Considerations: What being at the intersection of politics and healthcare taught me about the business of fashion: part 1
Heritage, hierarchy and hubris as observed by an ex-NHS strategist
Heritage institutions. Cultural zeitgeist. Creativity. Innovation. Emotional connection. Billions of pounds. Millions of clients with demand growing. I’m not talking about a legendary fashion house. I’m talking about the NHS, my professional home for the past 10yrs. Before that, central UK government, working for Department of Health and Social Care. Health and politics is where I cut my teeth, where I learned how large-scale organisations operate (or in some cases, fall apart), how hierarchy and perceptions of autonomous power work, how power actually works, how to operate in complexity, ambiguity, challenged circumstances and shifting contexts. How to translate ideas, add value to the service, deliver improvements for our citizens and taxpayers.
Translating that understanding and deep expertise into the fashion industry was actually far simpler than expected. Maybe it’s an over-extension or an over-simplification, but the two worlds have so many commonalities worth exploring. Starting this week with people, and exploring further next week with practices.
Leadership and culture
The NHS in England is one of the most complex systems in the world. And as with any large-scale, atomised bureaucracy, there are many empires built within it, on shifting sands, with presumed autonomous power. And true to any sector, ego and hubris at the top of the hierarchy truly set the tone. I witnessed and experienced first-hand excellent leadership, mediocre leadership and outright bullying and discriminatory leadership. Some were mission-driven, very clear on goals and priorities, others were indecisive, exclusionary, self-serving and agenda-pushing. And in each of those, the tone set from the top is insidious. In healthcare, internationally, there are countless studies which connect leadership, accountability and culture to better patient outcomes, more productive staff etc., so the evidence-base for why good leadership matters and the qualities, skills and strengths required are very simply spelled out. And yet restructure after restructure, even with the best evidence, advice and counsel, I experienced the same strategic missteps made, each time with different window-dressing. We were all in the business of good quality care and that should have flowed through every level of the big bureaucracy.
As with any artistic industry, there’s a presumption that the business exists to make beautiful art first, and make money second. The schism between creativity, craft and artistry and capitalism and profits appears to be growing in our increasingly values-driven world. But there’s a question mark about where the accountability lies when revenue flatlines and growth slows. The macroeconomic factors aside, is the strategy set out from leadership on course, is the creative output on point? Is serving the client at the heart of every decision of the business? With the great luxury reset currently taking place, there’s an existential threat to current business models and leadership’s accountability. We’re seeing this play out currently in Kering: a strategy set out by a CEO who doesn’t strictly seem convinced by his creative leadership. Vaccarello is out at YSL. Sean McGirr is now out at McQueen. And Pierpaolo Piccioli now rumoured to be leaving Balenciaga. That’s a convincing pattern for speculation. So if the design doesn’t connect initially with the market, and the creative doesn’t align with leadership’s vision, is that purely a problem with the creative director, or poor commercial decisions, poor psychological safety, underinvestment in marketing and storytelling etc. There’s the creative director musical chairs we’ve all experienced but at Board-level, are the conditions for success being generated? These conditions cultivated by leadership can empirically shift priorities and slow down transformation, insert wedges, or they can foster greater collaboration between functions all working together to achieve corporate-defined goals for their clients, existing and prospective, and their shareholders.
Leadership sets the tone, it cultivates the conditions for success. Leadership sets the strategic direction, communicates the priorities, agrees the model. The culture permeates. When course correction is required, a psychologically safe, inclusive and diverse culture allows discussion, nuance, investigation. A fearful culture prevents any scalable transformation required to service the client, the art and the shareholders.
Point of view
Politics means you unwaveringly need to have a point of view: that’s your differentiator. Your perspective and your goals which your populace are so deeply connected with they feel seen and understood. It’s almost visceral. You have to stand for something, and you need to repeat the message loudly. Zero tolerance for shifting the goalposts or U-turning a decision (unless of course it’s a poor one and even then it requires spin). Politics in Britain over the past 20yrs has become fractured, with factions splintering off across the whole political spectrum. Being clear, vocal and unequivocal on your point of view as a politician and as a party is the expected norm. Having worked in communications for both central government and the NHS, a British institution so deeply rooted in the psyche of the nation, clarity and certainty of message are paramount. This is who we are, this is what we stand for, this is what it means for you.
