There is an ‘institutional inadequacy’ in the way that NHS leadership is trained, developed and valued, and there is a lack of equal opportunity for managers to access training and progression, according to a report that exposes the shortcomings in the way the health service is managed.
An independent review of health and adult social care leadership, led by retired senior Royal Marines officer General Sir Gordon Messenger and Leeds Teaching Hospitals chair Dame Linda Pollard, has put forward seven recommendations to ensure the right leadership is in place at all levels of the NHS.
Although the review found many examples of inspirational leadership, there was evidence of a lack of consistency and coordination. People with existing networks or contacts were more likely to access training and progression opportunities.
It also found evidence of discrimination, bullying and blame cultures in certain parts of the health and social care system, with some NHS staff not feeling comfortable to speak up about issues.
More than 1,000 people were consulted during the review, including patients and users of social care services, GPs, allied health professionals, clinicians, care workers, managers and CEOs, among others.
The report is yet to be published. A delivery plan with clear timelines for implementing its recommendations is set to follow.
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General Sir Gordon Messenger said: “A well-led, motivated, valued, collaborative, inclusive, resilient workforce is the key to better patient and public health outcomes, and must be a priority.
“The best organisations are those which invest in their people to unlock their potential, foster leadership and accountability at every level, with good leadership running through the entire workforce.
“This must be the goal and I believe our recommendations have the potential to transform health and social care leadership and management to that end.”
Dame Linda Pollard said: “I have seen first-hand how hard NHS staff have worked over the last few years and how hard they continue to work as we tackle the Covid backlog.
“Today’s report is about empowering you to be the best version of yourselves – to work to the best of your abilities, have the tools to develop your careers and support each other and to create an equal opportunities workplace of which we can all be proud.”
NHS England chief executive Amanda Pritchard welcomed the NHS leadership review and said the organisation would “do all we can to ensure our leaders get the support they need to deliver the best care possible for patients”.
Health and social care secretary Sajid Javid said the government fully supported the report’s recommendations which would result in “the biggest shake-up of leadership in decades”.
“The findings in this report are stark, it shows examples of great leadership but also where we need to urgently improve. We must only accept the highest standards in health and care – culture and leadership can be the difference between life and death,” he said.
The seven recommendations are:
- Targeted interventions on collaborative leadership and a unified set of values across health and social care, including a new, national entry-level induction for all new joiners and a mid-career programme for managers.
- Action to improve equality, diversity and inclusion, including embedding inclusive leadership practice as the responsibility of all leaders, committing to promoting equal opportunity and fairness standards, stringently enforcing existing measures to improve equal opportunities, and enhancing Care Quality Commission’s role in ensuring improvement in EDI.
- Consistent management standards delivered through accredited training, including a single set of unified leadership and management standards for NHS managers, and a curriculum of training and development to meet these standards, with completion of this training required to advance to more senior roles.
- A simplified, standard appraisal system for the NHS to reduce variation in how performance is managed and focus on how people have behaved not just what they have achieved.
- A new career and talent management function for managers, including the creation of a new function at regional level to address a lack of clarity and structure in NHS management careers.
- More effective recruitment and development of non-executive directors and an expanded, specialist non-executive talents and appointments team to encourage a diverse pipeline of talent.
- Encouraging top talent into challenged parts of the system, including a better package of support and incentives to enable the best leaders and managers to take on some of the most difficult roles.
NHS Confederation chief executive Matthew Taylor said: “The report acknowledges that we have much more to do to create a more diverse leadership in the NHS. We can’t hide from the fact that all too often staff from ethnic minority backgrounds are still not being provided with the support they need to progress to leadership roles. We need to move beyond admiring the problem and make concrete progress in addressing it.
“The report is also right to point out the gaps in support for NHS leaders and what more can be done to ensure we deliver a consistent approach to leadership development at all levels within the NHS. And, in particular, how we support chief executives who take on highly challenging roles. This approach needs to be based on a culture of learning and improvement in the NHS, with less emphasis on top-down performance management.”
Danny Mortimer, chief executive of NHS Employers and deputy chief executive of the NHS Confederation, welcomed the fact that the researchers “sought to understand the challenging reality rather than the misleading rhetoric” about NHS and social care leadership roles.
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“Their recommendations are important and highlight the further work that is required to support leaders in social care and primary care,” said Mortimer.
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