Government announces biggest shake-up in health and social care leadership in a generation to improve patient care

The Health and Social Care Secretary Sajid Javid has welcomed the publication of an independent review of health and adult social care leadership, led by General Sir Gordon Messenger and Dame Linda Pollard – and, in what will be the biggest shake-up in health and social care leadership in a generation, is accepting all seven transformative recommendations they have put forward.

Strengthening leadership and embedding the best examples of management is vital in ensuring every pound of investment is well spent, with the government investing a record amount in health and care services over the next three years to tackle the Covid backlog.

The review team met over a thousand passionate front-line staff, managers and leaders across health and social care to hear their views which informed their recommendations for improving the skills of all leaders and managers and putting the right culture, training and incentives in place.

While it recognised the current pressures faced by the workforce and identified many examples of inspirational leadership, it found overall there was a lack of consistency and coordination – in particular that there has developed over time an “institutional inadequacy” in the way that leadership and management is trained, developed and valued.

The report also sets out new plans to attract great leaders to the most challenged areas in the NHS, with a package of support and incentives to recruit the top talent to these positions. Through support networks, peer mentoring, training and development, this will ensure the government and the NHS can continue to tackle disparities across the country.

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.

Health and Social Care Secretary Sajid 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 said:

“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.”

Aimed at ensuring the right leadership is in place at all levels, the recommendations seek to ensure services can deliver the best possible care, tackle the Covid backlog and address the disparities the pandemic has exposed across the country.  

These include an induction for new joiners to instil core values across health and social care, a mid-career programme for managers, stronger action on equality and diversity to ensure inclusive leadership at all levels, clear leadership and management standards for NHS managers with a standardised appraisal system, and greater incentives for top talent to move into leadership roles in areas facing the greatest challenges, to help combat disparities across the country. 

NHS Chief Executive Amanda 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 are:

1. Targeted interventions on collaborative leadership and a unified set of values across health and social care:
   1. A new, national entry-level induction for all who join health and social care.
   2. A new, national mid-career programme for managers across health and social care.
2. Action to improve equality, diversity and inclusion (EDI):
   1. Embed inclusive leadership practice as the responsibility of all leaders. 
   2. Commit to promoting equal opportunity and fairness standards.
   3. More stringently enforce existing measures to improve equal opportunities and fairness.
   4. Enhance CQC role in ensuring improvement in EDI outcomes.
3. Consistent management standards delivered through accredited training:
   1. A single set of unified, core leadership and management standards for NHS managers
   2. 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:
   1.  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:
   1. 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):
   1. 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:
   1. 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. 

Leeds Teaching Hospitals Trust Chair Dame Linda Pollard 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.” 

Publication of the report will be followed by a delivery plan with clear timelines on implementing agreed recommendations.

The review of health and social care leadership in England was announced in October 2021 and is the most far-reaching review of health and social care leadership in 40 years.

The review team was made up of representatives from the Department of Health and Social Care, NHS England, Health Education England, NHSX and social care leaders, as well as clinicians, managers and academics.  

The review engaged with more than 1000 stakeholders on over 400 different occasions including: patients and users of social care services, GPs, Allied Health Professionals, clinicians, managers, care workers, researchers, clinical fellows, chairs of previous reviews, NEDs, CEOs, Chairs and MPs.

Danny Mortimer, Chief Executive of NHS Employers and Deputy Chief Executive of 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.”

Saffron Cordery, Interim Chief Executive of NHS Providers, said:

“Trust leaders will welcome this constructive report. Sir Gordon Messenger and Dame Linda Pollard acknowledge the world-class leadership already in the NHS and have  listened carefully to what local leaders have told them, clearly understanding the many pressures that our large and complex health system is under.

“Trusts are committed to working more closely and effectively together 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.”

Matthew Taylor, Chief Executive of the NHS Confederation said:

“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.”