On 8 June, General Sir Gordon Messenger published his report into the state of leadership and management in the health and social care sector. Titled “leadership for a collaborative and inclusive future”, the report focuses on areas which “improve awareness of the impact that good leadership can have, and which instill it as an instinctive characteristic in everyone”.
The report makes seven recommendations:
- “Targeted interventions on collaborative leadership and organisational values.
- A new, national entry-level induction for all who join health and social care.
- A new, national mid-career programme for managers across health and social care.
- Positive equality, diversity and inclusion (EDI) action
- Embed inclusive leadership practice as the responsibility of all leaders.
- Commit to promoting equal opportunity and fairness standards.
- More stringently enforce existing measures to improve equal opportunities and fairness.
- Enhance CQC role in ensuring improvement in EDI outcomes.
- Consistent management standards delivered through accredited training
- A single set of unified, core leadership and management standards for managers.
- Training and development bundles to meet these standards.
- A simplified, standard appraisal system for the NHS
- A more effective, consistent and behaviour-based appraisal system, of value to both the individual and the system.
- A new career and talent management function for managers
- Creation of a new career and talent management function at regional level, which oversees and provides structure to NHS management careers.
- More effective recruitment and development of non-executive directors
- Establishment of an expanded, specialist non-executive talent and appointments team.
- Encouraging top talent into challenged parts of the system
- Improve the package of support and incentives in place to enable the best leaders and managers to take on some of the most difficult roles.”
The report found that the “current cultural environment tends to be unfriendly to the collaborative leadership needed to deliver health and social care in a changing and diverse environment”. It states that urgent tasks often “eclipse” the important, which is unsustainable.
The authors believe that a “greater awareness of the entirety of health and social care would lead to greater empathy and understanding”. The discovered that that “management tends not to be perceived – formally or informally – as a professional activity”, with no universal training standards.
The report offered a nuanced view of the CQC, which can “influence collaboration across the whole of health and social care through its inspections” but it at times “over-emphasis on metrics can be burdensome and counter-productive”. The authors therefore support the CQC’s “shift in emphasis from a punitive model to a remedial one”.
The “authority and influence that doctors have in society and the NHS”, the report says, means that they have a “unique responsibility for leading behavioural change”.
The report notes that there is “significant variation in leadership structures within and between GP practices”. It is “unclear to newly qualified GPs which route provides the best leadership experience in comparison to the traditional clinical director to medical director pathway in hospitals”. The new place partnership boards and ICBs should provide outlets for primary care and public health leaders.
To implement their recommendations, the report suggests that a Review Implementation Office, formed of “multi NHS, social care and local government members” should be tasked by the Secretary of State to deliver on these reforms.