The Messenger Review of NHS leadership: what you need to know
Key points
- We have facilitated several engagement sessions between our members and General Sir Gordon Messenger and his team. We are pleased with the way in which the review team has engaged with our members and how we have been able to inform the report’s recommendations on how we can better support health and care leaders.
- Many of the recommendations are welcome and reflect what our members highlighted as key areas of improvement, including how we can better support chief executives who take on the most challenging leaderships roles in the NHS.
- The report rightly points out the gaps in support for leaders and what more can be done to ensure we deliver a consistent approach to leadership development at all levels within the NHS. This includes the need for a more consistent and substantive career development pathway from recruitment through to mid-career and beyond. It also talks about the value that needs to be placed on leaders and managers and the rewarding of collaborative behaviour as we move to systems.
- The report also rightly acknowledges that we have much still to do to create a more diverse leadership in the NHS, but we also need tangible action and changes to ensure this happens. 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 see a greater commitment to act on improving diversity in senior leadership, including making EDI a core aspect of the inspection regime.
- However, we have been disappointed to see how the report has been positioned today in the media by the government. We have urged the Secretary of State to resist the temptation to misrepresent the report as an attack on NHS leadership or to indulge in manager-bashing. That is because the context in which leaders are operating is critical and the government narrative risks under-appreciating this. No amount of heroic leaders can make a system work which is overwhelmed with demand and dealing with more than 100,000 vacancies. There must be a fuller appreciation of the reality of how top-down demands are putting ever more pressure on leaders to service targets and efficiency savings.
- Finally, we know that high-performing health systems require investment in effective management and, if anything, the NHS continues to be under-managed in comparison to other sectors. We must do more to support managers and leaders and we would urge the government to bear this in mind, while also doing more to support leaders in primary care and social care which this review has not considered as much as it intended.
Our summary and analysis of the review of leadership in health and social care, led by General Sir Gordon Messenger and Dame Linda Pollard.
What the review says
The review recognises the real difference that good leadership can make in health and social care and identifies many outstanding examples contributing directly to better service. However, it also finds lack of consistency and coordination in the way that leadership and management is trained, developed and valued.
Aimed at ensuring the right leadership is in place at all levels, the review lays out seven recommendations that seek to support services to deliver the best possible care while tackling the challenges the pandemic exposed across the country:
- 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 the Care Quality Commission’s 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.
Analysis
The Messenger Review is a welcome spotlight on NHS leadership and management; a vital element in delivering quality care. It rightly recognises what leaders and managers across the health service are achieving in often incredibly challenging circumstances. It is the latest in a long line of leadership reviews in the NHS dating back over 40 years to the Griffiths review. The hope is that this review succeeds where its predecessors have had limited traction.
The review addresses many of the asks that our members fed back to the review team, including practical recommendations for more structure and consistency in leadership development; promotion of collaborative behaviours; and a greater commitment, backed by tangible action, to promoting equality, diversity and inclusion in leadership roles.
We particularly welcome plans to better support and incentivise leaders to take on the most challenged leadership roles in the NHS. If this support materialises, it will start to address what our members consistently highlighted to the review team: that too often, chief executives are not given the time, support and incentives they need to succeed in organisations that face the most severe systemic challenges. It is all too easy to remove a chief executive but fail to address the underlying systemic challenges that make some roles extremely difficult. Rather than endlessly removing these chief executives, we need to incentivise, support and reward them to take on roles where their leadership skills can be best used by the health and care system.
The review is the latest in a long line of reports that rightly acknowledges that we have much still to do to create a more diverse leadership in the NHS. However, the litmus test for the government and NHS will be whether we follow this through with tangible actions and changes to ensure this happens. 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 see a greater commitment to act on improving diversity in senior leadership, including making EDI a core aspect of the inspection regime.
We have urged the Secretary of State to resist the temptation to misrepresent the report as an attack on NHS leadership or to indulge in manager-bashing
While we support many of the recommendations outlined in the report, we are disappointed in how the report has been positioned in the media today. We have urged the Secretary of State to resist the temptation to misrepresent the report as an attack on NHS leadership or to indulge in manager-bashing. To do so will only serve to undermine the important work of the review team.
We know that high-performing health systems require investment in effective management and, if anything, the NHS continues to be under-managed in comparison to other sectors. The habit of denigrating managers in the NHS is misplaced and counterproductive. At worst, it channels investment away from management and administration, forcing busy clinical professionals to pick up the slack, exaggerating the workforce crisis and preventing reform. The cumulative effects of this could exacerbate the workforce crisis and hold up much-needed reforms in the NHS.
Policymakers should change the narrative about NHS managers, to view them as part of the solution. There must be more recognition of the circumstances under which leaders are working to deliver. There are new more stretching activity targets and leaders have been asked to deliver double the level of efficiency savings, all the while staff shortages endure – not only in health but also in social care. And the service is delivering for populations with greater and greater need, worsened during the pandemic. This leaves less and less time to ‘lead,’ where there is already a significant lack of capacity and support to undertake some of the fundamental but longer-term strategic thinking for their organisations and systems.
...the review must also look at how primary care managerial leadership development is delivered, as well as how we can better support leaders in social care
For this review to make a difference, the requisite funding, support and resourcing must be provided to deliver on the recommendations. In implementing its recommendations, the review must also look at how primary care managerial leadership development is delivered, as well as how we can better support leaders in social care. Both primary care and social care were in the remit of the review, but they have not been as fundamentally addressed as other parts of the NHS have been. That remains unfinished business that the government should not overlook.
Finally, in implementing the recommendations the government and its arm’s-length bodies need to consider the role of the centre in ensuring we have the right leadership culture and behaviours in the NHS. It will continue to be the case that central leadership is needed on some issues and local leadership on others, supported by peer challenge and support and the use of information on comparative performance. But the balance has traditionally been too weighted towards top-down performance management and we now need to strike a different balance as we move to more devolved systems. As such, it was unfortunate that the review did not examine the role of the Department of Health and Social Care, NHS England and its regions, and other key regulators in creating an enabling environment for leadership. That remains a work in progress and we will continue to work on behalf of our members to inform NHS England’s new operating model, which is in development.
How we will be supporting members
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.
As the review sets out, the move towards health and care integration generates an opportunity for a fresh approach to preparing leaders and managers. As part of our commitment to improvement, the NHS Confederation will support our members to develop leadership styles that allow them to thrive in the new health and care landscape.
- Our ICS Network is working in partnership with the Forward Institute to design a bespoke leadership development programme for system leaders. This is set to be rolled out later this year.
- Our Provider Collaboration Forum will be running action learning sets for those leading provider collaboratives, offering a crucial platform for peer support and learning.
- We bring together provider and ICS non-executive leaders to discuss system working and to learn from one another. Read more on our leadership support web pages.
- Our EDI programme supports members to improve accountability and leadership, tackling inequality through EDI networks and partnerships.
- We will continue to work on behalf of our members to inform NHS England’s new operating model, which is in development. This follows the recommendations of the report we commissioned Prof Sir Chris Ham to undertake on behalf of the NHS Confederation earlier this year.
Please get in touch to learn more about these offers and opportunities.
