NHS leadership review highlights culture of discrimination and blame

A NHS leadership review has highlighted a culture of discrimination, bullying and blame across many areas of the health and social care system.

It also found that managers who have existing networks or contacts are more likely to access training opportunities and to progress their career.

Over one thousand front-line staff, managers and leaders took part in the review. Although it identified many examples of inspirational leadership, it also found that there was a lack of consistency and coordination in the way that management in the health service is trained, developed and valued.

Witnessed selflessness, professionalism and resilience first-hand

The review was led by General Sir Gordon Messenger and Dame Linda Pollard and aimed to ensure that NHS managers had the support and skills to deliver effective patient care as well as leading the recovery from the Covid-19 pandemic.

In November 2021, Sir Messenger and Dame Pollard sent a joint open letter to those who work in health and social saying that they recognised the complexity of the task ahead. They also acknowledged the strain that everyone working in the NHS was currently under with the potential for ‘review fatigue’.

They added that they wanted health and social care workers to view it as an opportunity to build on the current excellent leadership and management that existed across the system already.

Following the review, General Sir Gordon Messenger said he had always held the health and social care workforce in the highest regard, but his respect and admiration had only deepened through witnessing their selflessness, professionalism and resilience first-hand.

He added: “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.”

Recommendations from the leadership review

The focus of the report was on leadership and management, at all levels and across the breadth of primary care, secondary care and social care.

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.”

Its findings are due to be released later today but there are seven recommendations on ways to foster and replicate the best examples of leadership.

These include:

1. Targeted interventions on collaborative leadership and a unified set of values across health and social care
2. Action to improve equality, diversity and inclusion (EDI)
3. Consistent management standards delivered through accredited training
4. A simplified, standard appraisal system for the NHS
5. A new career and talent management function for managers
6. More effective recruitment and development of Non-Executive Directors (NEDs)
7. Encouraging top talent into challenged parts of the system.

Matthew Taylor, Chief Executive of the NHS Confederation, said that the report acknowledges that NHS leaders have much more to do to create a more diverse leadership in the NHS.

He added: “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.

“Finally, we must acknowledge the limited focus in this report on supporting leaders in primary care and social care. The risk is that this looks like an after-thought and we would encourage the government and its arms-length bodies to not overlook these sectors.”