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The 'Leadership for a collaborative and inclusive future' 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.

Strategies for embedding equality, diversity and inclusion Strive to achieve best practice in recruitment, retention and career progression practices as employers throughout the employment cycle. Support the development of good diversity practice by collecting and sharing examples of practical activities that contribute to progress. Achieving good and exemplar practice over time. Having allies who can confront discriminatory practices. Goal setting with training. Discussions on the subtler aspects of discrimination. Top management support. Framing equality, diversity and inclusion training so it doesn’t legitimise bias. Consistent reinforcement. Leading by example, act as role models for inclusive behaviour and challenge inequality.

Key issues raised Certain core skills and behaviours should apply in any leadership context, and a light-touch national framework that provides a consistent approach to developing leaders needs to be created to support people to develop these. The review should emphasise the new operating environment the NHS is moving into through integrated care systems (ICSs) and place-based partnerships. The focus on integration and collaboration will require different leadership characteristics than those incentivised by a system driven by marketisation and competition. Establishing a culture of learning and improvement, with less emphasis on top-down performance management will be key to developing effective system leadership. The review must address the need to ensure greater diversity across NHS leadership. Progress has been made in some areas to improve levels of diversity, but there is still a long way to go. The review presents an opportunity to invest in current diverse talent management and succession planning, as at present the NHS is effectively squandering talent through lack of inclusion. NHS leaders will need to be actively involved in the implementation of the report’s recommendations, in order to ensure the best chance of achieving lasting improvements,