Shake-up in health and social care leadership

The Health and Social Care Secretary Sajid Javid has welcomed the publication of an independent review of health and adult social care leadership, led by General Sir Gordon Messenger and Dame Linda Pollard – and has accepted all seven transformative recommendations.

The review team met over a thousand passionate frontline staff, managers and leaders across health and social care to hear their views, which informed their recommendations for improving the skills of all leaders and managers and putting the right culture, training and incentives in place.

While it recognised the current pressures faced by the workforce and identified many examples of inspirational leadership, it found overall there was a lack of consistency and coordination – in particular that there has developed over time an “institutional inadequacy” in the way that leadership and management is trained, developed and valued.

The report also sets out new plans to attract great leaders to the most challenged areas in the NHS, with a package of support and incentives to recruit the top talent into these positions. Through support networks, peer mentoring, training and development, the aim is to ensure the government and the NHS can continue to tackle disparities across the country.

It also found evidence of poor behaviours and attitudes such as discrimination, bullying and blame cultures in certain parts of the health and social care system, with some staff in the NHS in particular not feeling comfortable to speak up. It identified a lack of equal opportunity for managers to access training and colleagues to progress in their careers, with those who have existing networks or contacts more likely to access these opportunities.

The seven recommendations are:

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.

Commenting on the report, Health and Social Care Secretary Sajid Javid said: "The NHS faces huge challenges as we recover from the pandemic, from tackling the COVID-19 backlogs to addressing the widespread health disparities that exist across the country.

"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.

"I fully support these recommendations for the biggest shake-up of leadership in decades. We must now urgently take them forward, to ensure we have the kind of leadership patients and staff deserve, right across the country."

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