Lord Rose, the former boss of M&S, was invited by the Health Secretary at the start of 2014 to review what might be done to attract and develop talent from inside and outside the health sector into leading positions in the NHS; and to recommend how strong leadership in hospital trusts might help transform the way things get done.
He concludes that the level and pace of change in the NHS remains unsustainably high: this places significant, often competing demands on all levels of its leadership and management. The administrative, bureaucratic and regulatory burden is fast becoming insupportable.
The review identifies three areas of particular concern:
- Vision: There is a lack of One NHS Vision and of a common ethos.
- People: The NHS has committed to a vast range of changes however; there is insufficient management and leadership capability to deal effectively with the scale of challenges associated with these.
- Performance: There is a need for proper overall direction of careers in management across the medical, administrative and nursing cadres.
Many of these problems are chronic and have been unaddressed over an extended period and by different Governments. Clearly, some of these recommendations are of a strategic nature; others tactical and operational.
Several are interrelated and overlapping, as one would expect them to be in a complex organisation.
- Form a single service-wide communication strategy within the NHS to cascade and broadcast good (and sometimes less good) news and information as well as best practice to NHS staff, trusts and CCGs.
- Create a short NHS handbook/ passport/ map summarising in short and/or visual form the NHS core values, to be published, broadcast and implemented throughout the NHS.
- Charge Health Education England (HEE) to coordinate the content, progress and quality of all NHS training including responsibility for the coordination and measurement of all management training in the NHS. At the core of this is a 90-day action cycle. HEE must promote cross-functional training in all disciplines and at all levels, coordinating the teaching of management basics such as appraisal, motivation, negotiation and leadership.
- Move sponsorship of the NHS Leadership Academy from NHS England into HEE.
- Include accredited/nominated training establishments as part of a diverse training effort.
- Review, refresh and extend (x10) the NHS graduate scheme; establish career pathways, a greater variety of placements and a guaranteed job after three years’ training (quality and assessment permitting).
- Refresh middle management by training and a more porous approach both from within the NHS and externally (recruitment from, and secondment to, other sectors).
- Require senior managers to attend accredited courses for a qualification to show that consistent levels of experience and training have been reached across the NHS. On completion of this course they will enter a senior management talent pool open to all trusts.
- Set, teach and embed core management competencies and associated expected behaviours at each management level.
- Establish a mechanism for providing on-going career support for all those in a management role allowing individuals to increasingly take charge and identify their own development needs.
- Establish and embed an NHS system of simple, rational appraisal (a balanced scorecard for individuals) supported by a regular course in giving and receiving appraisals as part of the core provision of the single training body. At a senior level, these appraisals should be standardised across the NHS.
- Review the data demands of regulators and oversight bodies; these can then be rationalised and harmonised in order to produce consistent, clear and simple reporting that does not distract staff from patient care.
- Merge the oversight bodies, the Trust Development Agency (TDA) and Monitor.
- Spend time, on a regular basis, at all levels of the NHS to review the need for each data returns being requested and to feed any findings to the Executive and Non-Executive Teams to review.
- Establish and maintain a clearer system of simple rational appraisal (balanced scorecard for the organisation).
- Health and Social Care Information Centre (HSCIC) should develop an easily accessible Burden Impact Assessment template and protocol.
- Create NHS wide comment boards. Website and supporting technology to be designed and implemented to share best practice.
- Set minimum term, centrally held, contracts for some very senior managers subject to assessment and appraisal.
- Formally review Non-Executive Director (NED) and CCG lay member activity (including, competence and remuneration); and establish a system of volunteer NEDs from other sectors.
In his foreword in the review, Lord Rose calls for the government to let change settle down.
There is genuine concern within the service that further restructuring will be imposed upon the system, which would be unhelpful.
He adds that there must be a shared vision; attention must be paid to its people, and those people must be helped, guided and assessed in their performance and delivery.
A few simple things would make a huge difference, he says: some centralised effort on training; or helping middle managers keep their confidence and focus; or knowing that the top leaders of tomorrow may be doctors, nurses or administrators.
At the start of their NHS career, everyone should have adequate training; in mid-career they should have adequate support and clear pathways to progression as managers; and top leaders should have the appropriate support and experience to enable them to make correct decisions.
Rose poses three final questions related to his central themes:
– Leadership is the key to making changes stick. How is great leadership recognised across the NHS?
– How do we find and nurture the people that are needed to lead the NHS over the next 10 years?
– How do we help all NHS staff become the best versions of themselves at work?