Independent report: Leadership for a collaborative and inclusive future (8 June 2022)

Summary

In October 2021 the government announced a review into leadership across health and social care, led by former Vice Chief of the Defence Staff General Sir Gordon Messenger and supported by Dame Linda Pollard, Chair of Leeds Teaching Hospital Trust. The results of the review have now been published and recommendations made.

Content

The 'Leadership for a collaborative and inclusive future' review (also know as the 'Messenger review', led Sir Gordon Messenger and supported by Dame Linda Pollard, focused on the best ways to strengthen leadership and management across health and with its key interfaces with adult social care in England.

Findings

Cultures and behaviours

• The review found that the current cultural environment does not lend itself to the collaborative leadership needed to deliver health and social care in a changing and diverse environment. Leadership is seen as a job role rather than a characteristic that runs through the workforce. Staff respond reactively rather than constructively and respond to high levels of pressure from above. There is also a lack of accountability and authority in some areas.
• Although not universal, acceptance of discrimination, bullying, blame cultures and responsibility avoidance has almost become normalised in certain parts of the system.
• Equality, diversity and inclusion (EDI), which is about respectful relationships and underpins a wider culture of respect, is partial, inconsistent and elective. In some places it is tokenistic.
• There is a lack of psychological safety to speak up and listen, despite progress being made. The Freedom to Speak Up initiative can be perceived as just relating to whistleblowing rather than also organisational improvement.

Standards and structures

• The review found that management tend not to be perceived as a professional activity and there is a lack of universal standards for management competence and behaviour.
• There are inequities in how managers are perceived, valued and trained and inconsistencies in appraisals.

Regulation and oversight

• There is a positive view that the Care Quality Commission (CQC) can influence collaboration across the whole of health and social care through its inspections, and welcome its increasing focus on teams and systems. However, there is sometimes an over-emphasis on metrics which can be counter-productive.
• The review welcomes the shift in emphasis from a punitive model to a remedial one.

Clinical leadership

• The review found incidences of the flawed assumption that simply acquiring seniority in a particular profession translates into leadership skills and knowledge. Doctors are often not properly trained or equipped for leadership roles.
• Allied health professionals often highlighted that they felt their career opportunities in management were limited.
• Management and leadership training should be an integral part of all clinical training pathways.

Leadership delivery in the future

• The move towards health and care integration and the work currently underway to merge the arms-length bodies and create a new NHSE offers the opportunity for a fresh approach to preparing leaders and managers in the future.

Recommendations

1. 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.

2. 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.

3. 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.

4. 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.

5. 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.

6. Effective recruitment and development of non-executive directors (NEDs)

• Establishment of an expanded, specialist non-executive talent and appointments team.

7. 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.

All 7 recommendations have been accepted by the government and publication of the report will be followed by a plan committing to implementing the recommendations.