Health Secretary Sajid Javid has pledged urgent action to overhaul management in the health and social care sector after a major review found evidence of “poor behaviours” including discrimination, bullying and blame cultures.
The review, headed by the senior former military officer General Sir Gordon Messenger, concluded there was an “institutional inadequacy” in the way leadership and management in the sector was trained, developed and valued. Mr Javid said the findings – to be published in full later on Wednesday – were “stark” as he promised “the biggest shake-up of leadership in decades”.
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. A Department of Health and Social Care press release ahead of the full publication said that while the review recognised the pressures on the sector and had identified many examples of inspirational leadership, overall it found “a lack of consistency and co-ordination”.
In particular, it said that there had developed over time “an ‘institutional inadequacy’ in the way that leadership and management is trained, developed and valued”. The release added: “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.”
Mr Javid said he fully supported the report’s recommendations, saying it was essential that staff and patients had the leadership they deserved. He said: "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.”
Among the report’s recommendations 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”.
Gen Messenger, 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.
“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. “Trusts are committed to collaborating more effectively to develop and improve leadership, building on existing strong foundations, and local leaders must be fully engaged and involved in any changes to ensure a successful, high-achieving NHS,” she said.
Matthew Taylor, the chief executive of the NHS Confederation, said the report identified the need 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,” he said.
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