The NHS has received multiple leadership reviews in the past decade. Time after time, leadership and culture are cited to be at the heart of how a service or a whole organisation performs and how it is viewed.
In October last year, the government commissioned a review into leadership across health and social care, led by Sir Gordon Messenger and supported by Dame Linda Pollard. It focused on the best ways to strengthen leadership and management across health and social care in England. The Messenger Review (Messenger and Pollard, 2022) has now been published and recommends:
- Targeted interventions on collaborative leadership and organisational values
- Positive equality, diversity and inclusion (EDI) action
- Consistent management standards delivered through accredited training
- A simplified, standard appraisal system for the NHS
- A new career and talent management function for managers
- Effective recruitment and development of non-executive directors
- Encouraging top talent into challenged parts of the system.
The recommendations have been accepted by the government, with a commitment to publication of a delivery plan to implement them. There was initial concern among NHS leaders that the review was somewhat undermining of existing NHS leaders, and also that its timing could potentially bring an unhelpful distraction at a time of significant operational pressure to deliver the recovery programme. Having read the review, I consider that it offers us three priority areas, within which opportunities for nursing leadership need to be considered.
Respect and collaboration
First, the review is clear that, rather than focus on individual leadership development or potential, we should learn from other large organisations that invest heavily in taking a consistent approach to leadership—for example, through formal succession planning, linked to supportive development that addresses true capability.
As part of the Messenger Review, senior nurses are reported to have talked about ‘going to the dark side’, a comment often made when they moved to senior management roles. Although nurse postgraduate training provides elements of management learning, the review considered that the current approach was ad hoc and inconsistent. It recommends that future development should focus on both the culture of collaboration and the culture of respect, with both themes emanating from, and determining, how people treat each other and service users. Both, ultimately, affect the quality of care and outcomes for service users.
Building capacity
Second, as reflected by Hopson (2022), concentrating solely on the chief executive and most senior leadership community must be avoided, reflecting that there is a need to build leadership capacity and capability at all levels to maximise the impact on culture.
There are many senior nursing and midwifery roles to which it is extremely difficult to recruit, and the impact of these missing leaders is palpable. Hopson (2022) reflects that we do not have the right incentive and support structures to ensure that our best leaders are consistently attracted to the most difficult jobs, where their skills are needed most. This also links back to the earlier comment that leadership and management are often seen as ‘the dark side’ as a career development option for nurses.
Fostering inclusiveness
Third, the review concluded that it is still too difficult for colleagues from an ethnic minority background to progress into leadership roles. It recommends that there needs to be consistent approach to tackle the systemic, structural, barriers that exist in the NHS, as they exist in society.
The review cites that it is the task of leaders at every level to cultivate the conditions for individuals to overcome entrenched, and often unacknowledged disadvantages, by ensuring that staff recognise and remove subtle exclusionary practices, and by working to remove the set of unspoken assumptions that favour certain groups in terms of career advancement. The following recommendations are cited as key to progressing this area:
- Embedding inclusive leadership practice as the responsibility of all leaders
- Committing to promoting equal opportunity and fairness standards
- More stringently enforcing existing measures to improve equal opportunities and fairness. Enhancing the Care Quality Commission role in ensuring improvement in EDI outcomes.
Although over time there has been an increasing focus on collaborative and inclusive leadership in the NHS, I will very much be looking forward to the investment required to enable us to consider this critical leadership development at scale.