Fashion and personal style are tools used to communicate who we are, how we want the world to see us. Why are there certain designers and certain Houses we connect with more sincerely, intrinsically? Part of the desire and connection transcends the luxury codes and aesthetics, it’s a creative director conveying their point of view. It’s their point of view as a designer and as a human being. Phoebe Philo is a great example as a designer with a clear, unwavering point of view. Firstly she’s a woman designing in what’s currently a male-dominated landscape. She’s a mum and not only makes business and career decisions based on what’s best for her and her family, but that plays out in her designs, her brand’s art direction, her public persona. Her eponymous label’s designs are modern, authoritative, creative, and still sit at the zeitgeist of the industry. She innovates and leads trends, others follow. Philo’s design codes are so distinctly hers. A number of top creative directors, including Michael Rider and Matthieu Blazy, have worked for her. And you can see her through-line, her soft touches and subtle influence in their creative output. And not even her designs but her whole model has a different approach, a different flow. Greater creativity, less waste, seasons and collections become meaningless because the pieces all work together effortlessly. Philo knows who she is, what she and her business stand for, and what it means for her clients who flock in droves for her designs, current or archival.
You cannot compete by being laissez-faire. You must be unequivocal in what you stand for and communicate that, through words, through a design vocabulary, through your business practices. It’s the conduit to connection, to a fierce set of allies, to a loyal group of customers. Be unwavering and be brave.
Precarious positions
We have a five-year parliamentary cycle here in the UK. The NHS has an annual budget of approx. £200bn, and its funding settlements swing between one-year and three-year settlements. In the case of one-year settlements, that means politically, it’s more like a 1.5yr cycle. It’s almost impossible to demonstrate any discernible impact after 1.5yrs in health aside from incremental improvements. So a Health Minister setting out their long-term vision for the NHS? Don’t look beyond 5yrs as it’s pointless. They’re likely to be shuffled out, and while the policies and plans can still hold as civil and public servants provide that operational continuity, new political posturing needlessly interrupts given new personal agendas, projects and relationships. I remember just after Brexit referendum in 2016, David Cameron had resigned as PM and Theresa May took over. Jeremy Hunt was the Health Secretary and had managed to be in post for around 4yrs up to that point. The entire Cabinet was being reshuffled under May’s leadership and he was summoned to No10, his NHS badge pinned to his lapel. When he walked back into the Department, still wearing his badge, he was in shock, almost ghostly. He then gave the most candid speech to staff I’d ever hear a Minister give. He told us that he walked in assuming he’d be sacked and was ready to take off his NHS badge and hand it off to the next Health Secretary. Instead, he remained in post. He still couldn’t quite believe it, even 20mins later standing in front of 100 civil servants sharing with us how humbled and honoured he felt.
And lest we forget the current political cycle: even leadership isn’t protected. I moved to the UK in 2006. Since then we’ve had nine prime ministers. Nine prime ministers in 20yrs in a country with a 5yr parliamentary cycle. My son was born in August 2022. Since then we’ve had five prime ministers. He’s only just turned 4yrs old. Sometimes it’s self-inflicted capitulation, sometimes it’s a populace demanding more. Either way, politics means accountability, and someone has to fall on the sword. Here today, gone tomorrow.
As mentioned above, while I was writing this, Sean McGirr was announced to be departing McQueen and Veronica Leoni is out from Calvin Klein. Anthony Vaccarello left Yves Saint Laurent last week. And lest we forget the creative director musical chairs from 2024 which spilled over into 2025. These designers build their vision, design their collections, showcase their designs, receive professional and public critique and wait the long six months to see what resonates commercially. Is a creative director’s KPI solely based on revenue and prospective/actualised growth? Cynically yes, that’s how it appears. Positions are fragile if the business and commercial objectives aren’t met. But is a three collection tenure long enough to build emotional connection and desirability with clients and the culture at large? Creativity and output are on a continuum, they’re both in fact theoretically infinite, so should there be tolerance built in for adaptation, incremental change and marginal growth in the first few years of building (or in some cases rebuilding)? It’s a tough gig, and the sword of Damocles might not be the best tactic to ensure commercial viability, emotional connection, cultural relevance and innovation in craft.
A politician or a creative director aren’t ordained jobs for life, neither are sacrosanct. Both need to be unequivocal about their visions, and immediately start delivering value. Value to the people they serve, value to the bottom line. The outcomes and impact need measurable returns. Adaptation and course correction are critical but holding your nerve is paramount.
But that’s politics and fashion right? One season you’re in favour, the next you’re dropped. They’re cyclical and contextual and they’re intrinsically connected. You have to play a long game with so many daily built-in touchpoints, decisions and campaigns. They’re both on the vanguard of culture and power, driving societal and behaviour change against headwinds entirely outside of their control. Health, politics and fashion are each in the business of people, possibilities and progress.
