. And a civilisation that can be bought to its knees by such a simple thing
  • Our children suffering levels of anxiety and poor mental health that we have not been able to respond to with timely care and compassion
  • Hundreds of millionaires, billionaires, politicians and celebrities taking private jets to Davos to wring their hands over the state of the world

For some the message is loud and clear. Leadership is failing us. As leadership developers we have to accept, explore and develop our role in this.

Perhaps.

There is another story…

I’m sure some will not buy this narrative. It certainly isn’t the ‘whole truth’. Some may say that our scientific and technological prowess, capitalism and our ingenuity has raised the standard of living world wide. The greater the challenge thrown at humankind the greater our creative response. We will prevail. Humankind really will overcome all of its troubles.

Personally, I am not buying it. History suggests we shouldn’t buy it.

Every civilisation so far has had a rise, and a fall, often through over-confidence and hubris. Humility and uncertainty have been crushed by power, arrogance and self-belief. Until the whole pack of cards comes down.

For those that say now is not a time for reflection but a time to roll up our sleeves and help, I say thank you. Godspeed.

But perhaps some of us can help best by exploring whether leadership and leadership development is failing us and the planet? And if it is, then as leadership developers, educators, citizens, what is our role in this?

And how might we learn and develop ourselves and our practice?

Do you hear this call? Are you curious?

A Fresh Dialogue?

Over the coming weeks and months we will hold a series of online meetings with an aim to develop a generative dialogue to explore this issues surrounding Leadership and Leadership Development with a view to learning together and looking for possibilities of a new way forward. To generate a community of people who carefully and gently construct and develop a ‘pool of shared meaning’ from which new possibilities might form.

Pool of shared meaning
The Pool of Shared Meaning

Are you interested? Curious? Would you like to join us?

John Varney of the Centre for Creativity in Management and I will be hosting some online meetings in the coming weeks, provisionally titled ‘Learning to do together what we can’t do alone’ and we would invite you to join us.

  • Tuesday 26th May
  • Tuesday 23rd June

Book all dates here…

All sessions are free to join. Come to one or more. We would love for you to join us for the whole journey wherever that may take us – but dipping in and out is fine.

There is also an option to pay to cover costs and make donations that will support us to develop the work further.

Questions and comments welcome! Please do invite others who you think might heed the call to join us. Share this post. But also issue personal invitations.

We need to learn to do together…what we can’t do alone.