Mashhuda Kazi is a senior NHS Trust director with extensive experience in commissioning and operations. In this article, Kazi shares her take on the recent landmark review into the leadership of the health and social care sector and what must now be done to move on positively.
The health and social care industry is undergoing one of the biggest shake-ups in its history to address the longstanding challenges of problems within its culture. A landmark review was conducted by General Sir Gordon Messenger and Dame Linda Pollard into the health and social care sector’s leadership to improve patient care and address longstanding issues of harassment and bullying.
Bullying and harassment is a sensitive issue and is widespread within the health and social care sector. In 2018, the British Medical Journal [BMJ] carried out extensive research into the cost of bullying and harassment using data obtained from NHS Digital. That cost is estimated to be at around £2.28 billion a year, all at the taxpayers’ expense.
The existing health and social care landscape is so extremely toxic that employees with integrity and the right attitudes are forced out and toxic managers are promoted further up the chain of command to senior management roles. The current landscape is flourishing with the ‘who you know’, and much less or even no importance is placed on ‘what you know’. This shouldn’t come as a surprise, since most health and social care services are falling behind and are unable to catch-up with and bring themselves into the modern era.
The current leadership of the industry lacks flexibility, and the adaptability that is vital for the current healthcare market. Many executives also lack the skills and experience required for the role that they are appointed to. Furthermore, the incentive for training and programmes are given to those ‘contacts’ and who ‘follows orders’, rather than empowering the overall workforce to go out and learn more and target promotions themselves.
The landmark review’s report outlines seven most informative recommendations. While the new Health and Care Act outlines new milestones and we have had the long overdue review into the sector’s leadership, the new Act of Parliament enables the secretary of state to intervene when needed and with the leadership shake-up taking place now, such a move to hand such power to politicians is questionable. We need to ask now: what will the new leadership of the industry actually look like? Will the ineffective leaders simply be replaced by people who are known and are contacts of theirs? The review states the need for efficiencies and ensuring that every pound invested within health and social care needs to be scrutinised, so we need to know where that money is being channelled to by the new leadership.
It has been and still is a serious concern that toxic NHS senior managers are getting away with ever-worsening attitudes and this must be called out. The Health and Care Act promises new milestones and the ongoing leadership shake-up from the top-down adds to the hope that we could see a new and refreshing health and social care landscape.
Poor behaviour, targeted harassment, bullying and victimisation are considered a ‘norm culture’ within the current health and social care framework, which is extremely disturbing considering health and social care is a monopoly of the taxpayers’ money. The psychological safety the wider staff workforce within health and social care is given little to no consideration either. Staff become fearful for their jobs and worry about their job security should they speak up about being victimised. Staff are ruled with fear by their NHS bosses who have become comfortable with their own authoritative and dictatorial leadership.
Going through the Covid-19 pandemic has made next to no difference to senior managers within health and social care, and honest and true reflections of their own ways of leading are yet to be realised. Many senior leaders are far from adapting and flexing their leadership approaches to meet the needs of staff and the patients in their care. In fact, rather the opposite, I have observed a rise in institutional bullying and racism, in particular the act of ‘group bullying’.
The independent review suggests key improvements to shake-up leadership in NHS ranging from Equality, Diversity and Inclusion [EDI], inclusive leadership, progression, training and development and encouraging the best leaders to take on the most challenging roles.
The NHS workforce is under considerable pressure to deliver on its targets. The NHS is driven by numbers rather than measurements of staff morale. The NHS culture is one of punishment and retribution when targets are not met.
As much as ministers now need to outline and publish their delivery plan, there needs to be much tighter scrutiny to hold each NHS Trust accountable. Simply painting an ideal image of the senior manager and the way they ought to lead is not enough to bring about change within the health economy.
Overall, it is encouraging that long-awaited discussions are being had around the toxic issues of bullying and harassment and these problems are now being addressed. The report following the landmark review was well overdue and much welcomed, addressing longstanding and challenging concerns. But all of that said, it still lacks several key elements. It is not a hidden fact that ethnic minorities within the health workforce are not provided with the training and upskilling they need to progress into leadership roles.
The review is most certainly a ‘window of opportunity’. However, if the delivery plan lacks detailing of ‘accountability’ on all its milestones, then this is just another review with no value and efficiency in improving the standards of health and social care. In fact, the delivery plan would create greater disparity among staff groups than is already the case. It would, in simple terms, be a recipe for a disaster.
For-example, the NHS Workforce Race Equality Standard [WRES] was announced on July 31, 2014, to improve access to training for BAME individuals. That standard made similar recommendations to this report, including training, promotions and creating pathways into more senior roles.
Speaking in 2022, we still have long way to go with this ongoing disparity. The difference here is that we have to acknowledge that there are some limitations within WRES and the current report in how the sector’s leadership ought to be overhauled. We are behind with our promises to deliver and are lacking in accountability and transparency from top-down management. This must be changed.
The report is an acknowledgement of the long road ahead for us to close the gaps of personal and cultural differences and ending the heartbreak of employees who are constantly faced with harassment and bullying within the workplace. Those employees are taken away from direct patient care, driven away to long periods of sick leave which cost the NHS billions of pounds.
The new approach to leadership needs to take the form of a strict regime of accountability, where we manage toxic managers by enforcing much harsher consequences on poor behaviour and practices. We must also combat regularly occurring unconscious biases and implement cultural awareness training from the top-down. The report doesn’t go far enough in acknowledging the current state of NHS, which I find an appalling and dire state of affairs.
Photo by National Cancer Institute on Unsplash
