The independent review into health and adult social care leadership, led by General Sir Gordon Messenger and Dame Linda Pollard, has been published today.
The landmark review outlined seven transformative recommendations in its findings, all of which have been accepted by health secretary Sajid Javid and will be implemented as part of a leadership shake-up in the sector to guarantee the best possible direction for the industry across the country.
The review – first announced in October 2021 – is the most comprehensive in scrutinising health and social care leadership to be carried out over the last 40 years. The review’s leadership duo was backed by a team comprised of representatives from the Department of Health and Social Care, NHS England, Health Education England, NHSX and social care leaders, alongside clinicians, managers and academics, all of whom contributed.
It garnered accounts from more than 1,000 people on 400 different occasions, including patients and users of both NHS and social care services, clinicians, managers, GPs, researchers, clinical fellows, allied health professionals, previous review chairs, non-executive directors, CEOs, chairs and MPs. All views on improving the skills of leaders and managers and the overall standard of services were considered.
Their input has helped shape the seven recommendations, which are geared toward improving culture within health and social care and putting in place tangible training pathways and incentives.
The Department of Health & Social Care has said that strengthening leadership and embedding the best examples of management will be vital in ensuring every pound of the government’s record levels of investment in health and care services for the next three years are spent responsibly, and can make a real impact on the ground in bringing down the Covid backlog.
While the independent review was sympathetic toward the health and social care workforce given current pressures on the industry, it found that despite instances of inspirational leadership there was an overarching lack of consistency and co-ordination. This has led to an “institutional inadequacy” manifesting over time in the way that sector leaders are trained, developed and ultimately valued in their roles.
The report outlines new initiatives to attract strong leaders to the most in-need areas of the NHS, with support packages and incentives to help recruit. Continuous support networks, peer mentoring, training and development programmes will be implemented to help the government and NHS continue to crack down on disparities.
Concerningly, the review uncovered evidence of discrimination, bullying and blame cultures within parts of the health and social care sector. There was also a lack of equal opportunity for managers to access training and a lack of progression pathways, with those who have existing contacts or networks higher in the chain of authority being found to be more likely to move up the ladder.
Perhaps more shockingly, it was found that some NHS staff are being made to feel uncomfortable about voicing their concerns around these issues.
Commenting on the report ahead of its publication, health secretary Sajid Javid said that urgent improvement was needed.
Javid said: “The NHS faces huge challenges as we recover from the pandemic, from tackling the Covid 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.”
General Sir Gordon Messenger, one of the leaders of the review, commented: “I have always held our health and social care workforce in the highest regard, and my respect and admiration has only deepened through witnessing their selflessness, professionalism and resilience first-hand.
“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.”
NHS chief-executive, Amanda Pritchard, welcomed the report’s conclusions.
Pritchard said: “As this report recognises, leaders across the health service do a fantastic job in often very challenging circumstances, from designing and delivering the world leading Covid vaccination programme to delivering the elective recovery plan, and investing in developing our leaders must be a priority.
“The NHS is a learning organisation - we welcome this report and are determined to do all we can to ensure our leaders get the support they need to help teams deliver the best care possible for patients.”
The seven recommendations, which form the guiding principles for health and social care improvement, are geared toward ensuring that appropriate leadership is in place at all levels in the industry and guaranteeing the best quality of care can be delivered while tackling the Covid backlog and doing away with longstanding disparities in the sector.
The seven recommendations read as follows:
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 CQC’s 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.
Dame Linda Pollard, chair of the Leeds Teaching Hospitals Trust who co-led the review, 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.
“I remain incredibly proud to be part of the NHS, proud of the incredible people I have worked with over the years and the values held by staff across the board.
“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.”
A coherent delivery plan with clear timeframes on implementing the seven recommendations will be published in due course.
Danny Mortimer, chief-executive of NHS Employers and deputy chief-executive of the NHS Confederation, said: “Our members very much appreciated the engaging, thoughtful and authentic way in which Sir Gordon and Dame Linda undertook their review. They sought to understand the challenging reality rather than the misleading rhetoric about the roles that those in leadership positions in social care and health undertake.
“Their recommendations are important and highlight the further work that is required to support leaders in social care and primary care.
“We look forward to supporting the implementation of the report, and will be particularly concerned to ensure that the NHS is a fairer and more inclusive employer for people of all backgrounds and communities.”
Mortimer’s CEO at the NHS Confederation, Matthew Taylor, added: “This important report demonstrates the vital role that NHS leadership and management plays in delivering high quality and efficient care. It rightly recognises the new operating environment which means we require system leadership built on collaboration – this can no longer just be about leaders working autonomously within their own organisations.
“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.
“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.”
Suzie Bailey, director of leadership and organisational development at The King’s Fund, a health and social care think tank, said: “At a time when many services feel close to breaking point, this review makes clear that collaborative and inclusive leadership is key to successfully delivering good-quality care.
“However, the elephant in the room is the deep workforce crisis that long pre-dates the pandemic and that government has been reluctant to face up to. Health and care leaders can – and will – work hard to support their staff and get the most out of the resources available, but there is a limit to what a leader can do when faced with an exhausted workforce and chronic staff shortages.
“The review does include helpful recommendations such as greater support for managers and leaders at induction and a stronger focus on good appraisals to support staff. If implemented, these measures will help improve the working culture of health and care services. The recommendations to increase diversity among health and care leaders are especially welcome. For too long, NHS and social care boards have not represented the diversity of the communities they serve.
“From increased demand for care, to huge treatment backlogs, health and care leaders are under immense pressure, all at a time when one-third of NHS employees report feeling burnt out because of their work. These challenges have often been compounded by relentless demands and pressure from politicians and national bodies. Leaders at the national level should also consider how they too can live up to the ambition of compassionate and inclusive leadership."
Bailey was also concerned by what she felt to be a lack of focus on the social care sector in the seven recommendations for change, saying that the industry warranted a comprehensive review of its own.
"The review offers little in the way of recommendations for social care, a sector that employs 1.2 million people, is struggling with huge recruitment and retention issues that warrants a dedicated review."
Professor Vic Rayner OBE, CEO of the National Care Forum, shared Bailey's sentiments on the review's lack of emphasis on the social care sector.
Rayner said: “There is nothing of substance in this report for social care leaders across the country, grappling right now with all of the same challenges around workforce and pressure that those in the NHS experience. Instead, the review focuses on secondary healthcare problems and solutions – it is not the leadership review of health and social care it purports to be. While Sir Gordon Messenger is right in his assertion that there is support for greater parity of investment in social care leadership, it is a completely wasted opportunity that this report does not highlight how and where that should happen.
“With just over three weeks to go until the new Integrated Care Systems are put on a statutory footing, it does little to inspire confidence. The report struggles to identify how to translate a single message about collaborative leadership into action across an entire system that stands or falls on collaboration. In a world that stresses the indisputable value of integration, it can no longer be acceptable to say that the absence of ‘identifiable levers’ to create change means that vast swathes of primary health and all of social care are out of reach in relation to national solutions, or indeed a reflective commentary on their current or future requirements.”
Photo by Sander Sammy on Unsplash
