The 18th of May 2011 could go down as one of the greatest days for NHS leaders and managers. On this day The King’s Fund released its report “The Future of Leadership and Management in the NHS – No More Heroes” and finally, NHS managers got the recognition they deserve.
In the report, The King’s Fund makes 11 recommendations covering the importance of supporting NHS managers, why the Government’s plans to cut administration costs by 33% should be revisited and more importantly, why the NHS needs a greater focus on developing and maintaining great leaders. The full recommendations are below:
- It is important, now more than ever, to promote the value of good NHS managers and leaders. Denigration of managers and the role they play in delivering high-quality health care will be damaging to the NHS and to patient care in the short and long term.
- The coalition government’s current plan to cut administration costs by 33 per cent and the number of management posts by 45 per cent must be revisited. There is no persuasive evidence that the NHS is over-managed, and a good deal of evidence that it may be under-managed. While administration and management costs will have to take at least their fair share of the pain as real-terms growth in NHS spending ceases, a more sophisticated approach to the reduction in both is needed.
- There is appreciable evidence that the NHS is over-administered as a result of extensive, overlapping and duplicating demands from both regulators and performance managers. There has not been a substantive review of the information demands placed on the service and its providers for many years. A review leading to a rationalisation of those demands is essential.
- Over recent years there has been considerable investment in both management and leadership development. These gains must not be lost in the transition to a redesigned health system. Every NHS organisation and provider must take responsibility for their leadership and management development. This includes the new GP consortia or commissioning bodies. Organisations should collaborate to undertake leadership development where this makes sense.
- The health service does need a national focus on leadership and management development, potentially delivered through a national NHS leadership centre. This should build on existing good practice in both the public and private sectors. Such a centre could play an important part in facilitating this. It should have the resources to support investment in leadership development of national importance; help to accredit and signpost development programmes; and support the evaluation of these programmes, including the return on investment from leadership and management development
- Leadership development needs to extend ‘from the board to the ward’. One of the biggest weaknesses of the NHS has been its failure to engage clinicians – particularly, but not only doctors – in a sustained way in management and leadership. Individuals within the service, and its providers, need to be given both the ability and the confidence to challenge poor practice. Management and leadership needs to be shared between managers and clinicians and equally valued by both.
- The service also needs to recognise that the type of leadership the NHS requires is changing. The old model of ‘heroic’ leadership by individuals needs to adapt to become one that understands other models such as shared leadership both within organisations and across the many organisations with which the NHS has to engage in order to deliver its goals. This requires a focus on developing the organisation and its teams, not just individuals, on leadership across systems of care rather than just institutions, and on followership as well as leadership.
- Board development and recruitment need particular attention, most notably, but far from exclusively, in the case of foundation trusts where governors are to take on a new role as the autonomy of foundation trusts is significantly enhanced.
- The same applies to the governance arrangements for the new commissioning bodies. The Commons Health Select Committee has recently made powerful points about the need for proper governance of commissioning bodies which this commission endorses.
- In the light of a run of serious failures of both leadership and management in the NHS, the commission acknowledges the need for a more effective mechanism to debar individuals who have clearly been culpable from holding executive positions in health care. It has reservations about professional accreditation of managers or the creation of a full-blown disciplinary body for them. Boards must ensure that they have competent, effective senior managers and leaders and hold them to account. A national NHS leadership centre should consider whether the effectiveness of senior management and leadership should be considered by the Care Quality Commission as an important determinant of organisational performance and be taken into account in processes for registering and licensing health care providers.
As a company that has worked with many NHS managers, we were very pleased to see them finally getting the recognition they deserve. As The King’s Fund says;
“The bottom line is that an organisation as large and complex as the NHS cannot be run without high-quality management and leadership. This will happen only through a commitment of time and resources and a willingness to value the role of managers whatever their background.”
Sarah Boyd, Senior Change Practitioner