Sajid Javid has pledged to bring health leadership “into the 21st century” after a damning report found discrimination and bullying “has almost become normalised” in parts of the NHS.
The Health Secretary told MPs: “We must do everything we can in our power to share and promote brilliant, innovative management and to act firmly where standards do fall short.
“This means culture change from the top of the system to the front line.”
It comes as a new report headed by the senior former military officer General Sir Gordon Messenger – commissioned by the Government – concluded there was an “institutional inadequacy” in the way leadership and management in the sector was trained, developed and valued.
We have encountered too many reports to ignore of poor behavioural cultures and incidences of discrimination, bullying, blame cultures and responsibility avoidance
In his study, Sir Gordon said collaboration in the NHS is “not always encouraged or rewarded in a system which still relies heavily on siloed personal and organisational accountability”.
He said staff were under “very public external and internal pressures” which “combine to generate stress in the workplace”.
NHS staff and managers face “constant demands from above, including from politicians” which creates an instinct to “look upwards to furnish the needs of the hierarchy rather than downwards to the needs” of patients and those using social care services.
The report added: “These pressures inevitably have an impact on behaviours in the workplace, and we have encountered too many reports to ignore of poor behavioural cultures and incidences of discrimination, bullying, blame cultures and responsibility avoidance.
“We experienced very little dissent on this characterisation; indeed, most have encouraged us to call it out for what it is.”
Sir Gordon said such behaviours must not be tolerated as “they directly affect the care of the service user as well as the staff”.
He said the NHS was under such pressure that often there was an “instinct to prioritise the needs of the system and its hierarchy over a focus on the better patient and public health outcomes”.
This also feeds “a sense of futility and helplessness in the workforce because individuals perceive they lack the tools or ability to rectify what they know is wrong”.
The report comes as the NHS is under pressure to ensure that a £12 billion-a-year cash injection to deal with the backlog that has built up during the Covid pandemic is spent efficiently.
Among the report’s recommendations – which have been accepted by Mr Javid in full – are action to improve equality, diversity and inclusion, the development of consistent management standards through accredited training, and clear routes to progression and promotion to ensure a “strong pipeline of future talent”.
It also calls for support and incentives for the best leaders and managers to take on the most difficult roles so they are seen as “the best jobs rather than the most feared jobs”.
Sir Gordon, a former vice chief of the defence staff who led the Royal Marines in the invasion of Iraq, said he believed the recommendations could transform leadership in the sector.
I believe our recommendations have the potential to transform health and social care leadership and management
“A well-led, motivated, valued, collaborative, inclusive, resilient workforce is the key to better patient and public health outcomes, and must be a priority,” he said.
“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.”
The findings were welcomed by the interim chief executive of NHS Providers, Saffron Cordery, who said the review had identified a “window of opportunity” for change.
