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‘Institutional inadequacy’ in the way NHS management is developed and valued, review finds

by Beth Gault
8 June 2022

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Health secretary Sajid Javid has promised an overhaul of NHS leadership following a review that found ‘institutional inadequacy’ in the way NHS leadership and management is trained, developed and valued.

The review, by General Sir Gordon Messenger and Dame Linda Pollard, looked at leadership and management across primary care as well as secondary and social care levels.

It hoped ‘to avoid a disproportionate focus on secondary care’ and made recommendations that are of relevance across the sectors, according to the review’s authors.

However, Matthew Taylor, chief executive of NHS Confederation, has said the review had ‘limited focus’ on primary care and social care, and that it risks these sectors looking like ‘an after-thought’.

Over 1,000 stakeholders across the NHS were interviewed for the review, including GPs, managers, allied health professionals and patients.

The authors made seven recommendations to try and improve the culture, equality, development and value placed on leaders within the NHS structure. These include a commitment to improve diversity, equality and inclusion, accredited training, a more effective appraisal system and clearer progression routes.

The review’s seven recommendations:

  1. 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 who join health and social care and a new, national mid-career programme for managers across health and social care.
  2. Action to improve equality, diversity and inclusion (EDI), including embedding inclusive leadership practice as the responsibility of all leaders, committing to promoting equal opportunity and fairness standards, more stringently enforcing existing measures to improve equal opportunities and fairness, and enhancing the Care Quality Commission’s (CQC) role in ensuring improvement in EDI outcomes.
  3. Consistent management standards delivered through accredited training, including a single set of unified, core leadership and management standards for NHS managers, and a curriculum of training and development to meet these standards, with completion of this training made a prerequisite to advance to more senior roles.
  4. A simplified, standard appraisal system for the NHS, including a more effective and consistent appraisal system, to reduce variation in how performance is managed and focus on how people have behaved not just what they have achieved.
  5. 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, providing clear routes to progression and promotion, and ensuring a strong pipeline of future talent.
  6. More effective recruitment and development of non-executive directors (NEDs) – NEDs play a vital role in providing scrutiny and assurance, and an expanded, specialist non-executive talent and appointments team will encourage a diverse pipeline of talent.
  7. Encouraging top talent into challenged parts of the system, including a better package of support and incentives in place to enable the best leaders and managers to take on some of the most difficult roles, whereby roles in challenged areas are seen as the best jobs rather than the most feared jobs.

Source: DHSC

The review said: ‘We strongly believe our recommendations should transform health and social care leadership and management and drive the cultural and structural changes necessary to future-proof it.

‘But we also recognise that previous reviews have reached equally sensible conclusions but have failed to have the impact they deserve.’

The authors recommended several steps to avoid this happening again, including making the participation in the training and development areas mandatory.

Mr Javid said the findings of the report were ‘stark’, but that he will ‘fully support’ the recommendations and will ‘urgently’ take them forward.

Mr Taylor, at NHS Confederation, said it was an important report, despite his criticism of the lack of primary care inclusion.

‘While there may be a view in some quarters that money spent on NHS managers is wasted, we know that high performing health systems require investment in effective management,’ he said.

‘We need to move away from the damaging narrative that managers are somehow an unnecessary expense. Put simply, our NHS is not over-managed and never has been.’

Earlier this year, practice managers criticised alleged plans to bring general practices under control of hospital trust leadership, saying it would not improve workforce morale or patient care.