Royal College of Podiatry responds to Messenger review on NHS leadership

Summary of the review and comments from the College
Eight months after the Prime Minister announced it at the Conservative Party Conference, Sir Gordon Messenger and Dame Linda Pollard published their review of leadership and management in the health and social care sector in England. Titled Leadership for a collaborative and inclusive future, this review makes seven recommendations for improving current systems of identifying, including, and promoting talent within the leadership structures of the NHS and social care.

Messenger’s key conclusion from this review is that, currently, the:

“Development of quality leadership and management is not adequately embedded or institutionalised in our health and care communities”.
Linking the work of this review to the wider challenges facing the NHS, he outlines that a:

“well-led, motivated, valued, collaborative, inclusive, resilient workforce is ‘the’ key to better patient and health and care outcomes, and that investment in people must sit alongside other operational and political priorities. To do anything else risks inexorable decline.”

This review also criticises:

“the sense of constant demands from above [which] creates an institutional instinct to look upwards to furnish the needs of the hierarchy rather than downwards to the needs of the service-user.”

It also criticises the:

“too many instances of poor behavioural cultures and incidences of discrimination, bullying, blame cultures and responsibility avoidance” which researchers came across during their investigation.

The report makes seven recommendations for improvement. Short summaries of each are outlined below:

1. Targeted interventions on collaborative leadership and organisational values

Firstly, this review proposes the introduction of an entry induction for all new health and social care staff to encourage the “cultures and values” of the various bodies in the health and social care sectors into new employees.

The review also proposes the creation of a national mid-career programme for:

  • GPs
  • mid-career clinicians
  • NHS middle managers
  • principal social workers
  • registered managers.

This would be organised at a local level and would seek to create collaboration between the sectors beneath the national leadership programme outlined in the Integration White Paper.

2. Positive equality, diversity, and inclusion (EDI) action

The recommendation of this review which has grabbed most of the headlines since its publication has been around the future role of Equality, Diversity, and Inclusion (EDI) leads, particularly in the NHS. The review highlights its hope that these EDI leads would be reduced over time as its core values become instilled in the broader leadership. However, it does recommend that the CQC takes Equality, Diversity and Inclusion data into account when considering its organisational assessments.

3. Consistent management standards delivered through accredited training

This review also recommends the introduction of a unified, single standard for management for the NHS, which would cover operational, strategic, and behavioural components for inclusive leadership, accompanied by dedicated training and development materials.

4. A simplified, standard appraisal system for the NHS

This review recognises internal criticism of the current appraisal system in the NHS, paused throughout COVID-19. This review commits to the importance of these appraisals, which it outlines should focus on individual performance and facilitating conversation around career ambition and aspiration. The review highlights the importance of standardising this appraisal process to ensure a move away from progression based on “siloed processes, short-termism and the whims or biases of individual leaders and managers”.

5. A new career and talent management function for managers

This review also recommends the introduction of a career and talent management function at an NHS regional level. This would have the purpose of ensuring succession planning within organisations and maximising existing talent pools. It would also support individuals with career advice, providing clear routes to promotion for every individual.

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

This review criticises the current use of non-executive directors in the NHS. It outlines how they currently make up more than half of NHS board positions but that NHS trusts often have difficulty recruiting high-quality candidates for these roles. This review recommends establishing an expanded specialist non-executive talent and appointments team at NHS E/I as a solution. That team would work collaboratively with NHS regional teams to maximise the attraction of these roles, set standards for recruitment and provide support in terms of role preparation, induction and onboarding.

7. Encouraging top talent into challenged parts of the system

Finally, this review recommends the greater incentivisation of senior leadership in rural and coastal areas. This includes maximising flexibility and available terms and conditions when recruiting for these roles, including relocation support, where appropriate, to encourage senior managers to move to these areas.

Secretary of State for Health and Social Care, Sajid Javid MP, has accepted these recommendations in full, stating:

“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.”

Responding to the Report, Royal College of Podiatry Chief Executive and General Secretary Steve Jamieson said:

“This important report lands at a time when health and social care services are close to breaking point, staff under are under pressure from the post-COVID backlog, a real-terms pay freeze over 12 years, a lack of a workforce review or any clear plan on how services will be able to meet the growing population need. The report demonstrates the vital role that management and leadership within all areas and at all levels play in delivering high quality, joined-up care across sectors.

“Cultures change from the top, but the NHS is also attempting to be an inclusive organisation involving clinicians and patients in the re-design of services. Leadership within such a vital organisation to the well-being of society needs to be listening as well as forward-thinking, inclusive and adapting to the needs of their populations.

"If we are to encourage the best people to develop and foster a culture of leadership at all levels, then standardised career pathways are required in order to retain people within the NHS and they must be linked to a reward package that is fair, equitable, and encourages NHS staff into management”.

RCPod welcomes a standardised appraisal system for the NHS. All parties must ensure that it includes the ever-increasing independent sectors and CICs supplying many NHS services in this, not just those directly employed by NHS Trusts. The Report rightly acknowledges the lack of diversity within NHS leadership, something that has needed addressing for some time and not just on a surface level. People from all backgrounds need support to enable them to move forward into leadership positions. The Secretary of State has accepted the Report's recommendations in full. Yet about the number of NHS roles dedicated to promoting equality and diversity, he had previously called for a cut.

The Report makes one brief mention of Allied Health Professionals (AHPs). As the third largest workforce in health care, AHPs are fundamental in ensuring innovative, preventative care across primary care, community health services and acute services; this is a massive exclusion. The AHP workforce often suffers from poor representation on Trust Boards. Therefore it is a missed opportunity to highlight this and put in place measures to rectify it. We would encourage DHSC and NHS England/ NHS Improvement to address this.